ABSTRACT
Hepatitis B and C are rare in Sri Lanka. Nonalcoholic fatty liver disease is increasing in the country. Eighty-one patients referred for liver transplantation (LT) over a period of 18 months were prospectively evaluated. Ninety-two percent (n = 74) were males. Cryptogenic cirrhosis was the leading indication for LT (58%, n = 47) followed by alcohol in 27% (n = 33). Hepatitis B and C were not seen in our cases. The liver biochemistry and clinical status of cirrhosis were similar in cryptogenic and alcoholic cirrhotics. Fourteen patients died while waiting for transplant, and nine transplants were performed. Cryptogenic cirrhosis is the leading cause for LT in Sri Lanka.
Subject(s)
Liver Cirrhosis/congenital , Liver Cirrhosis/surgery , Liver Transplantation , Adolescent , Adult , Aged , Female , Humans , Liver Cirrhosis/epidemiology , Liver Function Tests , Male , Middle Aged , Prospective Studies , Risk Factors , Sri Lanka/epidemiologyABSTRACT
BACKGROUND: We surmised that if rectopexy was performed without dissection of the lateral rectal stalks in patients with full-thickness rectal prolapse and normal preoperative transit, sigmoid resection may not be required. This study evaluated a new approach to abdominal suture rectopexy for rectal prolapse. METHODS: A total of 81 patients (57 male, 24 female; median age 37 years, range 5-82 years) with rectal prolapse were assessed by clinical examination, anal manometry (maximum resting pressure, MRP, and squeeze pressure, MSP) and radioopaque marker transit studies. Of the 81 patients, 70 with normal preoperative transit underwent suture fixation alone, without resection, performed under spinal anaesthesia, through a 7-cm transverse left lower quadrant incision gaining access to the presacral space via a left pararectal "window", preserving the lateral stalks. RESULTS: Average surgical time was 50 min, mortality was zero, and morbidity was 9% (three patients with wound infection, four with urinary retention). Anal incontinence improved in 43 of 53 patients (81%, p=0.001). MRP and MSP had improved at 3 months after surgery: MRP from a mean of 27.6+/-1.4 mmHg (range 2-30 mmHg) before surgery to 32.5+/-2.21 mmHg (2-60 mmHg) after surgery (p=0.008); MSP from 69.25+/-6.4 mmHg (8-153 mmHg) before surgery to 79+/-4.77 mmHg (35-157 mmHg) after surgery (p=0.001).. Transit was unchanged in 18 of 20 patients (90%) who were evaluated before and after surgery; none was constipated after surgery. At 56 months, prolapse had recurred in five patients (7%). CONCLUSION: Abdominal suture rectopexy with a left pararectal approach without sigmoid resection in those with normal preoperative transit resulted in an improvement in anal incontinence and satisfactory long-term control of prolapse. The operation did not alter transit and did not result in significant constipation.
Subject(s)
Rectal Prolapse/surgery , Rectum/surgery , Suture Techniques/instrumentation , Sutures , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Defecation , Equipment Design , Female , Follow-Up Studies , Humans , Male , Manometry , Middle Aged , Patient Satisfaction , Pressure , Rectal Prolapse/diagnosis , Rectal Prolapse/physiopathology , Rectum/physiopathology , Retrospective Studies , Sigmoidoscopy , Treatment Outcome , Young AdultSubject(s)
Gallstones/therapy , Sphincterotomy, Endoscopic/methods , Aged , Cholangiopancreatography, Endoscopic Retrograde , Gallstones/complications , Gallstones/diagnostic imaging , Gallstones/pathology , Hepatic Duct, Common , Humans , Lithiasis/complications , Lithiasis/therapy , Lithotripsy/methods , Liver Diseases/complications , Liver Diseases/therapy , Male , Recurrence , Stents , Treatment OutcomeABSTRACT
The case of a 79-year old man who was suspected to have an insulinoma is presented. Although clinically and biochemically an insulinoma was the most probable diagnosis there was no supportive radiological evidence. Open surgery and exploration revealed a lesion which was confirmed to be an insulinoma. The patient's hypoglycaemia improved immediately following surgery. In the Sri Lankan setting where sophisticated imaging procedures are not freely available, open exploration of the pancreas is a good alternative to locate a suspected insulinoma.
