Innovative surgery at Lilavati Hospital offers independence to spina bifida patient

Posted by Niilesh waghela 

Mumbai — Lilavati Hospital & Research Centre Mumbai, has successfully performed a first-of-its-kind minimally invasive colonoscopic cecostomy on Merlyn D’mello, a 28 year-old IT professional living with spina bifida related neurogenic bowel. The innovative endoscopic technique created percutaneous cecum access with colonoscopic guidance and introduction of a 24 Fr PEG catheter, allowing self-performed antegrade colonic irrigation without open surgery or abdominal incisions.

The patient has been receiving medical attention since childhood for congenital spina bifida and has lifelong issues with severe constipation, incontinence, and reliance on caregiver-administered enemas. An earlier surgical procedure (Malone Antegrade Continence Enema/MACE) did not yield sustainable bowel control and necessitated advanced endoscopic management.

During a well-planned intervention, the hospital's multidisciplinary team, guided by Dr. Ravikant Gupta, and Dr. Santosh Karmarkar, used a colonoscopy-only approach to percutaneously access the cecum. This technique avoided laparotomy and minimized perioperative risk, despite prior abdominal surgeries and adhesions. The entire procedure was completed in less than one hour, marking a significant step forward in minimally invasive gastrointestinal surgery for complex neurogenic bowel cases.

Within 24 hours of the procedure, a spontaneous evacuation of stool was accomplished by an antegrade saline flush via the cecostomy tube. The patient reported minimal discomfort, required no postoperative analgesia, and was discharged in stable condition the next day.

“This procedure is a paradigm shift in how we treat complex cases of neurogenic bowel dysfunction,” said Dr Ravikant Gupta, Consultant, ENDOSCOPY Interventions, Lilavati Hospital “For patients with spina bifida, bowel control issues are not only a medical challenge but also a profound quality-of-life concern that affects independence and dignity. Colonoscopic cecostomy offers an incision-free, safe, and reliable option with reduced recovery time and long-term functional benefits. It provides new possibilities for patients who have exhausted conventional treatment approaches.”

Further, Dr. Santosh Karmarkar, Consultant Paediatric Surgeon & Spina Bifida Expert, Lilavati Hospital stated, “This patient has been treated since childhood and endured years of dependence on caregivers for bowel care. With this procedure, we have obtained permanent independence. Aside from the clinical success, the effect on the patient's self-confidence, capacity for independent living, and general psychosocial health is amazing. Medicine is not merely about technique medicine is about giving back dignity and autonomy to patients."