Browsing by Author "Chandrasinghe, P.C."

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Adapting surgical services at a tertiary care unit amidst the COVID19 pandemic: a Sri Lankan perspective
(College of Surgeons of Sri Lanka, 2020) Chandrasinghe, P.C.; Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, B.; Weerasuriya, A.; Munasinghe, N.M.; Thilakarathne, S.T.; Pinto, D.; Fernando, R.F.
No Abstract available.
Basics in molecular evolution of colorectal cancer and their implications for the surgeon: is it a 'big-bang' or a 'survival of the toughest'?
(College of Surgeons of Sri Lanka, 2018) Chandrasinghe, P.C.
Multi disciplinary management of cancer has enabled a comprehensive involvement of clinicians in disease management. For the surgeon involved in colorectal cancer (CRC) management it is pertinent to possess a basic knowledge in tumour biology for effective participation. Several models exist to explain the intra tumour heterogeneity (ITH) seen in cancers; clonal expansion, big-bang theory and the cancer stem cell theory. All of these aim to describe the extreme variability seen within cell populations in solid tumours and their implications on clinical management. This review aims to provide the practising surgeon a basic knowledge of colorectal tumour biology and their implications in clinical phenomena.
Basics in molecular evolution of colorectal cancer and their implications for the surgeon: is it a 'big-bang' or a 'survival of the toughest'?
(College of Surgeons of Sri Lanka, 2018) Chandrasinghe, P.C.
Multi disciplinary management of cancer has enabled a comprehensive involvement of clinicians in disease management. For the surgeon involved in colorectal cancer (CRC) management it is pertinent to possess a basic knowledge in tumour biology for effective participation. Several models exist to explain the intra tumour heterogeneity (ITH) seen in cancers; clonal expansion, big-bang theory and the cancer stem cell theory. All of these aim to describe the extreme variability seen within cell populations in solid tumours and their implications on clinical management. This review aims to provide the practising surgeon a basic knowledge of colorectal tumour biology and their implications in clinical phenomena.
Botulinum toxin injection to the puborectalis in the management of pelvic floor dyssynergia
(College of Surgeons of Sri Lanka, 2015) Pradeep, H.D.S.; Chandrasinghe, P.C.; Siriwardana, S.A.S.R.; Kumarage, S.K.
No abstract available
Clopidogrel and surgical intervention: A point to ponder
(College of Surgeons of Sri Lanka, 2011) Chandrasinghe, P.C.; Liyanage, C.A.H.
No Abstract Available
Colorectal cancer burden and trends in a South Asian cohort: experience from a regional tertiary care center in Sri Lanka
(Biomed Central, 2017) Chandrasinghe, P.C.; Ediriweera, D.S.; Hewavisenthi, J.; Kumarage, S.K.; Fernando, F.R.; Deen, K.I.
OBJECTIVE: Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. RESULTS: Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000-61, 2000 to 2004-178, 2005 to 2009-190, 2010 to 2014-250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided preponderance, younger age at presentation and advanced stage at presentation was observed. CRC disease pattern in the South Asian population may vary from that observed in the western population which has implications on disease surveillance and treatment.
Colorectal cancer in the young, many questions, few answers
(Baishideng Publishing Group, 2016) Deen, K.I.; Silva, H.; Deen, R.; Chandrasinghe, P.C.
