Browsing by Author "Sabaratnam, V.Y."

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A new on-table colonic irrigation device- results of a pilot study
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V.Y.; Deen, K.I.; Kim, J.H.
INTRODUCTION: Management of left colon obstruction either by primary anastomosis or by diversion almost always requires decompression and lavage of the colon. This will facilitate colonic mobilization primary anastomosis, delivery of stoma without contamination and tension free abdominal wound closure. Objective: To examine the results of a new devise that enables on-table he ability to perform concomitant colonoscopy. METHODS: 8 patients (5 males, median age 44 years; range 23 to 78 years) underwent resection of left colon cancer (I), recto-sigmoid cancer (3), and rectal cancer (4). Four were obstructing tumours, while in the remaining 4, full bowel preparation with polyethylene glycol was deemed risky hence requiring intraoperative preparation. The device consisted of a screw-on plastic tube (diameter- 35mm), with an inlet valve and a single outlet for faecal effluent. Following complete irrigation. on table colonoscopy was possible through the inlet. Features assessed were extra intestinal faecal leakage, bowel perforation, irrigation time, volume infused and total time taken. RESULTS: There was no technical problem with introduction and securing the device to the bowel wall. Leakage of faeces was not encountered in a single case. Total time taken for irrigation was (median. range) 20 minutes (8-20), colonoscopy time was 8 and 10 minutes respectively in 2 patients who underwent colonoscopy. 5 underwent primary anastomosis whilst 2 underwent Hartmann operation and I had a Paul-Mickulicz procedure. No anastomotic leakages were detected clinically. No faecal contamination was encountered. All were commenced on oral fluids on day 1 after operation, median time to pass flatus was 2 days (1-3) and discharge from the hospital was (median. range) 8 days (6-12). CONCLUSION: This disposable irrigation device guarantees a complete bowel seal during on-table lavage and ensures complete decompression with bowel cleansing, enabling safe anastomosis
A Structured training programme in laparoscopic cholecystectomy
(Sri Lanka Medical Association, 2006) Liyanage, C.A.H.; Sabaratnam, V.Y.; Deen, K.I.
No abstract available
Training in laparoscopic cholecystectomy: lessons from a structured training programme
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V.Y.; Deen, K.I.
INTRODUCTION: Data have shown that structured training in Laparoscopic cho!ecystectomy (LC) reduces morbidity and mortality related to the learning curve. OBJECTIVE: This study was performed to evaluate morbidity, mortality and to provide insight into steps in operation that requires trainees assistance in LC. METHODS: Five higher surgical trainees with no previous laparoscopic experience were evaluated from July 2000. Each trainee should have held a camera during operation, learnt the skills of Veress needle insertion and acquired hand-eye coordination on a laparoscopic trainer. The operation was divided into 4 steps; I. Creation of pneumoperitoneum 2. Port insertion and laparoscopic survey 3. Dissection in Calot's triangle and application of clips 4. Dissection and delivery of the gall bladder. We audited total time taken, complications and the requirement for assistance. RESULTS: 29 LC's were performed. One (3%) was converted to open cholecystectomy to establish biliary drainage from a duct of Luschka. One (3%) death resulted from pulmonary embolism. There was no significant postoperative morbidity. Overall trainer assistance was required on 18 occasions in 8 (26%) patients (step I - 2; step 2 - 4; step 3 - 8; step 4 - 4). Detailed stepwise evaluation revealed frequent requirement for trainer assistance in insertion of the umbilical port (in step 2), delineation of the junction of the cystic duct with infundibulum and common bile duct and application of clips (in step 3 and 4) and the delivery of the gall bladder. Total time taken was (median& range) 2.08 ( 1.5-3 .18) hours. Median number of LC performed by a trainee was 5 (range 3- 7).CONCLUSION: It is possible to undertake structured training in LC safely. Dissection in Calot's triangle required most trainer assistance