In a remarkable milestone, Gleneagles Hospital has become the first in the city to successfully perform a rare and scarless procedure called Per-Rectal Endoscopic Myotomy (PREM) on a two-year-old child suffering from a congenital condition that made him unable to pass stool naturally since birth.
He is free from abdominal pain and swelling, without any external stitches, and no longer needs further medical intervention.
A couple Mr and Mrs Vaidya (name changed) were overjoyed with the birth of their first child, Aryan (name changed). He was a cheerful and playful baby, bringing immense happiness to their lives. However, after he turned one month, they began noticing that he was struggling with severe constipation, which soon became a constant cause of concern. He was unable to pass stool for as long as 8 days. Despite multiple medications and daily enemas given by our family doctor at Nashik, his condition never improved. His tummy often swelled with gas, and his weight gain remained poor. The family travelled from Nashik to Mumbai in December 2024 and consulted Dr Vibhor Borkar who suspected Hirschsprung’s disease. A few diagnostic tests like barium enema, endoscopy biopsy, and manometry confirmed the condition at Gleneagles Hospitals, Parel, Mumbai.
Dr Vibhor Borkar, a Paediatric Gastroenterologist, said “Hirschsprung’s disease occurs when nerve cells (ganglion cells) in the lower part of the large intestine fail to develop, causing stool to accumulate, causing blockage and leading to chronic constipation. Hirschsprung’s disease affects 1 in 5,000 to 10,000 children. There is no medical management for this condition, and it can even become life-threatening due to infections. In very young babies, delayed passage of the first green potty (meconium) can be an early sign. Older children usually suffer from swollen stomachs, vomiting, poor weight gain, and constant constipation while some may suffer from infections. Standard treatment requires major surgery that is either open or laparoscopic where the affected part of the intestine is removed and rejoined. However, in this child’s case, we used a minimally invasive technique called Per-rectal Endoscopic Myotomy (PREM), which avoids any external scarring. The child is free of symptoms, eating well, and passing stools without the requirement of enema. Not treating the child at the right time could have led to complications like enterocolitis, infection, and poor weight gain. Though this is a congenital condition, antenatal diagnosis is extremely difficult and the child becomes symptomatic after birth only.
Dr. Shankar Zanwar, Interventional gastroenterologist underscored, “The child had a congenital condition called Hirschsprung’s disease, where the last part of the intestine lacks the necessary nerve cells, preventing stool from passing. As a result, the portion above it keeps enlarging, like a blocked pipe building pressure. When the child came from Nashik to us in Mumbai, he was extremely uncomfortable, his stomach was swollen, and he couldn’t pass stool without daily enemas. After confirming the diagnosis through manometry and biopsy, we treated the child using an advanced endoscopic technique known as Per-Rectal Endoscopic Myotomy (PREM). This procedure is done under general anesthesia where we were helped by Dr Aditya Prabhudesai and Dr Dhanashree Karkhanis. The whole procedure is done endoscopically where a small cut is made just inside the anus of the patient. From this cut a tunnel was made within the layers of the intestine and a nonfunctional segment of the intestine which lacks nerves was cut internally. The entry cut is then closed with clips. As the procedure is done endoscopically no scar or cut is seen on the body surface and the patient is pain-free after the procedure. The entire procedure lasted 3 hours. This procedure allowed us to manage the condition without traditional open surgery. Globally, only 13 such procedures have been reported, and this is the first case to be treated by the endoscopic method in the city of Mumbai. Everything was done internally through an endoscope and there were no cuts or stitches outside. Within two days, the child was discharged and no longer needed enemas. His stomach has flattened, and he now passes stool normally. This procedure has truly changed his life.”
"My son Aryan was fine after birth. However, after a year, he started having constipation and was in pain. Our family doctor referred us to Dr Vibhor. His biopsy revealed Hirschsprung’s disease. After successful treatment, my son is fine now and is able to pass his bowels without any difficulty. We thank Dr. Vibhor and Dr Shankar for timely intervention, said Usha (name change), mother of the patient.
“This case highlights our hospital’s advanced capability in handling complex cases with both precision and compassion. At Gleneagles Hospital, we are committed to embracing innovation and ensuring that every child receives the highest standard of care possible. Successfully performing the PREM procedure, which is minimally invasive and leaves no external scars, reflects our focus on patient comfort and long-term recovery. We are proud to have offered this pioneering solution for a child who has been suffering since birth. The success of this surgery not only brings hope to families facing similar conditions but also sets a new benchmark in pediatric care,” said Dr Bipin Chevale, CEO of Gleneagles Hospital Mumbai.
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