At a time where the incidence of colorectal cancer, a disease predominantly of developed nations, is showing a decline in those 50 years of age and older, data from the West is showing a rising incidence of this cancer in young individuals. Central to this has been the 75% increase in rectal cancer incidence in the last four decades. Furthermore, predictive data based on mathematical modelling indicates a 124 percent rise in the incidence of rectal cancer by the year 2030 - a statistic that calls for collective global thought and action. While predominance of colorectal cancer (CRC) is likely to be in that part of the large bowel distal to the splenic flexure, which makes flexible sigmoidoscopic examination an ideal screening tool, the cost and benefit of mass screening in young people remain unknown. In countries where the incidence of young CRC is as high as 35% to 50%, the available data do not seem to indicate that the disease in young people is one of high red meat consuming nations only. Improvement in our understanding of genetic pathways in the aetiology of CRC, chiefly of the MSI, CIN and CIMP pathway, supports the notion that up to 30% of CRC is genetic, and may reflect a familial trait or environmentally induced changes. However, a number of other germline and somatic mutations, some of which remain unidentified, may play a role in the genesis of this cancer and stand in the way of a clear understanding of CRC in the young. Clinically, a proportion of young persons with CRC die early after curative surgery, presumably from aggressive tumour biology, compared with the majority in whom survival after operation will remain unchanged for five years or greater. The challenge in the future will be to determine, by genetic fingerprinting or otherwise, those at risk of developing CRC and the determinants of survival in those who develop CRC. Ultimately, prevention and early detection, just like for those over 50 years with CRC, will determine the outcome of CRC in young persons. At present, aside from those with an established familial tendency, there is no consensus on screening young persons who may be at risk. However, increasing awareness of this cancer in the young and the established benefit of prevention in older persons, must be a message that should be communicated with medical students, primary health care personnel and first contact doctors. The latter constitutes a formidable challenge.
Columnar cell variant of papillary thyroid carcinoma - a rare and clinically aggressive variant
(College of Surgeons of Sri Lanka, 2015) Pradeep, I.H.D.S.; Chandrasinghe, P.C.; Kannangara, K.R.; Epitakaduwa, E.K.G.D.C.; Fernando, R.F.
No abstract available
Congenital hypertrophy of retinal pigment epithelium (CHRPE) in patients with familial adenomatous polyposis (FAP); a polyposis registry experience
(BioMed Central, 2014) Nusliha, A.; Dalpatadu, U.; Amarasinghe, B.; Chandrasinghe, P.C.; Deen, K.I.
BACKGROUND: Familial Adenomatous Polyposis (FAP) is an autosomal dominant condition giving rise to multiple adenomatous polyps in the colon which invariably become malignant by the fourth decade. Congenital hypertrophy of retinal pigment epithelium (CHRPE) is one of its extra intestinal manifestations early in childhood seen, present in 90% of FAP population and is easy to detect. FINDINGS: Patients diagnosed with FAP and at risk first degree family members were screened for CHRPE using a slit lamp and indirect ophthalmoscopy. The retina of 17 diagnosed FAP patients and 13 individuals at risk were examined. The site and size of CHRPE lesions were documented. Thirteen (76%) of 17 FAP patients (male-10, female - 7, median age - 30 years; range 15-55 years) had CHRPE lesions; seven (54%) had bilateral CHRPE lesions and six (46%) had unilateral lesions. A single lesion was detected in 6 (46%) while 7 (54%) patients had multiple lesions. Of 13 at risk individuals (7- male, female-6 ; median age 34; range 16-52 years), one was positive for CHRPE and 12 were free of retinal lesions. The sensitivity of the presence of a CHRPE lesion in association with colonic polyps in FAP was 76%, specificity 92%, positive predictive value 93%, and negative predictive value 75%. CONCLUSIONS: This study found a high sensitivity and specificity for a CHRPE lesion to be associated with colonic polyps of FAP and hence a useful screening method in a burdened health-care system. The method is minimally invasive and simple and would be of particular value in screening children at risk for FAP
Current concepts in management of chronic wounds
(College of Surgeons of Sri Lanka, 2010) Chandrasinghe, P.C.; Ariyaratne, M.H.J.
No Abstract Available
Detection of incidental thyroid carcinoma is significantly higher in goiters with background thyroiditis
(College of Surgeons of Sri Lanka, 2015) Pradeep, I.H.D.S.; Chandrasinghe, P.C.; Wijewardana, B.D.A.N.; Dissanayaka, D.M.C.D.; Fernando, F.R.; Buddika, U.A.; Kannangara., K.R.
