Browsing by Author "Gunetilleke, M.B."

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A Case of persistent portal hypertension following ligation of a large porto - systemic shunt during cadaveric donor liver transplantation
(Sri Lanka Medical Association., 2020) Siriwardana, R.C.; Shanthanayagam, N.; Gunetilleke, M.B.; Weerasuriya, A.P.; Niriella, M.A.; Dassanayake, A.S.; Dissanayake, R.
No abstract available
Characteristics and survival of advanced untreated hepatocellular carcinoma of non-viral etiology
(Indian Society of Gastroenterology, 2024) Ekanayaka, S.P.N.; Luke, N.; Thilakarathne, S.B.; Dassanayake, A.; Gunetilleke, M.B.; Niriella, M.A.; Siriwardana, R.C.
INTRODUCTION AND OBJECTIVES Hepatocellular carcinoma (HCC) is an aggressive tumor and presents late. The underlying etiology of HCC is changing rapidly. HCC in Sri Lanka is unique due to its predominant non-viral etiology (nvHCC) but lacks survival data.METHOD Data was collected from patients who presented with HCC from 2011 to 2018. There were 560/568 (98.6%) nvHCC. The patients who were not candidates for tumor-specific treatment (149/560 [26.7%]) were selected. Population characteristics, demographic data, tumor characteristics, survival and factors affecting survival were analyzed.RESULTS The median age was 64 years (range 30-88) and 86% (n = 129) were males. As many as 124 (83%) were cirrhotic. The overall performance score was 80%. Nearly 21/124 tumors were detected in cirrhotic screening. Tumors were single nodular in 32 (21%), up to three nodules in 28 (18%), more than three nodules in 33 (22%) and diffusely infiltrating in 56 (37%). The major venous invasions were present in 78 (52.3%). Extra-hepatic tumor spread was seen in 19 (12.7%) (lungs 13 [72.2%], bones 2 [11.1%]). The median survival of patients receiving palliative care was three months (1-43 months). Tumor size and cirrhotic status were significant predictors in univariate analysis.CONCLUSION A quarter of nvHCCs were not amenable to treatment at presentation as they had dismal survival.
Clinical characteristics and outcomes of hepatocellular carcinoma: results from prospective study, from a tertiary referral center in Sri Lanka
(Sri Lanka Medical Association, 2018) Bulathsinhala, B.K.S.; Siriwardana, R.C.; Gunetilleke, M.B.; Niriella, M.A.; Dassanayake, A.S.
INTRODUCTION:Hepatocellular carcinoma is increasing globally. Compared to global patterns, hepatitis B and C are rare in Sri Lanka whilst non-alcoholic fatty liver disease (NAFLD) and alcohol are the commonest causes of hepatocellular carcinoma.OBJECTIVE:To determine the characteristics of a cohort of Sri Lankan patients with hepatocellular carcinoma of non-viral aetiology.METHODS:Details of 550 consecutive patients with hepatocellular carcinoma referred from 2012 to 2017 were collected prospectively. Demographic data, clinical and biochemical details, aetiology, comorbidities, tumor characteristics and type of treatment offered were retrospectively analyzed.RESULTS:Median age was 62.9 years (range 12 - 88) with male preponderance (n = 473; 86%). Overall median BMI was 35.8 kgm-2. Majority (n=309; 56 %) had NAFLD induced cirrhosis, second commonest cause was alcohol (n=203;36.9 %). Tumour was single nodular 233(42.4%) and diffusely infiltrating 92(16.7%). Diagnostic rise in serum alpha-fetoprotein (over 200 micrograms) was seen in 30.2%. Venous invasion was present in 28.5% [portal vein 136 (24.7%), hepatic vein 9 (1.6%) and cava 12(2.2%)]. Extra hepatic tumor spread was seen in 6.9% [lungs 20(3.6%), bones 4(0.7%), peritoneal 6 (1.1%) and metastases at other sites 8 (1.45%)]. Curative surgery was offered in 78(14.2%). Tumour embolization was done in 192(34.9%), radio frequency ablation 34(6.2%), alcohol injection 42(7.6%) and 204(37.1%) patients were offered palliative care. Overall median survival was 20.6 months.CONCLUSION:In a large Sri Lankan cohort, most hepatocellular carcinomas were due to cryptogenic cirrhosis and it was aggressive at presentation. Screening of high-risk NAFLD patients needs to be considered and further palliative care needs to be improved.
