A SIMPLE surgery for a complicated life-threatening disease has added firepower to the fight against tuberculosis (TB).
Two Shillong-based doctors – neorusurgeon Bernard Trench Lyngdoh, 41, and gastro surgeon Mohammad Shamsul Islam, 58 – have modified a technique tried only once in 1958 to let hydrocephalus patients live a better life.
Hydrocephalus is the deadliest complication of brain TB. It affects the absorption of brain fluid by other organs following which the fluid accumulates in the brain to increase pressure. A patient can be killed if this fluid is not diverted.
The complication is usually treated by shunting via a tube the fluid from the brain to the peritoneum, a large space between the abdominal viscera. But the problem arises when peritoneum is also infected with TB, as was the case with two children in 2008.
The children – an 11-year-old girl and an eight-year-old boy – were among 105 TB patients Lyngdoh and Islam treated in Shillong’s missionary-run Nazareth Hospital from 2007-2011.
“Fluid-shunting is a standard procedure across the globe. But an affected peritoneum is not the place to divert the brain fluid to. In such cases, neurosurgeons have tried shunting the fluid to the heart via the jugular vein as well as to into the pleura (space between the lungs and lung covering) and renal pelvis but with little success due to complications,” Lyngdoh said from Shillong.
“Islam and I developed upon an unpublished technique by one Dr Yarzagaray in 1958, changed the place of the shunt chamber and placed the shunt end into the gall bladder. Our procedure was given a new name, ventriculo cholecysto (VC shunt),” Lyngdoh added.
The two children operated upon have not required follow-up surgeries (unlike most TB patients with complications) in these four years and have been leading normal lives.
The Lyngdoh-Islam technique was acknowledged in Acta Neurochirurgica, the European Journal of Neurosurgery last September.
“While Lyngdoh dealt with the cranial part of the surgery, I handled the abdominal part,” Islam said, adding VC shunt can be done even in the smallest of hospitals that has basic sterile OT facilities with a neurosurgeon and general surgeon.
TB remains a major killer disease in India with a prevalence rate of 256 per 100,000 people and a mortality rate of 26 per 100,000. A worrying fact is that relapse occurs in 38% of the patients, treatment after failure in 6% and treatment after default in 25% because of the increase of multi-drug resistant strains of TB.