INTRODUCTION: Incidence of 'incidental thyroid carcinoma' (ITC) is reported to be 3 % to 16% in operatively treated benign thyroid diseases. This study analyses the results of a single surgeon performing total thyroidectomy for benign diseases and is the continuation of the study preliminary published in 2009. MATERIAL AND METHODS: All patients, who underwent total thyroidectomy for benign diseases at the unit from January 2003 to October 2014 were included. All patients had preoperative ultrasonography and fine needle aspiration cytology (FNAC). Diagnosis of ITC was based on post op histopathological reporting. Test of proportions with a P value of 0.05 was considered significant. RESULTS: Total thyroidectomy specimens of 449 (Median age- 37 years; range: 25 - 65 years, female – 74.07 %) patients were analyzed. ITC was detected in 6.01% (n=27) of patients. Papillary carcinoma was the commonest (62.96%) subtype. There were 8 (29.62%) follicular and 2 (7.4 %) medullary cancers. Males had a significantly higher proportion of ITC (Male: ITC/benign = 15% Vs Female: ITC/ benign = 5%; P= 0.02). Specimens with ITC reported a significantly higher rate of background thyroiditis (ITC = 33% Vs benign = 15 %; P= 0.02). ITC was not significantly associated with a family history (P= 0.7887). Postoperative transient hoarseness was observed in 3.56%and hypocalcaemia in 10.69%. CONCLUSIONS: A significant proportion of 'benign' goiters may harbor ITC, especially with background thyroiditis. With emerging evidence to support total thyroidectomy with low morbidity it may be prudent to offer total thyroidectomy for benign goiters with background thyroiditis.
Epidemiology of goitres in Sri Lanka with Geographic Information System Mapping: a population based cross sectional study
(Jaypee Publishers, 2015) Fernando, R.; Chandrasinghe, P.C.; Nandasena, S.; Pathmeswaran, A.
BACKGROUND: Sri Lanka is considered an endemic region for goiter. Early researchers have suggested the existence of a goiter belt based on rainfall pattern. Subsequent studies done in school children have challenged this theory. Current study is a community-based cross-sectional study done to assess the epidemiology of goiters. Geographic information system (GIS) mapping of the goiter prevalence is developed for the first time in Sri Lanka. METHODS: Study subjects were selected using a multi-staged cluster sampling with probability proportionate to size (PPS) method. Examination for the presence of goiters was done by two trained investigators and graded. ArcGIS 10 software was used for geostatistical analysis and developing a map by interpolating the data collected for the first time in Sri Lanka. RESULTS: A total of 5200 individuals (female-66%, median age-38 years; range 10-92 years) were assessed and 426 goiters were detected. The adjusted prevalence rate of goiters was 6.8%. Kriging interpolation method was used to develop the most appropriate epidemiological map clustering of high prevalence areas with scattered pockets of high prevalence was observed. Current map does not show a prevalence pattern in relation to the rainfall or elevation above sea level as proposed in the past. CONCLUSION: Goiter prevalence in Sri Lanka appears to be different from earlier proposed patterns. Use of GIS has contributed to develop a comprehensive epidemiological map of goiters demonstrating the absence of an endemic goiter belt in the wet zone as proposed earlier.
Fish bone migration through a sigmoid colon diverticulum causing an anterior abdominal wall abscess
(The College of Surgeons of Sri Lanka, 2024) Ekanayaka, E.M.M.; Gunasekara, K.; Fernando, R.; Chandrasinghe, P.C.; Kumarage, S.
No abstract available
Hypocalcemia and hoarseness following total thyroidectomy for benign disease: Relationship of incidence to the size of the gland
(Jaypee Brothers Medical Publishers (P) Ltd, 2011) Fernando, R.; Chandrasinghe, P.C.; Bandara, M.; Renuka, M.B.S.; Athulugama, N.S.