Diffuse and nodular type hepatocellular carcinoma - a comparative study
(Sri lanka Medical Association, 2015) Wickramarathne, S.D.J.; Jayarathne, V.S.; Siriwardana, R.C.; Liyanage, C.A.H.; Niriella, M.A.; Dassanayake, A.S.; Gunetilleke, M.B.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Incidence of hepatocellular carcinoma (HCC) is increasing. Diffuse HCC (dHCC) is rare and data on such tumours are limited. METHOD: Ail consenting patients with HCC referred to Colombo North Liver Unit, Ragama (September 2011-February 2014) were Included. Tumours with diffuse margins on imaging were categorized as dHCC, while tumours with clear nodular morphology were categorized as nodular HCC (nHCC). Baseline parameters, treatment options and survival were compared between the two types. RESULTS: 203 HCCs were included in the study [dHCC=41(20%):87.8% males; nHCC=162(80%) 89.5% males]. The median age at presentation in the two groups was similar [dHCC 63.58(47-76) years, nHCC 62.13(12-88) years]. More patients with dHCC had a significant alcohol intake (68.9% vs. 41.7%, p=0.002). Background cirrhosis was present in 90.2% of dHCC compared to 79.1% in nHCC (p<0.05). Aspartate transaminase, Alanine transaminase, INR, total bilirubin, platelet count and MELD scores were similar in the two groups. Median alfa fetoprotein (AFP) was significantly higher in dHCC (136 vs 31ng/mL, p<0.001). Similar typical enhancement pattern on dynamic imaging was noted in the two groups (80.5% dHCC, 84.4% nHCC). dHCC had high incidence of major vascular invasion(78% vs 23.5%, p<0.001). Seventy six point nine percent of dHCC had only palliative care compared to 28.4% in nHCC was two months compared to 8 months in nHCC. CONCLUSION: 1/5 of HCCs were of the diffuse type. Patients dHCC had a significant alcohol intake. They had higher AFP, advanced disease at presentation with more vascular invasion and a worse prognosis than nHCC.
Diffuse and nodular type hepatoma: a prospective, comparative study
(Sri Lanka Medical Association, 2014) Wickramarathne, S.D.J.; Jayarathne, V.S.; Siriwardana, R.C.; Niriella, M.A.; Liyanage, C.A.H.; Dassanayake, A.S.; Gunetilleke, M.B.; de Silva, H.J.
INTRODUCTIONS: Incidence of hepatocellular carcinoma (HCC) is increasing. Diffuse type HCC is rare and data on such tumors are limited. METHODS: All patients referred to North Colombo Liver Unit with HCC from September 2011 to February 2014 were included. Data were collected prespectively from 206 patients. Tumors with diffuse margin in imaging were categorized as diffuse HCC (n-41, 21%). Baseline parameters, treatment options and survival were compared with nodulartype'HCC. RESULTS: 87.8% of patients in the diffuse HCC group were males compared to 89.54 % in nodular HCC group. The median age in the two groups were similar (nodular 62.13 years (range 12-88), diffuse 63.58 years (range 47-76)). Heavy alcohol use was commoner in the diffuse HCC group (68.9% vs. 41.7 %, p=0.002). 90.2% with diffuse HCC had cirrhosis compared to 79.1% with nodular HCC (p<0.05). Aspartate transaminase (AST), alanine transarninase (ALT), INR, total bilirubin, platelet count, MELD score were similar in two groups. Alfa Feto Protein (AFP) value was significantly higher in diffuse HCC group (p<0.001). 80.5% patients with diffuse type HCC had typical enhancement pattern compared to 84.4% with nodular type. Diffuse HCC group had higher incidence of major vascular invasion (78% vs. 23.5%, p<0.001). 76.9% of diffuse HCC group had only palliative care compared to 28.4% in nodular type (p<0.001). Median survival in diffuse group was 2.0 months compared to 8.0 months in nodular type. CONCLUSIONS: 21% of HCC are diffuse type. Alcohol intake was commoner in this group. Diffuse HCC had poorer prognosis with high AFP level and vascular invasion. Majority had advanced disease at presentation.
