Baby gets historic surgery

THE Universiti Kebangsaan Malaysia Medical Centre (UKMMC) has performed a “minimally invasive” surgery on a 14-day-old baby to remove 95% of his pancreas — making the surgery (pancreatectomy) the first of its kind in the world for patients below 30 days old.

The surgery had to be performed to protect the patient from brain damage.

The newborn was suffering from a rare case of Persistent Hyperinsulinemic Hypoglycemia of Infancy (PHHI) where the pancreas produces excess insulin.

This causes the glucose level in blood to drop inducing a hypoglycemic state that can cause brain damage or death in an infant.

A newborn with PHHI would be treated with medication but in this case the patient had stopped responding to medication, so a substantial part of the pancreas had to be removed.

UKMMC consultant paediatric surgeon and paediatric surgery unit head Dr Dayang Anita Abdul Aziz who performed the surgery said: “The treatment is to remove nearly the entire pancreas.

“But extra care has to be taken because if we overdo it, the child will become diabetic when he is older. The removal has to be just right. We call it a ‘near total pancreatectomy’.”

She said she was nervous at first because such a procedure has never been attempted before anywhere on a patient that young.

Dr Dayang Anita credited her surgical team for giving her the confidence to perform the surgery.

By using a 3mm laparoscopic camera inserted just above the navel, the pancreas can be viewed on a high definition (HD) screen without having to cut the patient’s abdomen open.

Dr Dayang Anita then inserted surgical instruments through a small incision (5mm in diameter) on each side of the abdomen.

Guided by magnified images of the pancreas on the HD screen, she then cut the pancreas into small pieces to remove it one piece at a time.

The whole process took nearly two-and-a-half hours.

“To be honest it was easier than I thought, because the pancreas in a newborn is small.

“It is like we are operating in a small compartment like a match box so we had to take it out piece by piece,” she said.

She said keyhole surgery is like building a miniature vessel in a bottle with tweezers, except state-of-the-art equipment is used to extract the pancreas, which is located behind the stomach.

The surgery was a success and the patient has since gone home to Terengganu.

“He is doing so well that he would not need any follow up treatment until he is four months old,” she said.

The surgery was performed last August but was only made public as they needed to ensure the patient was actually the youngest for the procedure.

“We did a Med search for laparoscopic pancreatectomy in children and could not find a 14-day-old or younger patient who had undergone the surgery. The youngest for that procedure had been reported in Vietnam for a baby aged over 40 days,” said Dr Dayang Anita.

Dr Dayang Anita is in the midst of publishing her achievements. — UKM News Portal

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