No operation option for kids born with gastroschisis

FEBRUARY 29: For the first time ever in Mumbai, doctors at the Wadia Children's Hospital have managed to avoid the rigours of an operation...

FEBRUARY 29: For the first time ever in Mumbai, doctors at the Wadia Children’s Hospital have managed to avoid the rigours of an operation for a rare congenital condition in which a child is born with the intestines outside the body. Infants with gastroschisis are usually wheeled straight in for surgery, where the intestines are inserted into the abdomical cavity. But at Wadia Hospital, paediatric surgeons have deployed a non-operative technique in two recent cases.

Gastroschisis is an abnormal development of the abdominal wall. In an ultrasound scan, it has the appearance of a honeycomb floating in the amniotic fliud outside the abdominal cavity. The condition is said to occur once in every 8,000-10,000 live births, and Wadia hospital itself sees about four to five such births every year.

In the first case, Kamal Jadhav delivered a baby boy with gastroschisis on January 28. The infant was admitted to Wadia the same evening, a prerequisite if the non-operative technique is to succeed, says Dr Santosh Karmarkar, full-time consultant pediatric surgeon at the hospital. The surgeons had been reading about the new technique over the last two years in the United Kingdom, and decided to try it out on the infant.

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Under this technique, the intestines are gently pushed back into the body through the orifice from which they protude, a procedure that lasts about 45-80 minutes. Anesthesia is kept on standby, in case an operation is required.

Dr Karmarkar lists the relative advantages of the new technique: operations last two to three hours on children and run the risk of anaesthesia and of infection to the abdominal cavity. And after the infection, the wounds could take a fortnight to heal.

But the non-operative method eliminates the chances of infection. “Another advantage,” he jokes, “is that the child will have a belly button and not just a nasty scar.”

In the other case, a boy born to Pramila Bose on February 22 at her Malad residence was also promptly admitted to Wadia Hospital, where Dr Ila Meisheri and her team tried out the technique again. The infant is stillrecuperating at the hospital.

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Gastroschisis can easily be diagnosed in utero through ultrasound, says Dr Karmarkar. “But most people are not aware of the importance of pre-natal testing. And sometimes, sonologists could do a cursory job of the tests,” he adds. Ideally, the disorder should be diagnosed before delivery and mother and child should be transferred to hospital before delivery.

The alternative technique is not without risk: if the intestines are packed in too fast, blood supply could be compromised or pressure put on the abdominal veins. Dr Meisheri adds that preference for the non-operative technique would spread only after a series of such procedures are witnessed. For now, these are the only two cases in the city and possibly, the country.