Factors affecting the clinical outcome of transarteriai chemo treatment for hepatocellular carcinoma in Sri Lankan patients
(Sri lanka Medical Association, 2015) Jayatunge, D.S.P.; Siriwardana, H.D.R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Gunetilleke, M.B.; Upasena, A.; Sirigampola, C.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC. METHOD: Of 290 patients with HCC (July 2011 -December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization fever (PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AK1). RESULTS: 84 patients [90.5% males, 89.2% cirrhotics, 89.2% nodular HCC, median age 63(34-84) years] underwent 111 TACE sessions. All were Child class A [69.4% sessions (n=77)] or B; ascites and portal vein invasion was present in 18 (16.2%) and 15 (13.6%), respectively. 42 (38.2%) TACE procedures resulted in complications [PEF 28 (25.2 %), NV 4 (3.6%), abdominal pain 9 (8.1%), infection 7 (6.3%), AHD 13 (11.7%), AKl 3 (2.7%)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p=0.046) and low serum albumin (p=0.035) predicted PEF while low serum albumin (p=0.021) and low platelet counts (p=0.041) predicted AHD. In the multivariate model, factors with p<0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p=0.029, OR=1.412), ascites (p=0.030, OR = 1.212), elevated serum bilirubin (p=0.007, OR= 4.357) and large tumour size (p=O.Q36, OR=3.603) were independent risk factors for PEF. Tumour diameter >5cm (p=0.049, OR=2.410) and elevated serum bilirubin (p=0.036, OR=1.517) predicted AHD. CONCLUSION: In NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE, Tumours>5cm with elevated bilirubin predicted AHD post-TACE.
First paediatric live donor liver transplant in Sri Lanka with 1 year outcome : challenges for the future
(The College of Surgeons of Sri Lanka, 2021) Siriwardana, R.; Thilakarathne, S.; Fernando, M.; Gunetilleke, M.B.; Weerasooriya, A.; Appuhamy, C.
INTRODUCTION: Liver transplantation in the paediatric age group is demanding due to smaller body proportions and physiology. This paper describes the first successful paediatric liver transplant in Sri Lanka along with its one-year outcome. Describing the challenges faced during the process, we highlight the factors that need to be considered for a sustainable programme in the future. METHODOLOGY: A 9-year-old girl who had progressive familial intra hepatic cholestasis type 3 was referred to us with features of end stage liver disease. She was identified as a suitable candidate for liver transplantation. Her 38-year-old mother was selected as the donor, who was evaluated for suitability of a left lateral segment donation. RESULTS: The first paediatric liver transplantation was performed in July 2020. The child's mother donated the left lateral segment weighing 325g. During the postoperative period the child developed outflow tract obstruction at the hepatic venous anastomosis. This was managed with a percutaneously placed stent. Six months after transplant, she developed an acute rejection that required steroids. Treatment of rejection was complicated with multiple liver abscesses caused byAspergillus. The infection was treated with systemic antifungals and drainage. At one-year post transplant, the recipient had recovered from the trauma of surgery and had normal liver biochemistry, a patent hepatic venous stented anastomosis and complete resolution of the abscesses. We faced dual challenges in dealing with a live liver transplant donor and a young child who was the recipient. Our success, on this occasion, was underscored by the multidisciplinary contribution from specialists scattered across the island combined with state-public partnership. CONCLUSION: To offer a sustainable live donor liver transplant service for the future, many other aspects, beyond surgery itself, need to be addressed.
