Browsing by Author "Ekanayake, C.S."

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Internal biliary diversion to avoid liver transplantation in an adult with intractable pruritus due to idiopathic intrahepatic cholestasis
(Springer Nature, 2020) Siriwardana, R.C.; Jayatunge, D.S.P.; Ekanayake, C.S.; Tilakaratne, S.; Niriella, M.A.; Gunetilleke, B.; Dassanayake, A.S.
BACKGROUND: Cholestasis is due to the obstruction at any level of the excretory pathway of bile. One particularly troublesome symptom of cholestasis is pruritus which leads to a profound effect on a patient’s quality of life. In children with progressive familial intrahepatic cholestasis (PFIC), medical treatment often fails. An alternative surgical procedure using biliary diversion offers significant relief for intractable pruritus in non-responders. CASE PRESENTATION: A 43-year-old male presented with a history of persistent jaundice and intractable pruritus for a 2-month duration. His liver enzymes were markedly elevated. However, his liver synthetic function was preserved. After extensive evaluation, a cause for cholestasis was not identified. A multi-disciplinary decision was to consider liver transplantation, but as his liver synthetic functions were remarkably preserved and the intractable pruritus was the sole indication for a transplantation, it was finally decided that internal biliary diversion should be done for symptomatic relief. His pruritus dramatically improved at 6 weeks post-operative. His liver enzymes and bilirubin levels also decreased compared to his pre-operative status. Currently, his liver functions are being closely monitored. CONCLUSION: Though it is not used in adults, the experience of biliary diversion in children with PFIC shows that there is a considerable improvement of symptoms and postpone the need for a transplant. In our patient, liver function and bilirubin as expected did not show a major improvement. But the dramatic improvement of the symptoms gave us the time to postpone the liver transplantation. A biliary diversion is a reasonable option that needs to be considered even in adults with refectory pruritus due to cholestasis.
Long- term glycemic control after pancreatectomy- prospective study
(College of Surgeons of Sri Lanka, 2015) Ekanayake, C.S.; Bandara, L.M.P.M.; Liyanage, C.A.H.; Siriwardena, R.C.
INTRODUCTION: Pancreatic resection leads to loss of functional pancreatic tissue. The study evaluates the glycemic control and factors affecting the glycemic control in long-term survivors after pancreatic resection. MATERIAL AND METHODS: Patients who survived for three months or more after pancreatectomy were selected. Baseline parameters were collected with an interviewer administered questionnaire. All patients had a fasting blood sugar (FBS) and HbA1C. Previous non diabetics had oral glucose tolerance test (OGTT) at one and two hours. There were 49 Whipple procedures and 6 distal pancreatectomies. 20 Whipple procedure patients and 5 distal pancreatectomy patients consented. Sixteen (64%) participants were females. Median age was 47 (15-70) years. Eleven (44%) were previously known diabetic patients. The median Body Mass Index (BMI) was 18.28 kg/m3 (11.36-30.07). The median time since surgery was 16 (3-37) months. There was one (4%) newly diagnosed diabetic patient. Out of non-diabetics, one had more than 200 mg/dl OGTT at 2 hours. Nine diabetics had HbA1c elevation more than 7%. Mean post-surgical FBS in diabetic patients (136.9 mg/dl) were significantly (p<0.05) higher than pre-surgical FBS (109.4 mg/dl). BMI (p=0.006), waist to hip ratio (p=0.039) and percentage of pancreas removed (p=0.002) showed a significant correlation to worsening of post-surgical sugar control. CONCLUSIONS: Pancreatectomy leads to worsening of blood sugar control in known diabetics. New onset diabetes is rare. Close follow-up and strict control is needed in known diabetics with high BMI and high waist to hip ratio.
Post hepatectomy adjuvant trans-arterial chemotherapy- A pilot study
(College of Surgeons of Sri Lanka, 2015) Ekanayake, C.S.; Bandara, L.M.P.M.; Liyanage, C.A.H.; Niriella, M.A.; Dassanayake, A.S.; Siriwardena, R.C.
INTRODUCTION: Hepatic micro metastases lead to early recurrence after surgery for hepatocellular carcinoma (HCC). Trans arterial therapy (TAT) without selective embolization may be an effective treatment that induces tumour necrosis. This potential has not been investigated before. This study looks in to the tolerability of TAT in patients after major hepatectomy. MATERIAL AND METHODS: Consented patients were offered trans arterial chemotherapy after normalization of liver functions following surgery. Through the femoral artery, right and left hepatic arteries were selectively cannulated. Doxorubicin 50mg was mixed with 10ml of Lipidol and injected. Post procedure biochemistry and complications were assessed at day 3, 7 and 14 intervals. RESULTS: 11 Patients consented (81% males, median age 61y [range 47y-76y]. There were 7(63.6%) cirrhotics. Four (36.3%) were extended right or left hepatectomies while others were bisegmentectomies. The median time period from surgery to chemotherapy was 25 weeks (range 4-60weeks). Post procedure, 1 (9%) had right hypochondrial pain, 2 (18.1%) had fever, 4(36.3%) had nausea, 2(18.1%) had vomiting within 48 hours. All were discharged at 48 hours. One patient developed a transient bradycardia during procedure. There was no clinical evidence of liver failure. Two patients had three-FOLD rise in transaminase levels at day3 and 7. All recovered by day 14. None of the patients had significant rise in prothrombin time or bilirubin levels. CONCLUSIONS: Post hepatectomy adjuvant trans –arterial chemotherapy is a well-tolerated procedure in the view of short term complications.
Short and medium term glycaemic control after pancreaticoduodenectomy
(College of Surgeons of Sri Lanka, 2016) Siriwardana, R.C.; Bandara, L.M.P.M.; Atulugama, N.; Gunetilleke, M.B.; Ekanayake, C.S.
Introduction: Perioperative outcomes of pancreaticoduodenectomy (PD) have improved over the years. Glycaemic control in longterm survivors is a matter of concern. Materials and methods: 48 surviving patients of 66 patients who underwent Whipple surgery from 2011 to 2015 were evaluated. Patients with recurrences, who had chemotherapy within three months and patients who had not completed a minimum six months follow-up were excluded. 25 patients were selected. Patients' demographic data, HbA1c level, fasting blood sugar level, physical activity index and waist to hip ratio were calculated. Volume of the pancreatic specimen was calculated. Non diabetics underwent oral glucose tolerance test (OGTT). Results: There were 6 (24%) pre-existing diabetics, 3 new onset diabetics and two patients with impaired glucose tolerance (20%). Median preoperative BMI, body fat distribution, calculated median pancreatic volumes resected or underlying pancreatic pathology did not differ in diabetic and non-diabetic groups. In non-diabetics, HbA1c level or two hour OGTT did not associate with age, preoperative BMI, waist to hip ratio and resected pancreatic volumes. Conclusion: Significant proportion of patients develop diabetes immediately after PD. Reliable prediction of this group pre-operatively is difficult due to many interacting, confounding factors. They need close monitoring in immediate perioperative period.
Use of a rectus abdominis muscle cube to seal presacral venous haemorrhage
(College of Surgeons of Sri Lanka, 2014) Tillakaratne, M.S.B.; Ekanayake, C.S.; Wijenayake, W.; Deen, K.I.