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Ahmedabad Civil hospital doctors perform rare surgery on 12-year-old

PRIMARY BLADDER EXSTROPHY: Operation usually performed on Children as young as six-month-old

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A 12-year old girl from Samastipur in Bihar underwent a rare surgery at the Civil Hospital in Ahmedabad. She was cured of a congenital defect in the urinary bladder and genital organs called "primary bladder exstrophy".

Doctors said that normally such operations are performed when the patient is over three months old but in the Civil Hospital, children aged up to five or six years have been operated upon.

According to Doctor Rakesh Joshi, professor and head of paediatrics surgery at Civil Hospital, the patient had "primary bladder exstrophy", a defect where the urinary bladder, instead of being in its normal position inside, is on the surface of the abdomen and the genital organs are split open instead of being closed in a normal person.

Doctors were shocked as the girl was never treated for the defect. Urine constantly leaked as a result of this defect, causing discomfort to the girl as her clothes would get wet and she had to change them repeatedly.

The challenge was to close a 10cm wide gap called "pubic diastasis" and to perform osteotomy on a patient of this age meant that the associated bone structure was cut in such a manner that the pubic bone could be brought and fixed in midline to support closed bladder and genitalia.

Moreover, there was a risk of bleeding because the operation was performed on a 12-year-old girl. Normally, such operations are performed on children up to five years of age and the gap is very small.

Dr M M Prabhakar, superintendent of Civil Hospital and professor of orthopaedic department and Dr Piyush Mittal, associate professor of orthopaedic department began the surgery on June 6 and started with the cutting of a bone. With this, the doctors were able to approximate the defect.

Following this, Dr Rakesh Joshi and Dr Jaishri Ramji started soft tissue mobilisation, repair of bladder along with genitoplasty and ultimately they were successful in repairing the defect. Surgery took close to seven hours. After the operations, catheter and fixators were removed after a month in a phased manner. Anesthesia was maintained by Dr Seema Gandhi and her team.

"We were able to restore the urinary bladder and genital organs to a normal position, causing relief to the girl. Now she is able to walk with a normal posture," said Joshi.

Dr Joshi said that the family had earlier approached AIIMS – Jodhpur but the operation was delayed for some reason. A private doctor suggested the Ahmedabad Civil Hospital to the family. "Normally, such operations cost around Rs 7 lakh. But it was performed free of cost here," said Dr Joshi.

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