Hepatocellular carcinoma in Sri Lanka - where do we stand?
(College of Surgeons of Sri Lanka, 2013) Siriwardana, R.C.; Liyanage, C.A.H.; Gunetilleke, M.B.
Hepato-cellular carcinoma (HCC) is the sixth commonest cancer and third in cancer-related mortality worldwide. There are no published reports on the pattern of HCC in Sri Lanka. North Colombo Liver Unit maintains a prospective database of 105 HCC patients from September 2011. HCC was diagnosed based on characteristic radiological appearance. Best form of treatment was decided by a multidisciplinary team (MDT). Median age at presentation 63 (12 - 79) years. 87% (n=93) males. 45% (n= 47) had alcohol consumption above safe limits .41% (n=53) had diabetes. Cirrhosis was present in 79% (n=83) .median Model for End Stage Liver Disease (MELD) score 12 (4-22); Childs- Pugh class A 45% (n=37), Childs- Pugh class B or C 55% (n=46)]. A biopsy was necessary in 7 (6.6%) while others were diagnosed on radiology .62.5% had AFP level above the reference range (> 10 ng/ml). 51(49%) had a single modality, 17 (16%) had combined treatment and the rest had no treatment. The overall mean survival was 15 months. Majority of HCCs in Sri Lanka were among males and is likely to be secondary to NASH related cirrhosis. Majority of the tumours were diagnosed at late stage.
Immediate outcome of microwave ablation for liver tumours in a single cohort of patients in Sri Lanka.
(The College of Surgeons of Sri Lanka, 2022) Appuhamy, C.; Ganewatte, E.; Ranaweera, L.; Dassanayake, A.S.; Gunetilleke, M.B.; Tillakaratne, S.; Gunawardena,H.P.; Niriella,M.A.; Siriwardana,R.C.
Introduction and Objectives Microwave ablation (MWA) is an emerging treatment modality for hepatocellular carcinoma (HCC) and other liver tumours. We aimed to assess the immediate success and complications of MWA in a cohort of patients. Method Patients were assessed retrospectively, using an intervieweradministered questionnaire and a follow-up CECT/MRI at, 6-week.Result 55 patients underwent MWA from October 2021-May 2022, at Colombo-North Teaching Hospital, Ragama, Sri Lanka, and selected private hospitals( Durdans Hospital, Colombo, Nawaloka Hospital, Colombo, Lanka Hospital, Colombo).The median age was 64 (40-82) years, with a male preponderance (n=45, 81.1%). The indication was HCC in 54 (98.1%) and metastatic tumour in one (1.8%). The median tumour size was 28 (10-80) mm. Segment VII was the commonest site to be involved (n=18, 34.6%). The majority (n=40, 72.7%) was a single lesion. No participant underwent the procedure twice. The mean post-procedural hospital stay was 12 hours (95%CI=11.4-12.5, SD=2.0).In the 6-week follow-up, 2 recurrences (3.6%) and single death (1.8%) with no relation to the procedure, were reported. Another 2 (3.6%) denied the follow-up. Complete ablation was reported in 46 patients (83.7%), comparable to the rates in literature (95-97%), with only 7 patients (12.7%) having residual tumours. No major complications were reported. 9 patients (16.4%) developed 'Post ablation syndrome', not as common as in literature (34%). They presented with abdominal pain (7.3%), vomiting (7.3%), and fever (3.6%).Conclusion MWA is a successful and safe treatment option for primary liver tumours in Sri Lanka, with ablation rates comparable to the western world.
