Manhood lost and regained

Sports Page 17 Doctors at NHSL re-attach the severed male organs of a 27-year-old labourer after nine-hour groundbreaking surgery

He was "less" of a man when he was rushed by the Puttalam Hospital in the "right manner" to the National Hospital in Colombo on Monday (October 7).

The details of the incident which had occurred around 2 that morning, which led to the complete severance of the male reproductive organ comprising the penis and the testes, of this 27-year-old labourer are unclear.

Although in Sri Lanka, penises have been re-attached before, this is the first time not only the penis but also a testicle has been re-implanted with this feat being performed by the Plastic and Reconstructive Surgical Unit of the NHSL, the Sunday Times learns.

On being taken to the Puttalam Hospital on Monday morning, the doctors there had stabilised this father of one, while they also contacted the Plastic and Reconstructive Surgical Unit of the NHSL for advice on how to transfer the reproductive organ, along with the patient.

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Commending the Puttalam Hospital doctors for the way they handled this case, Consultant Plastic Surgeon Dr. Dulip Perera who heads the NHSL unit explains that they had placed the organ in a vessel, closed it tightly and then placed the vessel in a container of melting ice before sending it to Colombo for re-attachment.

This is the right way to transport severed organs, he says, stressing that the organ should not come into direct contact with iced water or saline.

Another crucial issue was how the massive bleeding due to the severance had been controlled. It was by using direct pressure, the Sunday Times understands, without aggravating the cut injury on the structures which needed repair later.

Now it was the turn of the skilled team of doctors of the NHSL's Plastic and Reconstructive Surgical Unit to perform the complex procedure to re-attach the reproductive organ.

The surgery which began at 10 a.m. lasted nine hours, the Sunday Times learns, with the team concentrating on the job including Consultant Plastic Surgeon Dr. Dhammika Dissanayake and Senior Registrars Dr. Arunajith Amarasingha and Dr. Kapila Mendis under the guidance of Dr. Dulip Perera.

With the nursing and junior staff giving their unstinting cooperation and with advice from retired Plastic Surgeon Dr. Lalantha Amarasinghe and also Prof. Neville Perera, Professor of Urology, Department of Urology and Renal Transplantation at NHSL, re-attachment had begun.

Even though at this unit, about two years ago, surgery on a penis which was partially severed had been carried out successfully, Monday's operation was different. For, the team was dealing with the full male organ which had been completely severed from the man's body.

With a time lapse of more than six hours and the team worried about what toll the lack of blood may have taken on the testes, a decision had been taken to re-implant the penis and only one testicle instead of both.

The re-attachment of the organ under general anaesthesia entailed re-establishment of the blood supply and repair of structural and functional damage to nerves, tendons, muscles and ducts.

In a "race against time", using micro-surgical technology which allows a 20-fold magnification to deal with 1 mm or 1.5 mm size vessels, they not only worked on minute vessels inside erectile tissue but also on nerves to enable them to grow and bring back feelings to the beleaguered reproductive organ.

"As the size of the scrotum had reduced, we implanted the testicle just under the skin of the left thigh," says Dr. Amarasingha.

Post-surgery, the Sunday Times understands that the immediate concerns are whether the reproductive organ would survive the severance and re-attachment, while in the first few weeks it would be possible infection and issues with blood flow.

Would the patient be able to pass urine on his own without any obstruction and without a catheter and would he be able to get an erection? Would his sole testicle be able to perform its hormonal and reproductive functions?

In answer, Dr. Amarasingha says they are hopeful, adding that they did everything possible. The results would come only in several months— between three and six.

With the patient recovering in the unit, at least with his manhood intact, Dr. Perera adds: "We'll have to wait and see."