Overview: Burch colposuspension is introduced in 1961 and since then it has been the gold standard treatment modality for genuine urinary stress incontinence. Methods:In this prospective cross-sectional study we have analyzed data from 36 women aged 42 to 63 years who had undergone laparoscopic Burch colposuspension at Colombo South Teaching Hospital Sri Lanka during the period from 2012 to 2021. Patients completed a self-administered Short Urinary Distress Inventory (SUDI) and Short Incontinence Impact Questionnaire (SIIQ) at both the baseline and the post-operative follow up (6 months, 12 months) period. The Genito-Urinary Treatment Satisfaction Scale (GUTSS) was utilized to assess satisfaction with the outcomes of the laparoscopic repair surgery.Results: Six months following the surgery, Stress Urinary Incontinence (SUI) was 9.38% with p=0.38, SUI and/or urge incontinence was 18.75% with p=0.56, which were statistically not significant. In both analyses of SUDI and SIIQ there were significant improvements in outcomes. Satisfaction with treatment outcomes from the GUTSS at six months follow up was 32.5 ± 5.8 with p=0.48. At 12 months following surgery, 15.6% of patients had GSI while 9.38% had stress incontinence frequently (p=0.26). Conclusion:Laparoscopic Burch colposuspension is an effective technique and treatment modality for urinary stress incontinence. Both objective and subjective evaluation of surgical outcomes at 6 and 12 months of follow-up demonstrated significant improvement and repetitive corrective surgeries are uncommon.
Overview: Laparoscopic myomectomy has become increasingly popular in Sri Lanka due to its favorable long term outcome. Purpose of this study is to evaluate not only laparoscopic myomectomy technique but also operative time, blood loss depending on site, size and number of fibroid. Method:In this retrospective study we have analyzed data from 432 women who had undergone laparoscopic myomectomy at Colombo South Teaching Hospital, Sri Lanka during the period from 2011 January to 2021 January. Data were collected from patient database, hospital records and histopathology data base. Data were collected according to demographical details including age, BMI, parity and past surgical histories, myoma details including size, type, site and number, intraoperative details and postoperative data.Results: Mean age of patients undergone laparoscopic myomectomy are 35.5 years (SD 6.083) Majority of the population (67%) were nulliparous. Indication wise 192 patients (44.4%) had pressure symptoms,137 patients (31.7%) presented with heavy menstrual bleeding and 103 patients (23.8%) had subfertility history. Regarding fibroids characteristics, single fibroid found in 168 patients (38.9%), fibroids between 2-4 found in 199 patients (46.1%) and fibroids 5-10 found in 65 patients (15%). Considering the location of fibroid, 192 patients (44.4%) had anterior wall, posterior wall in 125 (28.9%), fundal in 87 (20.1%), broad ligament in 21 (4.1%) and other locations in 7 patients (1.6%). Regard to type of the fibroids intramural fibroids identified in 196 patients (45.4%), sub serosal in 136 (31.5%), submucosal in 75 (17.4%) and pedunculated in 22 patients (5.1%).Mean blood loss was 159.4 +/-68.03 ml while mean operative time was 124 +/-49.6 minutes. But those differs with number and size and site of the fibroids. Mean blood loss and operative time increased when fibroids number and size increased. Mean operative time is 92.23 minute for fibroid size less than 8cm vs 178.9 minute for fibroid more than 12cm. Mean blood loss is 115.25ml for fibroid less than 8cm vs 238.27ml for fibroid size more than 12cm. Mean operative time for single fibroid is 90.8 minute vs 179.5 minute for fibroids 5-10. Mean operative time and blood loss are increased with posterior wall and broad ligament fibroids. However, it is not statistically significant (P Value 0.006 and 0.008 respectively). Prolonged operative time did not impact on surgical outcomes in terms of hospital stay and blood transfusion. Conclusion:In experienced and expert hand, laparoscopic myomectomy is a safe procedure with good surgical outcomes and low complication rate. Operative time and blood loss are mainly associated with the size of largest fibroid and number of fibroids. Open myomectomy may be of benefit for number of fibroids > 10 when considering completeness of surgery. Hand morcellation through suprapubic port is a safe and effective method of specimen retrieval in laparoscopic myomectomy.
Objective: Our aim in this study is to compare pregnancy and fetal outcomes following the diagnosis of gestational diabetes according to HAPO/IADPSG, NICE criteria or when using both criteria.Methods: Diagnosis of GDM was made using the lowest recommended cut off values of HAPO/IADPSG criteria and NICE criteria. NICE diabetes in pregnancy guidelines were used in management once GDM was diagnosed. The outcomes of the three groups were compared, Group A: the patients diagnosed using any criteria, Group B: only from HAPO/IADPSG criteria (patients fasting value within 92-100 mg/dL and other values with in the normal). Group C: only from NICE criteria (patients with 2 nd hour value within 140-153 mg/dL but the rest were normal)Results: Out of all women with GDM 70% were in group A, 25% in group B, and only 4% in group C. 62% of women needed metformin or insulin apart from Medical nutrition therapy in Group A, and 50% in group B and only 17% in group C. Average period of gestation at the delivery in Group A was 37 weeks and 3 days , and it is 37+5 for group B and 38+4 for group C. Induction rate in Group A was 56%, 14% in Group B and 4% in Group C.LSCS rate was 48% in Group A, 41% in group B and 36% in group C. 7% of babies were macrosomic in Group A, 2% and 1% respectively in groups B and C. Special Care Baby Unit (SCBU) admission rates were 11% in group A and 1% in group B. The average birth weights of Group A were 2.93kg, Group B 2.900kg and group C 2.818kg. Conclusion:HAPO/IADPSG criteria diagnosed more women with gestational diabetes than NICE criteria. Only 4% of mothers will be missed if HAPO/IADPSG criteria is used. Pregnancy outcomes of the Group B is similar to that of Group A and 50% of women needing further intervention apart from MNT could have prevented adverse pregnancy outcome in a significant number of patients compared to the few number of patients in group C. It was observed that IADPSG criteria provide better diagnostic cut-off values for our population compared to NICE.Limited number of patients especially in group C is a limitation of this study to evaluate further since this is an on-going observational study and will be able to provide more information in the future.
This study focuses on the importance of a safety checklist for gynaecological laparoscopic surgeries. Although several general safety checklists are used in practice (e.g.: The WHO Safety Checklist), there is no dedicated safety checklist for gynaecological laparoscopic surgeries.Our aim is to introduce a safety checklist dedicated to gynaecological laparoscopy. It is based on our experience in performing various gynaecological laparoscopic surgeries in a tertiary care center with a substantially high workload. It has been compiled after studying the complications occurring in areas covered by the aforementioned checklist. We present data from 776 cases performed over 4 years at the Professorial Unit in Obstetrics and Gynaecology affiliated to the University of Sri Jayewardenepura, at
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