Liver transplantation - initial experience at Colombo North Liver Transplantation Service
(Sri Lanka Medical Assosiation, 2012) Bogamuwa, M.M.M.P.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Wijesuriya, S.R.E.; Liyanage, C.A.H.; Gunetilleke, M.B.; de Silva, H.J.
INTRODUCTION: Liver transplantation (LT) is the treatment of choice for end stage liver diseases. LT is still in its infancy in Sri Lanka. AIMS: To describe the initial experience of the Colombo North Liver Transplantation Service (CNLTS) METHODS: The study population included all patients referred for LT to CNLTS. All cases were evaluated for the indication and medical, social and psychological suitability for LT. Decision to list patients for LT was reached by a multidisciplinary team consisting of surgeons, physicians and anaesthetists. All data were collected prospectively. RESULTS: 52 patients were referred for LT over a period of 7 months. 48/52[92.3%) were males. The median age at referral was 52(range 13-66) years. The median Child-Turcotte-Pugh(CTP) score at referral was 9/15(range 5-13/15). Median Model for End Stage Liver Disease (MELD) score at referral was 17(range 9-26). 3/52(5.8%) had hepatocellular carcinoma and 9/52(17.3%) had a low MELD score (<14) but with life threatening complications of cirrhosis as indication. 4/9(44.4%) of those being upper gastrointestinal bleeds from varices. 28/52(53.8%) of the referrals had cryptogenic cirrhosis (CC), 18/52(34.6%) had alcoholic cirrhosis, 2/52(3.8%) each had metabolic, congenital and other causes for cirrhosis. 7/52(13.5%) transplants were performed [3 Live Donor LTs(LDLT) and 4 Deceased Donor LTs(DDLT)]. 5/7(71.4%)[2 - LDLT, 3 -DDLT] had a successful LT outcome. 11/45(24.4%) patients died while on the LT waiting list. CONCLUSIONS: High MELD CC was the commonest reason for referral for LT in our group. There was a high waiting list mortality highlighting the need for an efficient DDLT service.
Local infiltration versus Laparoscopic e guided transverse abdominis plane block in laparoscopic cholecystectomy e double blinded randomized control trial
(Elsevier, 2018) Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, M.B.; Thilakarathne, S.B.
BACKGROUND: Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. METHODS: This randomized control trial was designed to compare the effectiveness of additional laparoscopic guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions - Both groups received standard port site infiltration with 3-5ml of 0.25% bupivacaine. The test group received additional laparoscopic guided TAP block with 20ml of 0.25% bupivacaine subcostaly, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. RESULTS: The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at six hours (P = 0.043) and opioid requirement at six hours (P =0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. CONCLUSION: Laparoscopic-guided transverses abdominis plane block does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores
Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial
(Springer, 2019) Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, M.B.; Thilakarathne, S.B.; Wijesinghe, J.S.
BACKGROUND: Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. METHODS: This randomized control trial was designed to compare the effectiveness of additional laparoscopic-guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions-Both groups received standard port site infiltration with 3-5 ml of 0.25% bupivacaine. The test group received additional laparoscopic-guided TAP block with 20 ml of 0.25% bupivacaine subcostally, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. RESULTS: The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at 6 h (P = 0.043) and opioid requirement at 6 h (P = 0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. CONCLUSION: Laparoscopic-guided transverses abdominis plane block using plain bupivacaine does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores.
Outcome of hepatic resection: First five-year experience in elderly and younger patients
(Sri Lanka Medical Association, 2018) Bulathsinhala, B.K.S.; Thillekaratne, M.S.B.; Gunetilleke, M.B.; Niriella, M.A.; Wijegunawardena, D.G.A.; Siriwardana, R.C.
No Abstract Available
Pancreatico-duodenectomy with long segment portal vein resection and reconstruction with left renal vein autologous graft
(College of Surgeons of Sri Lanka, 2017) Bulathsinhala, B.K.S.; Tillakaratne, M.S.B.; Gunetilleke, M.B.; Siriwardana, R.C.
