Gomati Hospital successfully performed a complex hernia surgery on an 85-year-old with severe comorbidities using TAP block anaesthesia. This marks a first in Tripura’s district-level healthcare, showcasing innovation in treating high-risk elderly patients with localized anaesthesia under ultrasound guidance for safer, effective outcomes.
In a landmark medical achievement, Gomati District Hospital in Tripura has successfully conducted a highly complex hernia surgery on an 85-year-old patient with severe health complications. This surgery not only alleviated the patient’s chronic suffering but also marked the first instance of a regional anaesthesia technique known as the Transversus Abdominis Plane (TAP) block being utilized under ultrasonography at a district-level hospital in the state.
The patient, Bijoy Chandra Das, a resident of Palatana, had been grappling with intense abdominal pain caused by dual hernias—stomach and pantaloons inguinal. His already fragile health condition was exacerbated by multiple serious comorbidities including chronic kidney dysfunction, uncontrolled high blood pressure, and severe bradycardia, with a dangerously low heart rate of just 44 beats per minute.
In light of these risk factors, conventional surgical procedures such as those involving spinal anaesthesia were ruled out, as they carried a high potential for triggering a cardiac arrest. Recognizing the complexity and urgency of the case, a multidisciplinary team at Gomati District Hospital decided to employ an innovative and far safer approach.
The medical team was led by Dr. Biswajit Paul, Senior Surgeon, and supported by Dr. Moutoshi Choudhary, Anaesthesiologist, and Dr. Priyanka Debbarma, Radiologist. After extensive deliberations with nephrologists and physicians, the team chose to proceed with the TAP block technique, which allows precise targeting of nerves responsible for pain sensation in the abdominal region. Guided in real time through ultrasonography, this method provides localized anaesthesia, avoiding systemic complications and maintaining cardiac stability—critical in such a fragile patient.
Speaking about the procedure, Dr. Biswajit Paul said, “The patient’s advanced age and low heart rate made this a highly challenging operation. Though hernia repair is generally considered routine, his multiple comorbidities transformed this into a potentially life-threatening condition. Our primary goal was to relieve his pain while avoiding any further stress on his cardiovascular system.”
Anaesthesiologist Dr. Moutoshi Choudhary elaborated on the challenges: “Spinal anaesthesia was simply not an option due to the risk of cardiac arrest. The TAP block allowed us to achieve complete pain relief without compromising the patient’s heart function. Using ultrasonography ensured that the anaesthesia was delivered with pinpoint accuracy, providing safety and effectiveness.”
The successful outcome of this surgery underscores a major advancement in healthcare delivery at the district level. Following the operation, Mr. Das is reported to be recovering well and is in a stable condition, experiencing significant relief from the chronic pain that had severely affected his quality of life.
Dr. Kajal Kumar Das, Medical Superintendent of Gomati District Hospital, praised the medical team for their innovation and bravery. “This is a tremendous milestone for our hospital. Successfully performing such a high-risk surgery with cutting-edge techniques like the TAP block, especially for the first time at a district hospital in Tripura, highlights our dedication to providing advanced medical care even in rural settings.”
The success of this case sets a precedent for similar high-risk procedures to be considered and executed at district hospitals, significantly strengthening the capacity of primary referral units across the state. It demonstrates that with the right expertise, equipment, and collaborative medical practice, complex surgeries can be performed safely without having to refer patients to tertiary hospitals.
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As medical infrastructure in India’s districts continues to evolve, the remarkable achievement at Gomati District Hospital serves as a beacon of what is possible with innovation, teamwork, and a commitment to patient-centered care.
