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Times of India
01 February 2011
By Pushpa Narayan

Bowel Kept In Preservative For 4 hours, Put Back In After Cutting Off Growth
In Rare Surgery, Doctors Take Out Small Intestine To Remove Tumour
In a 14–hour surgery, doctors in the city removed the small intestine of a 30–year–old patient, left it in a preservative for four hours and removed a large tumour from his abdomen before putting the bowel back in its place.

The patient (name withheld) who under went the auto–bowel transplant three months ago at the Global Hospitals in Chennai, is now back home in West Bengal. Doctors who operated on him said he is doing fine but will have to be monitored for a few more months.

"He came to hospital after being turned away by several hospitals," said liver transplant surgeon Dr Mohamed Rela. Reports showed that he had a large tumour in his pancreas, the organ that produces insulin. It was a slow growing lump called neuroendocrine tumour, which extended up to his stomach, crushing the vital artery that supplies blood to the bowels. If the tumour wasn’t removed, the patient’s bowels could have become dysfunctional, proving fatal.

"It was a complicated surgery. There was very little space to work on," recalled Dr Rela. The transplant team decided to go ahead with an autobowel transplant. They cut open the abdomen and removed the small intestine from the body and placed in a special preservation solution. Doctors then carefully removed the tumour, which looked bigger than a tennis ball. They then put the small intestine back into the abdomen.

During the post surgical period, doctors ensured that the patient developed no complications. A few weeks later, the patient was discharged from the hospital. Transplant surgeons in the city said the surgery was rare and required skill.

"In such surgeries, it extremely important to do anything to save the patient," said senior surgical gasteroentrologist Dr J S Rajkumar, who heads Lifeline Hospitals. So how far are doctors from doing a bowel transplant? Can transplant surgeons now successfully replace ailing bowels with the ones that are donated by relatives of brain dead patients? "Not yet," said Dr Rela, who has done bowel transplants in the UK.

"A bowel transplant is more challenging than the surgery we did. Here the bowel is patient’s own and chances of rejection is very low. But for a bowel transplant, we need a bigger team of experts and a better environment."

End–stage bowel disease patients are extremely weak and malnourished; the chances of rejection are extremely high and patients are put on immune–suppressing medications to prevent this. The post surgical ward has to be sterile enough to prevent infection and death. "We are not there yet to see success," Dr Rela said.

But Dr Anil Dhawan of King’s College Hospital, London, who was in the city to address a scientific session on liver diseases, said it would not take too long. Ten years ago, India did not see big success in liver transplant when countries like the UK were doing it efficiently. At that time, doctors in the UK failed in bowel transplants. Now, we see a fair amount of success. Surgeons here will find a way to do it," he said.

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