Perioperative outcome following establishment of deceased donor liver transplantation: A single center experience in Ragama, Sri Lanka
(Sri Lanka Medical Association, 2018) Withanachchi, A.D.; Thalagala, T.A.E.S.; Liyanage, I.K.; Dassanayake, A.S.; de Silva, A.P.; Gunetilleke, M.B.; Siriwardana, R.C.; Niriella, M.A.
INTRODUCTION AND OBJECTIVES: Liver transplant (LT) perioperative mortality is a good performance indicator among transplant centres. Colombo North Teaching Hospital (CNTH) is the first LT program in Sri Lanka. We aimed to evaluate the perioperative (30 day) outcomes and complications of patients who underwent deceased donor liver transplantation (DOLT) at CNTH between the first 9 DDLTs that were carried out before 2016 (Tl) and the last 10 DDLTs after 2016 (T2). METHODS: Retrospective analysis of pre-operative records, operation notes, discharge and follow up notes were carried out on all patients who underwent DOLT at CNTH. RESULTS: A total of 19-DDLTs were performed during this period. Mean age of the recipients was 50.3 (Tl :52.9, T2:47.9) years: Indications (n) for DDLT were: advanced cirrhosis with high MELD (12), other complications of cirrhosis (3),."cirrhosis with hepatocellular carcinoma (3) and acute liver failure (1 ). Aetiology of cirrhosis (n) were: cryptogenic (13), alcohol (3), autoimmune hepatitis (1), other (1). Pre transplant MELD was 16 in Tl and 18 in T2. Average hospital stay was 11.1 days (7.4 days in the intensive care). Perioperative mortality was 4/9 (44%) in Tl and 2/10 (20%) in T2. Mortality was due to PNF (3), sepsis (2) and post-operative reperfusion syndrome (1). Other post-operative complications (in Tl and T2) were: hepatic artery thrombosis (0,0), cholestasis (0, 1 ), acute cellular rejection (0,2), hydrothorax (0,3), clinically significant tacrolimus toxicity (1,o) and acute renal failure (4,2). CONCLUSION: Perioperative mortality has reduced and outcomes improved in the second half indicating success of the CNTH LT program.
Pre-treatment alphafeto protein in hepatocellular carcinoma with non-viral aetiology - a prospective study
(BioMed Central, 2017) Siriwardana, R.C.; Thilakarathne, S.; Niriella, M.A.; Dassanayake, A.S.; Gunetilleke, M.B.; Habarakada, L.C.A.; de Silva, H.J.
BACKGROUND: Alpha-fetoprotein (AFP) is a biomarker for hepatocellular carcinoma (HCC). The significance of pre-treatment AFP (pt-AFP) in non-viral HCC (nvHCC) is not clear. METHODS: Patients with nvHCC, referred to a Hepatobiliary Clinic from September 2011-2015 were screened. HCC was diagnosed using American Association for the Study of Liver Disease guidelines, and TNM staged. nvHCC was diagnosed when HBsAg and anti-HCVAb was negative. Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores were calculated. AFP level was evaluated against patient characteristics, tumour characteristics and survival. RESULTS: Three hundred eighty-nine patients with nvHCC [age 64(12-88) years; 344(88.4%) males] were screened. Median AFP was 25.46 ng/ml (1.16-100,000). 41.2% (n = 160) Of patients had normal AFP level. 22.9% (n = 89) had AFP over 400 ng/ml. Female gender (P < 0.05), vascular invasion (P < 0.001), tumours over 5 cm (P < 0.05), late TNM stage (P < 0.001) and non-surgical candidates had higher AFP levels. Diffuse type (P < 0.001), macro vascular invasion (P < 0.001) and late stage tumours (P < 0.001) had AFP over 400 ng/ml. Having AFP below 400 ng/ml was associated with longer survival (16 vs. 7 months, P < 0.001). CONCLUSION: Pre treatment AFP has a limited value In diagnosing nvHCC, Having a AFP value over 400 ng/ml was associated with aggressive tumour behaviour and poor prognosis.
