Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Postoperative adhesions and small bowel obstruction - New insights(College of Surgeons of Sri Lanka, 2000) Deen, K.I.Patients having surgical procedures below the level of the transverse colon are at risk of adhesion formation. Small bowel obstruction is the commonest presenting feature of adhesions, is estimated that up to 10 percent of patients undergoing laparotomy will require re-operation for adhesions in a life time. Economic implications, the nature of adhesions formation and its aetiology to formulate methods of prevention is discussed in the articleItem Closed loop small bowel obstruction caused by a retained faecolith complicating acute appendicular perforation(College of Surgeons of Sri Lanka, 1999) Gunawardena, P.A.H.A.; Deen, K.I.Case report of an 11 year old boy presented with a 36 hour history of central abdominal pain which localized in the right iliac fossa, vomiting and fever. A diagnosis of appendicitis was made. He developed abdominal distension and vomitting on the third post-operative day. The primary cause of the complication was the retained faecolith which was not found at the time of apendicectomy, despite extension.Item Prospective clinical and functional audit of emergency and elective haemorrhoidectomy(College of Surgeons of Sri Lanka, 1999) Deen, K.I.; Paris, M.A.S.; Ariyaratne, M.H.J.; Samarasekera, D.N.Background Traditionally, prolapsed thrombosed haemorrhoids have been treated conservatively because of the popular belief that the incidence of complications are greater after emergency operation compared with elective operation for haemorrhoids. An audit comparing emergency operation for prolapsed thrombosed haemorrhoids with elective operation for third and fourth degree haemorrhoids is presented. Patients and methods 104 patients (82 male, median age 47 years, range -18 to 80 years) undergoing emer- gency (65) or elective haemorrhoidectomy (39) were evaluated for complications after operation, hospital stay and postoperative bowel function which was assessed at 3 months by mailed questionnaire. Results Trainees performed as many operations as consultants (trainee 48 (46 percent) vs. consultant 56 (54 percent) although consultants performed more emergency operations (trainee-20, consultant-45). Postoperative complications were seen in 13 (12percent) ; emergency-9 versus elective-4 (p=0.69). There was no difference in complications after trainee performed operation (8) compared with operation by consultant (5). Median (range) duration of hospital stay after emergency operation was 2 days (1-17) compared with elective operation -2 days (1-10). A subset of 41 patients responded to a questionnaire on bowel function at 3 months: 5 of twenty five (20 percent) after emergency haemorrhoidectomy and 2 of sixteen (12.5 percent) after elective haemorrhoidectomy reported transient incontinence to gas or stool up to 3 weeks after operations but none were incontinent at 3 months. After emergency haemorrhoidectomy, 9 (36 percent) reported a sense of anal narrowing compared with 2 (12.5 percent) after elective haemorrhoidectomy (p=0.13). None required corrective surgery for anal stenosis. Conclusion There were no significant differences in complications, hospital stay and postoperative bowel function in patients after emergency and elective haemorrhoidectomy. Emergency haemorrhoidectomy is likely to result in low morbidity when undertaken by trained persons.Item Histological assessment of the distal 'doughnut' in patients undergoing stapled restorative proctocolectomy with high or low anal transection(1994) Deen, K.I.; Hubscher, S.; Bain, I.; Patel, R.; Keighley, M.R.A non-randomized prospective study of 38 patients, 32 with ulcerative colitis and six with familial adenomatous polyposis (FAP), who underwent high or low anal transection during stapled restorative proctocolectomy was undertaken. The median (range) height of the staple line 6 months after operation was 5.2 (3.2-6.0) cm after high transection compared with 2.9 (1.8-3.6) cm after low transection. Nineteen of 20 patients after high anal transection had columnar epithelium in the distal 'doughnut' versus 16 of 18 after low transection. Active colitis was present in 12 of 19 'doughnuts' in patients with high anal transection and columnar mucosa and in seven of 16 after low transection. Nine patients (high transection two, low transection seven; P < 0.05) had striated muscle in the stapled distal 'doughnut'. Dysplasia was found in the resected colon in one patient with ulcerative colitis and adenocarcinoma in two colectomy specimens (ulcerative colitis, one; FAP, one). No dysplasia or carcinoma was seen in any of the 'doughnuts' from patients with ulcerative colitis. Four patients with FAP (high transection, two; low transection, two) had microadenoma in the distal 'doughnut'. Despite attempts to place a stapled pouch-anal anastomosis below the anal transition zone, it was not possible to remove columnar mucosa completely from the remaining anal canal in most patients (16 of 18). High anal transection and pouch-anal anastomosis should be the preferred option in restorative proctocolectomy, as a dentate-line anastomosis may not fully eliminate columnar epithelium and may involve resection of some of the external sphincter.