INTRODUCTION: Total thyroidectomy is considered as the standard surgical procedure for most malignancies and benign disease involving both lobes of the thyroid gland. Postoperative complications are likely to be commoner when the thyroid gland is large in size due to the alteration of structural anatomy. METHODS: Postoperative complications of 102 patients who underwent total thyroidectomy for benign disease, by the same surgeon, were analyzed. Patients were prospectively followed up and presence of hoarseness and hypocalcemia, both transient and temporary, were compared with the weight of the gland. RESULTS: Fourteen patients developed hypocalcemia of which 12 (11.7%) had transient and 2 (1.96%) had permanent deficiencies. Eight patients developed hoarseness following surgery of which seven (6.86%) had transient and only one (0.98%) had permanent hoarseness. A mean thyroid weight of 91.78 gm was observed in the uncomplicated group. Those who developed postoperative hypocalcemia and transient hoarseness had a mean thyroid weight over 100 gm. One patient, who had a thyroid weighing 195 gm developed permanent hoarseness due to RLN injury. CONCLUSION: There is no statistically significant difference in the incidence of transient RLN and transient or permanent hypocalcemia. With increased size of the thyroid gland increased rate of complications was observed with a mean thyroid weight above 100 gm. There may be a significant risk of permanent RLN injury when the thyroid gland is enlarged over 10 times (closer to 200 gm) its normal size. © Jaypee Brothers Medical Publishers (P) Ltd. AUTHOR KEYWORDS: Complications; Size of the gland; Thyroidectomy. INDEX KEYWORDS: adult; aged; article; controlled study; female; goiter; hoarseness; human; hypocalcemia; incidence; major clinical study; male; nerve injury; postoperative complication; recurrent laryngeal nerve injury; risk assessment; thyroid weight; thyroidectomy
Impactful research over impact factor
(The College of Surgeons of Sri Lanka, 2024) Chandrasinghe, P.C.
No abstract available
Incidental thyroid carcinoma in benign thyroid disease: A Cohort study
(World Journal of Endocrine Surgery., 2018) Pinto, D.; Munasinghe, N.; Chandrasinghe, P.C.; Fernando, R.
ABSTRACT: AIM: An incidental thyroid carcinoma (ITC) is a thyroid malignancy that is not clinically or cytologically detected preoperatively. The incidence of ITC is between 10% to 20% in the literature. A study was undertaken to assess the incidence of ITC in patients undergoing total thyroidectomy for benign disease of the thyroid to University Surgical Unit, North Colombo Teaching Hospital (NCTH), Sri Lanka. MATERIALS AND METHODS: Prospective cohort study was undertaken from November, 2002 to October, 2015. Patients with palpable thyroid nodules were assessed with fine needle aspiration cytology (FNAC) and ultrasound scan (USS) to ascertain benign thyroid disease (BTD). Hormone assays were conducted to detect thyroid status. All patients with BTD who underwent total thyroidectomy were included in the study. Histopathological assessments were made by a panel of pathologists. Patients with autoimmune thyroiditis (AIT) were excluded due to the known association with malignancy of the thyroid. Post-thyroidectomy histopathological diagnoses were collected prospectively and patients with ITC were identified. Statistical analysis was done using statistical package for the social sciences (SPSS) software, version 20. RESULTS: Hundred and sixty seven patients (n = 167) who fulfilled the inclusion criteria were analysed (Male–20, female–147, median age = 40.25 year, range 28 year–62 year). ITC was found in 19 patients with an incidence of 11.38%. No significant association was noted with morphology, biochemical status of the thyroid or gender. CONCLUSION: Incidence of ITC is 11.38% in this cohort. Incidence of ITC being approximately 1:10 emphasizes the need to consider total thyroidectomy in the management of BTD.
Intraoperative visualization of biliary anatomy using Indocyanine green (ICG) fluorescence in a Sri Lankan patient cohort
(The College of Surgeons of Sri Lanka, 2024) Kumarage, S.K.; Lakshani, D.H.J.P.U.; Pinto, M.D.P.; Chandrasinghe, P.C.
INTRODUCTION: Bile duct injury (BDI) is a complication with high morbidity, associated with laparoscopic cholecystectomy (LC). The risk of BDI can be reduced by accurate visualization of the biliary tree with the use of indocyanine green fluorescence (ICG). This study describes the use of this non-invasive technique in a cohort of Sri Lankan patients to visualize the biliary anatomy intraoperatively. METHOD: A total of 121 consecutive patients undergoing LC were included. All received 5 mg of ICG intravenously, 30 minutes prior to induction of anesthesia. The Stryker 1588 laparoscope was used to visualize the anatomical landmarks, both pre and post-dissection of the Calot's triangle, using visible light and near-infrared imaging (NIR). RESULT: In 121 patients (female - 64.5%, median age - 42 years; range of 18-82) included in the study, biliary colic was the commonest indication (70%) for LC. ICG fluorescence resulted in significantly better visualization of the extrahepatic biliary tract (p=<0.001), both pre-dissection (95%CI = 91.7% [85.3%-96.0%]) and post-dissection (95% CI=71.1% [62.1%-79.0%]) of the Calot's triangle. Furthermore, the hepatic ducts were only visualized with ICG. Visualization of the Cystic duct common bile duct junction (CDCBDJ) improved from 6% to 88% (P<0.001) predissection with ICG. Fluorescence enabled the visualization of CDCBDJ post-dissection in all cases compared to 54% without it (P<0.001). ICG enhanced visualization of the Common bile duct (CBD) from 34% to 88% (P<0.001) predissection and 100% visibility post-dissection compared to 62% under visible light (P<0.001). No adverse effects of ICG or bile duct injuries were reported during the study. CONCLUSION: The use of ICG during LC significantly enhanced the identification of biliary landmarks in this cohort. Identification of anatomy can help reduce inadvertent BDI. This safe and effective modality may be considered a routine step in LC.
