[top: (from left) Rania with mum Jelita, Siti with mum Rosnani and Low with mum Liong.]
EXCEPT for four barely visible dots on her abdomen, there is little to indicate that little Siti Noraida Mohd Shukri had major surgery to remove 95 per cent of her pancreas.
Earlier this month, the three-month-old infant who suffered from hyper-insulinism underwent laparoscopic (keyhole) pancreatic surgery at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Cheras.
This is believed to be the first laparoscopic pancreatectomy surgery on an infant in the region.
The operation - pioneered by Professor Agostino Pierro, professor of surgery at Great Ormond Street Hospital in London - was performed by Pierro and UKMMC's Professor Tan Hock Lim, distinguished professor and paediatric surgeon, department of surgery, during an international seminar conducted at the medical centre.
Hyper-insulinism is a rare condition in newborn babies and happens when the pancreas produces excessive insulin, which results in these babies developing dangerously low blood sugar levels, explained Professor Wu Loo Ling. She is the paediatric endocrinologist with UKMMC who diagnosed that Siti was suffering from the condition.
"While there are many children who can be managed with medicine, some children like Siti do not respond to conventional medical treatment. They need to undergo an operation to remove 95 per cent of the pancreas, which is the organ responsible for producing the excess insulin," she said.
Usually this involves a major operation which is performed through a large abdominal incision that leaves behind a large scar as a reminder.
In Siti's case, thanks to keyhole surgery, this was avoided.
According to her mother, Rosnani Said, the surgery has given Siti a new lease of life. Prior to her life-changing surgery, she was often inactive and prone to excessive sweating; now, she is happy and active.
In the past year UKMMC has introduced many new keyhole and conventional surgeries in Malaysia. With its strong team of children's doctors like neonatal intensive care, paediatric intensive care specialists and paediatric anaesthetist, the medical centre is confident of handling the most complex of surgical patients and delivering results equal to the best in the world.
Tan, who operated on Siti said although some laparascopic surgery has been done on children here, the level of advanced or serious laparoscopic surgery has not been done here before.
"As a surgeon, I look at laparoscopic surgery like a stool with three legs. The surgery is one of those legs, the hospital infrastructure another leg. And the third leg is represented by the supportive team like Wu, other doctors, paediatrics ICU, etc that make it possible," he explained.
"A surgeon cannot come in as a one-legged stool, we cannot stand alone. What I am really proud to say is that I believe in that in Malaysia we have the three-legged stool where each leg is strong."
The medical centre recently achieved another first for the region, a laparoscopic removal of the upper part of the kidney in a six-month-old, Rania Zara Adam Damian.
Rania had a duplex kidney, where the upper part of her left kidney was not functioning and causing her to have urine infections. She underwent keyhole surgery about four weeks ago.
Her parents, who live in England and were given the option to have the surgery performed in Great Ormond Street, chose to have the surgery at UKMMC.
Doctors improving their
technique of keyhole surgery.
Adam Damien Cooke, Rania's father, said both he and his wife Jelita Othman decided to let their daughter have surgery here because " we felt that they had support and the team in Malaysia to change Rania's life and ours."
For the couple, the operation has brought much calm after the difficult three months they experienced going in and out of hospitals to find out what was wrong with their child, who constantly cried.
Othman said the couple thought she was merely suffering from wind.
"It was only one day I noted that when she passed urine, she cried. Then in December 2008, she was diagnosed with her condition, when doctors had her kidney scanned and learnt that she had a duplex kidney."
Othman said the couple initially decided to go back to England to get treatment for Rania, but after meeting Tan, decided to have it done here.
" We were reassured after meeting Professor Tan. He told us about laparoscopic surgery, and the lack of scarring except for three small holes. She would be out in a day," said Cooke.
Othman said Rania underwent the first operation to remove the blockage in her bladder on Christmas Eve and was discharged the same day.
"She stopped crying. It was like bringing a new baby home. She had a second surgery to remove the upper part of her kidney four weeks ago."
Apart from laparoscopic surgery, UKMMC's team of specialist have also performed difficult open tumour surgery - like that which was performed on 15-month-old Low Yong Xuan.
UKMMC's paediatric surgical team removed five large tumours from both her kidneys, preserving them and saving her from developing kidney failure.
"This operation is yet another first for Malaysia," said Dr Dayang Anita Abdul Aziz, consultant paediatric surgeon and senior fellow in paediatric surgery/ fellow in paediatric laparoscopic surgery.
Her parents were initially told that Low's tumour was not operable as the cancer involved both kidneys.
"For a team effort it is very good for UKMMC. Although it is not the first time we have removed cancerous growths, we are happy that it shows the credibility of UKMMC in dealing with this major illness. The growths were removed without without affecting any of the functions of the kidney," said Dr Dayang.
Low's mother Wendy Liong Mei Yun said her daughter underwent normal surgery on March 4, after completing eight chemotherapy sessions. Low's doctors in Kajang referred her to UKMMC after an ultra-sound performed on Low showed the growths in her kidneys.
" She is my only child and I had no choice. She is much better and more active, although she still has to continue with chemotherapy and radiotherapy after her operation."
