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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 A Review of post-operative morbidity following laparoscopic assisted vaginal hysterectomy compared to conventional types of hysterectomy(Sri Lanka College of Obstetricians and Gynaecologists, 2002) Weerasekera, D.; Padumadasa, G.S.OBJECTIVE: To analyse the indications, morbidity and duration of hospital stay for laparoscopic assisted vaginal hysterectomy in comparison to other types of hysterectomy. DESIGN: A prospective cohort study. PATIENTS: All women undergoing hysterectomy dur¬ing the period of October 2000 to April 2002 at the University Obstetrics and Gynaecology Unit, Colombo-South Teaching Hospital. INTERVENTIONS: A patient questionnaire completed prior to surgery, on discharge from the hospital, and two weeks after surgery. Data extracted from patient's hospital case notes. MAIN OUTCOME MEASURES: Indications, operative complications, postoperative morbidity and length of hospital stay for different types of hysterectomy. RESULTS: 270 women underwent hysterectomy during this period, out of which 60% were total abdominal hysterectomies, 19.6% were vaginal hysterectomy and repairs, and 17% were laparoscopic assisted vaginal hysterectomies. Common indications for hysterectomy were fibroids (39.6%), uterine prolapse (19.6%) and severe dysfunctional uterine bleeding (11.5%). Mean postoperative hospital stay was 2 days for laparoscopic hysterectomy, 4 for vaginal hysterectomy and repair, and 5 for total abdominal hysterectomy. CONCLUSIONS: Laparoscopic assisted vaginal hysterectomy appears to be a better alternative to conventional hysterectomy with regard to post-operative morbidity and hospital stay in selected patients.Item A Clinical and cost evaluation between outpatient endometrial biopsy and dilatation and curettage(Sri Lanka College of Obstetricians and Gynaecologists, 1997) Gunasekera, P.C.; Wijesinghe, P.S.; Saparamadu, P.A.M.Objective To evaluate the clinical and financial benefits of endometrial aspiration biopsy using a new aspiration device (Probet) over conventional dilatation and curettage. Design Comparison of histology and adequacy of samples obtained by endometrial aspiration and formal curettage. The histopathologist was blinded with regard to the biopsy method. Setting The gynaecology outpatient department of a teaching hospital. Patients 52 consecutive women requiring dilatation and curettage (D and C). Interventions Endometrial aspiration was performed in the out patient department and conventional D and C performed within 3 days. Main outcome measures Degree of discomfort to patients during endometrial aspiration was assessed by a visual analogue scale. Histological adequacy of the endometrial samples obtained was determined. The histological diagnosis of samples obtained by the two methods was passed. Cost of the two methods was determined. Results Eight patients experienced moderate to severe discomfort during endometrial aspiration. These were done for investigation of subfertility (2) and postmenopausal bleeding (6). Scanty or no endometrial aspirate was obtained in 9 women, 6 of whom had postmenopausal bleeding. No curettings were obtained in 5 of the women with postmenopausal bleeding. Active bleeding was present at the time of the procedure in 5 patients which was reported as blood clot and menstrual endometrium. In only 2 of the paired endometrial samples did the histological diagnosis differ from the specimen obtained by endometrial aspiration. Histological concordance was noted in 30 pairs. Conclusions Outpatient endometrial biopsy is acceptable to the majority of patients. Nulliparous and postmenopausal woman feel discomfort. Endometrial biopsy in the presence of active bleeding is of little value. There is good histological concordance between samples from endometrial aspiration is as ten times cheaper than conventional curettage