Laparoscopically detected and nonsurgically managed ileal perforation by an ingested fish bone: a case report.
(BioMed Central, 2015) Chandrasinghe, P.C.; Pathirana, C.K.
INTRODUCTION: Ileal perforation due to fish bone is a rare event. The condition is difficult to diagnose due to lack of specific clinical features and low sensitivity of imaging techniques. We report a case of ileal perforation by a fish bone that was detected laparoscopically and managed nonsurgically. CASE PRESENTATION: A 45-year-old Sinhalese man presented with acute onset right iliac fossa pain and fever for three days. On examination, he had significant right iliac fossa tenderness and guarding. His white cell count and C-reactive protein level were elevated and an ultrasound scan was indicative of a bowel mass formation. A clinical diagnosis of acute appendicitis was made and laparoscopic appendicectomy was scheduled. At initial survey, a thin spike-like structure was retrieved from the bowel mass, which was revealed to be a fish bone. Our patient was managed with antibiotics only and did not develop any complications. CONCLUSIONS: Ileal perforation due to fish bone is a rare condition that can mimic common conditions like appendicitis. Preoperative diagnosis is rarely made. The slow process of fish bone migration results in concomitant sealing of the perforation, reducing contamination. Use of laparoscopy may be useful in diagnosing this condition and preventing the morbidity of laparotomy in these patients.
Lateral approach to thyroid
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Dissanayake, D.M.C.D.; Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Amaraweera, P.C.; Munasinghe, B.N.L.; Chandrasinghe, P.C.; Fernando, R.
BACKGROUND: Thyroidectomy is the commonest endocrine surgical procedure, undertaken throughout the world. Re-do thyroidectomies are challenging procedures with a higher morbidity rate. Lateral approach to thyroid (LATT) is a good alternative to the standard midline exploration. The key to the technique is the development of the natural tissue plane between the strap muscle and the ipsilateral sternocledomastoid muscle to explore the thyroid bed. OBJECTIVE: This study was done to assess the efficacy, safety and complications of LATT. METHODS: Data on patients undergoing LATT in Professorial Surgical Unit, Colombo North Teaching Hospital, Ragama from 2008 to 2015 was collected prospectively and analyzed. All procedures were done by a single surgeon. RESULTS: A total 36 LATTs were done. Data from 32 people were collected as 4 patients were lost to follow up. 29 (90.6%) were females and 3 (9.4%) were males. Age ranged between 28 and 61 (Median 43.37) years. Three (9.4%) LATTs were for parathyroid explorations and out of which one (3.1%) was for redo parathyroid explorations. Nine (28.1%) were redo thyroidectomies and 18 (56.2%) were mini incision thyroidectomies with lateral approach. Hemi thyroidectomies were performed for 28 (87.5%). Bilateral explorations done for 3(9.4%) patients and 4(12.5%) lateral approaches done for completion thyroidectomies were for follicular malignant lesions. Transient clinical hypocalcaemia was noticed in 4 (12.5%) patients and 1 (3.1%) developed hoarseness of voice which was temporary. None of them had complications such as haematoma or post-surgery stridor. CONCLUSIONS: LATT is a safe alternative to the standard approach, for re-explorative thyroid surgery.
Lymphangioma of the spleen in an asymptomatic patient
(College of Surgeons of Sri Lanka, 2011) Chandrasinghe, P.C.; Abeyrathne, I.G.K.P.; Fernando, R.F.
No Abstract Available