Risk factors for post operative complications, prolong ICU and hospital stay in patients with colorectal surgery
(Sri lanka Medical Association, 2015) Gunetilleke, M.B.; Jayatunge, D.S.P.; Munasinghe, A.H.E.; Jayarathne, K.D.V.S.; Liyanage, C.A.H.; Siriwardana, H.D.R.C.; Kumarage, S.K.; Deen, K.I.
INTRODUCTION AND OBJECTIVES: Identifying predictors for development of post-operative complications and prolong hospital stay will improve outcome of colorectal surgery. METHOD: Colorectal surgeries from May 2012 -February 2015 at NCTH were assessed for post¬operative complications, prolong ICU and hospital stay RESULTS: Out of 101 patients [43.6 % males, median age 52, 54.3% ASA class ll/lll ] 19 patients suffered complications (11 Sepsis, 10 respiratory complications and 4 ACS). Prolong hospital in 33 and prolong ICU stay in 14 were noted. On univariate analysis higher intra-operative fluid usage (IOFU), usage of blood products (UBP), increase blood loss and reduce usage of epidurals (RUE) predicted respiratory complications. Females, higher IOFU for sepsis and higher IOFU, UBP for ACS were predictors. Higher IOFU , higher ASA class, females, longer duration of anaesthesia ( LDOA ) for prolong ICU stay and UBP , LDOA , higher IOFU for prolong hospital stay were predictors. In multivariate model a higher IOFU, RUE for cardiorespiratory complications and low albumin & haemoglobin, female gender for sepsis were independent predictors. For prolonged ICU/ hospital stay higher IOFU (> 20 ml/kg), LDOA (> 240 min), higher ASA class were independent predictors. Patient without intra-operative vasopressors had a higher IOFU and no significance in development of complications. CONCLUSION: Patients without intra-operative vasopressor had higher IOFU. IOFU >20ml/kg is a major contributor for post-operative cardio¬respiratory complications, prolong ICU and hospital stay.
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.
A study of the relationship between the internal jugular vein and carotid artery assessed under direct vision and ultrasonically in surgical patients and in cadavers
(Sri Lanka Medical Association, 2017) Munasinghe, B.N.L.; de Silva, M.T.D.; Gunetilleke, M.B.
INTRODUCTION & OBJECTIVES: Use of anatomical landmarks to cannulate the internal jugular veins is fraught with danger due to variations in the relative positions of the common carotid artery (CCA) and the internal jugular vein (IJV). Objective of the study was to identify anatomical variations of the relative positions of the IJV and CCA. METHODS: This was a descriptive cross-sectional study carried out from October 2012 to July 2014 at the NCTH, Ragama. The anatomy was evaluated either ultrasonically or under direct vision. Relationship of the IJV to the CCA was recorded at three levels (sternoclavicular junction-SCJ, cricoid cartilage-CC and upper border of thyroid cartilage lamina-TCL), on the right (R) and left (L) sides. RESULTS: A total of 216 participants (60 male: 156 female; median age 48 years, range 16 to 75) consisting 192 patients (89%) and 24 cadavers (11%) were included. Patients were undergoing either neck USS at the radiology department (144, 67%), central venous catheterisation under USS guidance (22, 10%) or thyroidectomy (30, 14%). At all three levels IJV was lateral to the CCA in a majority (SCJ level: R 66.5%, L 29%; CC level: R 80%, L 85%; TCL level: R 89%, L 76%). IJV was anterior to the CCA at the SCJ level in a proportion of the sample (R 11.5%, L 22%) and antero-lateral in another proportion (R 20%, L 48%). CONCLUSION: Aberrant anatomical relations between the IJV and CCA are not uncommon. Reliance solely on a technique which assumes normal anato y can lead to damage to the CCA.