Journal/Magazine Articles
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/13
This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
Browse
2 results
Search Results
Item Rectal prolapse: impact on pelvic floor physiology and current management(Elsevier-W.B. Saunders, 1996) Deen, K.I.; Madoff, R.D.Rectal prolapse may be associated with fecal incontinence or constipation. Incontinence results from reduced internal sphincter tone and may be worsened by direct or neurogenic damage to the external sphincter and puborectalis muscles. Impaired anal sensation and previous anal sphincter injury may also contribute to incontinence. Constipation results from either difficulty in evacuation, delayed transit, or both. Management should aim to identify the extent of prolapse and degree of functional impairment. Almost all patients with occult prolapse should be treated conservatively. However, rare, markedly symptomatic patients with convincing evidence of occult prolapse may benefit from surgery. Abdominal fixation techniques are the abdominal operations of choice for fit patients with complete rectal prolapse. There is no evidence that addition of foreign material slings enhance the outcome of surgery. Considerable recent data support the use of a sigmoid resection in conjunction with rectal fixation, although this remains a contentious issue. Resection is not advised for patients with poor sphincter function associated with significant neuropathy. Patients with severe preoperative constipation require complete evaluation before surgery; those with documented slow-transit constipation may benefit from subtotal, rather than sigmoid colectomy, performed in conjunction with rectopexy. The Delorme operation and perineal rectosigmoidectomy are both acceptable choices for high-risk patients and patients who wish to avoid abdominopelvic dissection. Our preference is for the perineal rectosigmoidectomy, and we advocate associated levator plication at the time of surgery, particularly in incontinent patients. The Thiersch operation is associated with a high complication rate and should be avoided. The chief advantages of perineal over abdominal repair are avoidance of laparotomy and related complications, preservation of autonomic nerve function, avoidance of ureteric injury, and the ability to perform a concomitant sphincter or pelvic floor repair through the same incision. Laparoscopic prolapse repair is in its infancy with no data on long-term follow-up, making it impossible to evaluate its impact on the treatment of rectal prolapse.Item Scintigraphic defecography: quantitative and dynamic assessment of anorectal function(Lippincott Williams and Wilkins, 1993) Hutchinson, R.; Mostafa, A.B.; Grant, E.A.; Smith, N.B.; Deen, K.I.; Harding, L.K.; Kumar, D.PURPOSE: Conventional assessment of anorectal function with defecating videoproctography is semiquantitative and the high radiation exposure precludes prolonged or repeated testing. The aim of this study was to develop a dynamic scintigraphic method of assessing anorectal function. METHODS: Fourteen patients with fecal incontinence, 18 patients with chronic constipation, and 8 control subjects were assessed by scintigraphicdefecography. This involves introduction of a technetium-99m-radiolabeled artificial stool into the rectum of the subject and acquisition of gamma camera images during evacuation. RESULTS: Mean evacuation rate was 2.8 percent/second in incontinent patients and 0.9 percent/second in constipated patients (P < 0.001). The mean anorectal angles were 136 degrees and 133 degrees, respectively. There were 18 cases of pelvic floor descent and 6 rectoceles. Scintigraphicdefecography provides quantitative information on rectal evacuation. Anorectal angle and pelvic floor movement can be examined. The radiation dose to pelvic organs is significantly less than with videoproctography. CONCLUSION: We believe that scintigraphic defecography is the investigation of choice for objective and dynamic assessment of anorectal function