News
Laparoscopic repair brings relief for humiliating ailment
It had been a living hell for them – unable to do their daily chores or their jobs and even unable to go out of their homes, terrified that others would get an inkling of what was ailing them.
N.M. Ran Menika from Dehiattakandiya
Suffering in silence and shame, these women, along with their families, had hit rock-bottom physically, mentally and emotionally. They had also scraped bare the precious family budget not only going from this hospital to that hoping against hope that they will get cured but also spending on expensive adult pampers which had become a necessity.
After the long agony, now they are all smiles, for their embarrassing ailment has been cured at the Colombo South (Kalubowila) Teaching Hospital by Consultant Obstetrician and Gynaecologist Dr. Dhammike Silva and his team.
These women’s secret shame has been vesico-vaginal fistulae which had caused urinary incontinence without a moment’s respite, after they had undergone hysterectomies awhile ago — and there are numerous women from across the country still leading miserable lives, unaware that there is succour at the Kalubowila Hospital.
Skilful Dr. Silva, a laparoscopic or keyhole surgery expert, has provided these hapless women a solution — a laparoscopic vesico-vaginal fistula repair without undergoing major surgery.
“Mata anduna,” says a respected teacher, 47-year-old Dhammika Wijesooriya from Rattota in Matale, explaining that she wept when Dr. Silva reassured her that he could heal her.
We meet her first in the Professorial Unit before she undergoes the procedure at the Kalubowila Hospital and then see her later on the operating table.
All the women we speak to have similar histories. All have undergone hysterectomies (womb removal) after which they have been assailed by vesico-vaginal fistulae.
A mother of three children in the age range 19 to 12, Dhammika had in October 2017 undergone a hysterectomy. The trouble started soon after — urinary seepage all the time, being on catheters for a long period and finally being told that she would have to “live” with that condition forever and being in adult pampers.
The first time we meet her, worry lines mar her beauty — she does not know how to get more pampers because her husband is not able to travel to Colombo very often, while she is awaiting the laparoscopic repair.
Dhammika Wijesooriya from Rattota . Pix by Amila Gamage and M.A. Pushpa Kumara
Pampers have been her mainstay, essential to hold the urine from seeping down her legs and wetting her clothes.
“Mama godak peeda vinda,” she says, appreciative of her husband for being her pillar of strength through thick and thin.
A Sinhala teacher, she had been an active participant in all school matters – usually leaving home about 6.30 in the morning and returning only about 6 in the evening. Then came the hysterectomy and life changed.
As the incontinence was there every minute of the day, she had to appeal to the school authorities to get her students to come to the ground floor as she could not climb the stairs. “Imagine hilly Rattota and the inclines everywhere,” she says in dismay.
Across the short wall of the same ward of the Kalubowila Hospital, 50-year-old N.M. Ran Menika, a mother of four children, from Dehiattakandiya is all smiles. After a year of agony, she is free of a debilitating and embarrassing problem.
It was about a year ago that her womb was removed and three days later nikamma choo yanna patan gaththa. For 365 days, she battled this very personal and humiliating problem. From Dehiattakandiya where her home is, here and there she was sent, long hours on buses, hanging around hospitals but to no avail.
Avuruddak duk vinda. Hari giye ne, she says explaining that a year passed and nothing happened, even though many assured her that oka erila yayi (it will be alright).
But now, the smiles are evocative as Ran Menika says den hondai (now I’m good) after the repair. She is back in the fields helping her husband.
We see the skilful repair of Dhammika’s vesico-vaginal fistula by Dr. Silva during a Pre-congress Workshop of the Annual Scientific Congress of the Sri Lanka College of Obstetricians & Gynaecologists.
On the second floor OT table of the Kalubowila Hospital was Dhammika, while clear images and succinct explanations were relayed to the seventh floor auditorium where foreign and local doctors were gathered to witness it.
Now Dhammika is home. Both Dhammika and Ran Menika represent only the tip of the iceberg of the numerous women who are suffering in silence every moment of the day.
On the phone, we hear a horror story from a 46-year-old in Galle who was cut open to remove an ovarian cyst. Not only had her abdomen been a scarred wreck but the very sensitive trigone (the smooth triangular region of the internal urinary bladder formed by the two ureteric orifices and the internal urethral orifice) had been severely damaged.
Sangili Maria, 41, from Madinnagoda faced a similar ordeal after a hysterectomy which left her work-life packeting pepper and cinnamon in shambles and her income dropping to zero. It is after the repair that she is getting back on her feet again.
Kalubowila Hospital has given them an answer to their agonising ailment and a reason to live after repairing the devastating damage to their bodies.
The woman from Galle, after her nine-hour repair last year speaks for them all: “Raththaran” Dr. Dhammike did not just heal us, he boosted our morale and reinforced us to think positively.
| That abnormal connection in vesico-vaginal fistulae | |
| A vesico-vaginal fistula is an abnormal fistulous tract (connection) between the bladder (vesico) and the vagina that leads to the continuous involuntary discharge of urine into the vagina, says Consultant Obstetrician and Gynaecologist, Dr. Dhammike Silva.  Dr. Dhammike Silva This “abnormal connection” may link the bladder to the vagina (vesico-vaginal fistula) or the ureter to the vagina (uretero-vaginal fistula) causing urinary seepage, it is learnt, while there could also be an abnormal connection between the rectum and the vagina (recto-vaginal fistula) which would result in a leakage of faeces. Explaining that vaginal fistulae are embarrassing because they leak and emanate a bad odour, Dr. Silva says that very often it is caused by tissue damage. “Such tissue damage could be due to abdominal or vaginal surgery such as a hysterectomy (womb removal) or a Caesarian operation (C-section). The successful repair of a vesico-vaginal fistula through laparoscopy or keyhole surgery which is minimally invasive entails separating the vagina from the bladder, cutting off the fistula tract and repairing or patching up the organs (the bladder and the vagina) separately,” says Dr. Silva “putting it simply”.  Starting the vesico-vaginal fistula repair through the minimally-invasive laparoscopic (keyhole) procedure |
| SAMAGE awaits full accreditation from British Society | |
| Gynaecological laparascopic procedures have been taken to a different and exclusive level by the Kalubowila Hospital’s Obstetrics & Gynaecology Professorial Unit, making it unique in the region and the world with the setting up of the South Asian Minimal Access Gynaecology & Endometriosis (SAMAGE) Centre.  Kalubowila Hospital Director Dr. Asela Gunawardena The British Society for Gynaecological Endoscopy (BSGE) formally bestowed the SAMAGE Centre with provisional accreditation in January this year, the one-and-only such centre for Southeast Asia. As 2018 draws to a close, the SAMAGE Centre which has been under rigorous scrutiny and stringent evaluation by BSGE, awaits the final audit on December 31, to secure full accreditation. Full credit for supporting the doctors to go not only that extra mile but more, of course, should be accorded to Kalubowila Hospital Director Dr. Asela Gunawardena who has always been “there” for them, it is learnt. The Kalubowila Gynaecological Team comprises Consultant Obstetricians and Gynaecologists Dr. Dhammike Silva and Dr. Madura Jayawardane; Consultant Genito-Urinary Surgeon Prof. Srinath Chandrasekera; Consultant Colorectal Surgeon Dr. Bawantha Gamage; Consultant Anaesthetist Dr. Nilangani Lamahewage with a special interest in pain management; and Specialist Nurse Himali Malawiarachchi. |