Browsing by Author "Sabaratnam, V. Y."

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Abdominal suture rectopexy without large bowel resection for rectal prolapse does not result in constipation: data from prospective bowel function evaluation, anorectal physiology and transit studies
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V. Y.; Rathnayake, G.; Deen, K.I.
INTRODUCTION: Traditionally, suture rectopexy has been combined with sigmoid resection for rectal prolapse to prevent postoperative constipation. Furthermore, preservation of lateral ligaments will not result in constipation. Suture rectopexy alone without resection, is being popularised. OBJECTIVE: To study the influence of suture rectopexy without resection on colonic transit and postoperative constipation. PATIENTS AND METHODS: Forty-six patients (median (range) age 32(19-82) years) with rectal prolapse underwent suture rectopexy alone without division of lateral ligaments from March 1999. Prospectively, bowel function and anorectal physiology (ARP) were evaluated before and after surgery in a subset of 15 patients. Follow up (median, range) has been 12 (1-42) months. RESULTS: Follow up was complete in 36 patients. Recurrent prolapse was seen in 5 (full thickness 3 (8.3%); mucosa! prolapse 2 (5.5%)). Physiological data in a subset of 15 patients revealed no significant difference in anorectal physiology before and 3 months after the operation (table). Similarly there was no significant difference in the rate of evacuation of transit markers on day 3 and 5. Maximum resting pressure (median and range) was 25(7-50) mmHg and 33.2(7- 80, P value 0.026) before and after surgery. The median (range) maximum squeeze pressure were 67.5(19-i30) and 90(28 - 157, P 0.!64) before and after surgery. The maximum tolerable volume (ml) was 230 ( ! 80 -340) before surgery and 200 (50-290) after surgery (P. 0.139). Transit (as an excretion percentage) was 100% before and after surgery (P = 0. 197). CONCLUSION: Abdominal suture rectopexy without resection for rectal prolapse improves constipation and does not result in significant change in colonic transit. We recommend this procedure either by open operation or by laparoscopy.
Laparoscopic assisted colorectal resection; is it safe? does it provide a good quality specimen?
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V. Y.; Deen, K.I.
INTRODUCTION: Laparoscopic assisted resection (LAR) of Jarge bowel is now at accepted standard hybrid procedure in minimally invasive colonic surgery. OBJECTIVE: To compare the safety and quality of the resected specimens between LAR and open colonic surgery (OPC). METHODS: Twenty three patients who underwent LAR were compared with 19 patients who has had open colonic surgery. There were 12 males in the LAR group and 7 in the OPC group. The median age was 63(27.81) in LAR group and 55 (25-80) years in OPC group. RESULTS: The length mean of (and SD) the bowel resected was 22cm (2.83) in LAR, 18cm (5.7) in OPC for abdomino perinea! resection, 19cm (7.80) and 22.5cm(O. 78) for anterior resection, 21 cm and 20cm for left hemicolectorny, 31 cm(2.2 I) and 12cm( 4.24) for right hemicolectomy, I 4cm(6.3) and 14.8cm(4.8) for sigmoid colectomy. The number of nodes resected were 7( 1.41) and 4(5.6) in abdomino perinea! resection, 6(2.83) and 9(7.1) in anterior resection, 3 and 16 for left hemicolectorny, I 0(3.54) and 7(7.8) for right hemicolectomy, 4(3.67) and 8(5.6) for sigmoid colectomy and 6(5.6) for transverse colectomy for the two groups. There were no perforation of bowel or tumour. CONCLUSIONS: This study shows that there was no difference in length of bowel resected, number of nodes retrieved, disruption of bowel or tumour, port site/ abdominal wound recurrence and time taken for the operation. LAR is sate in trained hands and will provide a good quality specimen for pathology
Outpatient flexible Cystoscopy: prospective single centre experience
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V. Y.; Ariyaratne, M. H. J.
INTRODUCTION: Flexible cystoscopy is performed as an out patient procedure. OBJECTIVE: To audit the our experience of out patient flexible cystoscopy. Methods: Patients presenting with lower urinary symptoms (haematuria, irritability, dysuria, obstructive symptoms, pain, and recurrent urinary tract infection) were prospectively recruited into this study over a two-year period. Flexible cystoscopy was performed under surface anaesthesia using lignocaine 2% gel and single dose intravenous antibiotic prophylaxis (80 mg of Gentamycin if not contraindicated). RESULTS: This study included 552 (400 males) patients.None had complications. In 30 (5.4 %) patients instrument could not be introduced. These patients underwent meatal and urethral dilatation followed by rigid cystoscopy. Prostomegaly was present in 196 patients (49% of Males). Urethral stricture was present in 38 patients (6.8 %). Bladder stone was present in 24 (6.3%) patients. Bladder mucosal abnormality was detected in 59 (11 %). All patients who had mucosal abnormality were subjected to rigid cystoscopy. CONCLUSION: Flexible cystoscopy is a useful minimally invasive investigation with no complication in experienced hands. Commonest abnormalities found were prostomegaly followed by mucosal abnormality in the bladder.