In a remarkable medical breakthrough, Gleneagles Hospital, Mumbai, has become the first in the city to perform a Per-Rectal Endoscopic Myotomy (PREM) surgery on a two-year-old child suffering from Hirschsprung’s disease—a congenital condition that had left him unable to pass stool naturally since birth. The procedure was completely scarless, minimally invasive, and has successfully restored the child’s bowel function without any need for future intervention.
A Challenging Start for Baby Aryan
Mr. and Mrs. Vaidya (names changed) were overjoyed when their son Aryan (name changed) was born. For the first few weeks, he was a happy and playful baby. However, when Aryan turned one month old, his parents noticed a worrying trend—he couldn’t pass stool for days, sometimes as long as eight. His abdomen often appeared bloated, and despite daily enemas prescribed by their family doctor in Nashik, Aryan remained uncomfortable. His weight gain also lagged behind.
From Nashik to Mumbai in Search of Answers
In December 2024, the Vaidyas traveled to Mumbai and consulted Dr. Vibhor Borkar, Paediatric Gastroenterologist at Gleneagles Hospital, Parel. Suspecting Hirschsprung’s disease, Dr. Borkar ordered a series of diagnostic tests, including barium enema, endoscopic biopsy, and anorectal manometry, which confirmed the diagnosis.
Understanding Hirschsprung’s Disease
As per the press release, Dr. Vibhor Borkar explained, “Hirschsprung’s disease occurs when nerve cells (ganglion cells) in a section of the large intestine fail to develop. This causes a blockage, as stool cannot pass naturally. The condition, which affects 1 in 5,000 to 10,000 children, has no medical treatment and requires surgical intervention. Left untreated, it can result in chronic constipation, abdominal swelling, vomiting, poor weight gain, and even life-threatening infections like enterocolitis.” Traditionally, treatment involves open or laparoscopic surgery to remove the affected intestinal segment. However, in Aryan’s case, the team opted for a minimally invasive and scarless alternative.
A Groundbreaking Solution: Per-Rectal Endoscopic Myotomy (PREM)
Dr. Shankar Zanwar, Interventional Gastroenterologist, led the innovative procedure alongside Dr. Borkar, with assistance from Dr. Aditya Prabhudesai and Dr. Dhanashree Karkhanis. “The child was in visible discomfort when he arrived,” said Dr. Zanwar. “His abdomen was distended, and he depended entirely on daily enemas. After confirming the diagnosis, we decided to use PREM, an advanced endoscopic surgery performed under general anesthesia.” During the three-hour procedure, the team made a small internal incision inside the anus, created a submucosal tunnel, and cut the non-functional, nerve-free segment of the intestine from within. They then closed the entry point with endoscopic clips—eliminating the need for external cuts or stitches.
A Swift Recovery and Life-Changing Outcome
Remarkably, Aryan was discharged within two days of the surgery. He now passes stool naturally, is free of abdominal pain, and no longer requires daily enemas. The family expressed immense relief and gratitude. “My son was constantly in pain,” said Ms. Usha (name changed), Aryan’s mother. “After the biopsy confirmed Hirschsprung’s disease, the doctors treated him with compassion and precision. Today, he is back to being an active and healthy child. We are deeply thankful.”
Setting a New Benchmark in Pediatric Gastroenterology
“This case underscores Gleneagles Hospital’s ability to deliver complex care with compassion and innovation,” said Dr. Bipin Chevale, CEO of Gleneagles Hospital, Mumbai. “The successful use of PREM, which is both minimally invasive and scarless, not only reflects our clinical expertise but also sets a new benchmark in pediatric surgery. It gives hope to many families facing similar challenges.” Globally, only 13 cases of PREM surgery have been documented to date. This marks Mumbai’s first successful case, positioning Gleneagles Hospital at the forefront of pediatric gastrointestinal care.