Review of Colonoscopy in a Subacute Community Hospital
T.M.J. Chan, Y.L.M. Mak, S.C. Cho
Surgical Unit, Hong Kong Buddhist Hospital, Hong Kong

Colonoscopy is a common investigative procedure in most hospitals. It has potential complications and is relatively expensive in terms of time and manpower required. It may be that in the future practitioner will be unable to afford to colonoscope all the patients presently being examined. Hence, we reviewed colonoscopy service in our hospital to see its usefulness.

Between April 1995 and September 1996, 235 patients received colonoscopy examination our unit. The examination was done mainly as day surgery procedure. Abdominal pain was the most frequent indication. Other common indications included anaemia, change of bowel habit and gastrointestinal bleeding. Five patients had poor bowel preparation. Among the 230 patients who actually received colonoscopy, 86.5% had the large bowel completely examined.

The incidence of positive findings was 28.6%. The common findings were malignancy, colitis, colonic polyps and diverticulosis. Malignancy accounted for 22.7% and colonic polyps accounted for 53% of total positive findings. All the polyps were snared and sent for histopathological test. The percentage of positive findings which could only be diagnosed by colonoscopy (i.e. lesions which are beyond the reach flexible sigmoidoscopy) was 72.7%. Among the 235 cases, there was no procedure related morbidity.

With careful pre-operative assessment, we have found colonoscopy is a useful investigative procedure. Because of its dual diagnostic and therapeutic functions, colonoscopy has virtually replaced the use of Barium enema examination in our unit. It also appears the benefit achieved by colonoscopy cannot be replaced using other cheaper substitute e.g. flexible sigmoidoscopy.

Upper Endoscopy Audit in Hong Kong Buddhist Hospital
T.M.J. Chan, Y.L.M. Mak, S.C. Cho
Surgical Unit, Hong Kong Buddhist Hospital, Hong Kong

Dyspepsia is a common symptom in Hong Kong patients and Helicobactor pylori infection is often associated. The aim of our study is to evaluate our upper endoscopy and to find out a treatment regime that is suitable to our hospital. From 1 January 1998 to 31 August 1998, 526 upper endoscopies were performed in Hong Kong Buddhist Hospital. The mean age of the patient was 52.6. The male to female ratio was 1:2. The procedures were performed as a part of investigations for the patients presenting with dyspepsia (96.9%) or anaemia (3.1%). Two antral biopsies were done to detect the presence of Helicobactor pylori. One was for urease enzyme test (CLO test) and the other one was for histopathology examination. The respective positive rate for CLO test and histopathology examination at first examination were 32.1% and 34.0%. They were given Amoxicillin 1g BD, Metronidazole 400mg BD and Omeprazole 20mg BD for one week. They then returned for re-scope within six weeks. In comparison with the histopathology examination, the false positive rate and false negative rate of the CLO test at first examination was 4.5% and 3.7% respectively. The cure rate of our triple therapy is 69/87(79.3%). In conclusion, CLO test seemed sensitive to detect Helicobacter pylori. The triple therapy regieme we have been using appeared to be cost effective.

Childhood Circumcision: Conventional Dissection or Plastibell Device - A Prospective Randomized Trial
Y.L.M. Mak, S.C. Cho, M.W. Fai
Hong Kong Buddhist Hospital, Hong Kong

A prospective randomized trial of circumcision in children up to the age of 12 was conducted, comparing conventional dissection and Plastibell device circumcision. Indications for circumcision were phimosis, recurrent balanitis and ballooning of foreskin during micturition. One hundred and forty-seven children completed the trial. The mean age was 8.1 years for the conventional dissection group and 6.7 years for Plastibell device group. The mean operating time were 25.9 and 4.8 minutes for conventional dissection and Plastibell device circumcision respectively. The most common postoperative complication in both groups was infection. The infection rates were 14.9% and 13.7% for the conventional dissection and Plastibell group respectively. All infections subsided without adverse effects. The final cosmetic results were satisfactory with both methods. It is concluded that the Plastibell device is a satisfactory method of circumcision in children of the whole paediatric age group (up to the age of 12). Moreover, the shorter operating time makes circumcision by the Plastibell device an attractive method.

Day Surgery Service in a Small Community Hospital
YLM MAK, YS Chan, TMJ Chan,
Hong Kong Buddhist Hospital, Hong Kong

Hong Kong Buddhist hospital is a small community hospital within the Kowloon Central Cluster and is easily reached by public transports. A large proportion of our work are community based subacute surgery and we see an increasing demand of day surgery from our community. Day surgery commenced in July 1995 in our hospital and we report our data and patients' experiences in the first 4 months period.

From July to October 1995, 554 patients of age 1 to 92 were admitted into our day surgery ward, 308 (55.6%) patients were from our nearby communities. A total of 616 procedures were performed, which accounted for 63% of total procedures in the corresponding period. Three hundred and five (49.5%) day procedures were gastrointestinal endoscopy. Incorporating endoscopy into day surgery simplifies and streamlines administrative and nursing procedures. Three (0.5%) patients had operations cancelled on admission day. Twenty-eight (5%) patients did not attend admission, and 11 (2%) patients needed inpatient admission.

Telephone enquiries were conducted to find out the well being of patients (except endoscopy patients) on post-operative day 1. One hundred and thirty-eight enquiries were made, 127 or 92% (105 general anaesthetic and 22 local anaesthetic ) responded. No patient experienced severe pain and 90.6% of patients experienced mild or no pain. For general anaesthetic patients, 9.5% had experienced sickness, 88.6% felt well while travelling home, 95.2% felt well and 92.4% could do things normally at home at enquiry. There was no readmission for operation related complications. Questionnaires were later revised, 39/43 (90.7%) of patients would recommend day surgery to a friend.

Developing day surgery appears appropriate in our hospital in view of high patients’ preferences, the proximity of our patients and our convenient location. Our initial data revealed low morbidity. However, to maintain quality day surgery service, continual audit is important.

The Risk of Deep Venous Thrombosis in Hong Kong Chinese Following Laparoscopic Cholecystectomy.
Y.L.M. Mak, K.M. Cheung, M.F. Kung
Hong Kong Buddhist Hospital, Hong Kong

Haemodynamic studies have shown pneumoperitoneum creates a significant resistance to lower limb venous return. Postoperative thromboembolic complications following laparoscopic cholecystectomy (LC) have been reported in Western Societies. The deep venous thrombosis (DVT) occurred mainly early on postoperatively. DVT prophylaxis for LC were advocated. The incidence of DVT is low among Chinese, this study aimed to find the risk of DVT in Hong Kong Chinese following LC.

Patients undergoing LC were enrolled in the study. Preoperative risk factors were documented. Patients underwent venous duplex scanning of both legs at postoperative day 1-4 and day 7-11. No patient received DVT prophylaxis pre, intra, or postoperatively.

Forty-one patients mean age 55.1 year (24-75) were enrolled. Forty patients completed the study with one patient defaulted the second scan. One patient was obese. 1 patient was wheelchair bound and 1 patient had severe degree of varicose veins in both legs. Four patients required conversion to open cholecystectomy. The mean duration of pneumoperitoneum was 73.9 minutes (35-200). All 41 patients had negative finding of DVT on venous duplex scanning.

In an Australian study, as many as 11/19 LC patients had evidence of DVT on venous duplex scanning. None of our 40 patients had evidence of DVT on postoperative scanning. It appears pneumoperitoneum does not significantly increase the risk of DVT. And DVT prophylaxis for laparoscopic cholecystectomy seen not necessary in Hong Kong Chinese.