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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Relief of large bowel obstruction with a self-expanding metal stent(College of Surgeons of Sri Lanka, 2000) Malalasekera, A.P.; Deen, K.I.A 58 year old woman presented with progressive abdominal distension of 6 months duration associated with constipation is reported here.Item Patients' experience and quality of life with a loop ileostomy(College of Surgeons of Sri Lanka, 2000) Wijesuriya, S.R.E.; Rathnayake, G.; Deen, K.I.Background: Temporary proximmal faecal diversion has been either loop ileostomy or loop colostomy. Recently, loop ileostomy has been preferred over loop colostomy. This study evaluated patient's quality of life with a temporary diverting loop ileostomy. Patients and methods: Life quality of 25 (8 males, median age 40 years, range 22-70 years) patients who underwent creation of a loop ileostomy at the university surgical unit of North Colombo General Hospital were evaluated using self-administrated structured questionnaire. Responses were obrained for ten life quality questions on visual analogue rating scale (0-100mm) and graded good (71-100), satisfactory (31-70) or poor (0-30). Results: Twenty four (96 percent ) patients were able to purchase their stoma appliances without much difficulty. Almost all patients reported a tolerable ileostomy effluent. Seventeen (94 percent ) of 18 patients reported abstinence from sexual activity. A loop ileostomy had no effect on appetite in 60 percent , travel by public transport on 20 percent , and dress in 8 percent , or activities of daily living in 20 percent of patients. Conclusion: A loop ileostomy seems to impair quality of life in most patients. Strained sexual relationships appear to be the most distressing problem. Most patients are able to bare the cost of their stoma appliances.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.