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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Single incision laparoscopic surgery (SILS) for primary surgery in medically refectory ulcerative colitis: a case series(Wiely-Blackwell, 2016) Chandrasinghe, P.C.; Leo, C.A.; Samaranayake, S.F.; Santorelliei, C.; Strouhal, R.; Warusavitarne, J.INTRODUCTION: Medically refractive ulcerative colitis (UC) requires surgical intervention. Due to the ongoing inflammation in the colon this patient group is considered as high risk. Primary surgery includes subtotal colectomy (STC) as the first step of a staged restorative procedure, restorative proctocolectomy (RPC) or panproctocolectomy (PPC) with end ileostomy. Single incision surgery is gaining popularity in this group of patients. METHOD: Patients who underwent single incision surgery for medically refractory UC from 2013 January to 2015 December were prospectively followed up. Demographics, hospital stay and early complications were analyzed. Mann-Whitney U test was used to compare the medians. RESULTS: A total of 34 patients (male – 24, median age – 41.5 years; range 17–69 years) were included. There were 21 STCs, 9 PPCs and 4 RPCs done as primary surgery for medically refractory UC. The median hospital stay was 7 days (4–41 days). Four out of 34 patients had a complication with Clavien-Dindo score above 3; (2-re-operation for obstruction (5%), 2 required intensive care for sepsis (5%). Two procedures (5.8%) had to be converted strategically to open. Three patients had cancer in the resected specimen. The median age of those who had PPC was significantly higher compared to those who had restorative procedures (48 years: range 17–69 Vs 38 years: range 34–64; P < 0.005). CONCLUSION: Single incision surgery for medically refractory UC is safe with an acceptable complication profile in this group of medically unwell patients. The quality of life implications of this procedure require further evaluation.Item Single incision laparoscopic surgery (SILS) for primary surgery in medically refectory ulcerative colitis: a case series(Wiely-Blackwell, 2016) Chandrasinghe, P.C.; Leo, C.A.; Samaranayake, S.F.; Santorelli, C.; Strouhal, R.; Warusavitarne, J.AIM:Medically refractive ulcerative colitis (UC) requires surgical intervention. Primary surgery includes subtotal colectomy (STC), restorative proctocolectomy (RPC) or panproctocolectomy (PPC) with end ileostomy. Single incision surgery is gaining popularity in this group of patients. METHOD: Patients who underwent single incision surgery for medically refractory UC from 2013 January to 2015 December were prospectively followed up. Demographics, hospital stay and early complications were analysed. RESULTS: A total of 34 patients were included. There were 21 STCs, 9 PPCs and 4 RPCs done as primary surgery for medically refractory UC. The median hospital stay was 7 days (range: 4–41 days). Four out of 34 patients had a complication with Clavien-Dindo score above 3; (2-re-operation for obstruction (5%), 2 required intensive care for sepsis (5%). Two procedures (5.8%) had to be converted strategically to open. Three patients had cancer in the resected specimen. The median age of those who had PPC was significantly higher compared to those who had restorative procedures (48 years: range 17–69 vs 38 years: range 34–64; P < 0.005). CONCLUSION: Single incision surgery for medically refractory UC is safe with an acceptable complication profile. The quality of life implications of this procedure require further evaluation.Item The Role of the pathologist in the assessment of disease activity in ulcerative colitis(College of Pathologists of Sri Lanka., 2018) Mahendra, B.A.G.G.; Hewavisenthi, S.J.De S.ABSTRACT: In order to determine the role of the pathologist in assessing disease activity in UC, clinical and histological correlation of disease activity, correlation between endoscopy and histology and determining the most satisfactory method of scoring histological activity were assessed. A cohort of 41 patients attending a gastroenterology clinic in a tertiary hospital in Sri Lanka was studied. Their clinical activity was determined based on the simple clinical colitis activity index (SCCAI), endoscopically visible inflammation was recorded with reference to the extent of involvement and histology was assessed using three different histological scoring systems. The Spearman rank correlation coefficients between SCCAI and the three histological scoring systems were 0.298, 0.286, and 0.238 respectively denoting poor correlation. The kappa value of agreement between endoscopy and histology was poor (k=0.136). The Spearman rank correlation coefficients between the three histological scoring systems were 0.883, 0.883 and 0.952, reaching a level of statistical significance (p<0.01). The clinical activity and histological activity do not correlate and this is especially when assessing the more proximal colon. Endoscopy and histology also shows no correlation highlighting the importance of microscopic assessment of endoscopically normal mucosa. Finally, the histological scoring systems correlate fairly closely with one another enabling histopathologists to choose one that is most practical for routine use.Item The Asia Pacific Consensus Statements on Crohn's Disease Part 2: Management(Wiley-Blackwell, 2016) Ooi, C.J.; Hilmi, I.; Makharia, G.K.; Gibson, P.R.; Fock, K.M.; Ahuja, V.; Ling, K.L.; Lim, W.C.; Thia, K.T.; Wei, S.C.; Leung, W.K.; Koh, P.K.; Gearry, R.B.; Goh, K.L.; Ouyang, Q.; Sollano, J.; Manatsathit, S.; de Silva, H.J.; Rerknimitr, R.; Pisespongsa, P.; Abu Hassan, M.R.; Sung, J.; Hibi, T.; Boey, C.C.; Moran, N.; Leong, R.W.; Asia Pacific Association of Gastroenterology (APAGE) Working Group on Inflammatory Bowel DiseaseInflammatory bowel disease (IBD) was previously thought to be rare in Asia, but emerging data indicate rising incidence and prevalence of IBD in the region. The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region.1 The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field. This article is protected by copyright. All rights reserved.