Friday, September 9, 2016

Delhi doctors graft appendix on to urine duct, save boy's life

New Delhi: Born with a single kidney, Golu, 18, suffered the crisis of his life recently when doctors said he faced renal failure because a large portion of his ureter, the duct through which urine passes from the kidney to the bladder, had become too narrow.
Surgery was an option, but Lok Nayak hospital doctors struggled to find the right replacement for the narrowed part of the ureter.

Finally, they came up with a unique solution. In a complex procedure, surgeons used Golu's appendix — a tube-like structure attached to the large intestine that has no known purpose — to replace the damaged segment of the ureter.

Dr Pawanindra Lal, director-professor of surgery, told TOI the procedure was taught in theory but this was a rare case where it was used to save the boy's life.

Doctors said the constriction in the youth's ureter was five-six centimetres long, nearly one fourth the size of the ureter.

"There was no way we could rejoin the ureter after removing such a large chunk of the structure. So, we started looking for a replacement that would match the tubular structure in shape and size. It also ought to have a good blood supply. The appendix fitted the bill," he said.

The surgery was conducted on August 29. Dr Lal said first stage involved separating the appendix from the large intestine, while maintaining its blood supply, and then creating an opening at its blind end to give it a tubular structure. The constriction in the ureter was also removed in the meantime.

After that, the live graft created from the appendix was transposed in place of the constriction to make the ureter fully functional. "The boy is recovering well post surgery and he is likely to be discharged from the hospital soon," doctors said.

According to the doctors, "congenital ureteral stricture" is a rare condition and it is rarer even to find it in patients having a single kidney.

"It is a life-threatening condition because if the stricture is not removed the only functioning kidney can fail and the patient may die," said a doctor.

Golu, Dr Lal said, has received a second lease of life with the rare surgery. "He went into renal failure in 2006 also due to another constriction in the ureter.

Because it was smaller in size, the doctors had then simply removed the constriction and rejoined the ureter's ends. This time, however, the constriction was bigger and without the right replacement, surgery won't have helped," he added.

Dr Hansveen Kaur Lamba, an intern at the surgery unit of Maulana Azad Medical College, said she was excited to see path-breaking surgeries taking place in government run institutions.

Golu is the only son of a farmer couple from Badaun in Uttar Pradesh. Speaking to TOI, the 18-year-old said now he wanted to put the health issues behind him and focus on learning some skills to become the breadwinner of his family.

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