Browsing by Author "Hewavisenthi, S.J.D.S."

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    Bile reflux and quality of life after modified retrocolic posterior gastric gastrojejunostomy in whipple procedure
    (College of Surgeons of Sri Lanka, 2015) Rajapaksha, R.W.M.A.L.; Liyanage, C.A.H.; Hewavisenthi, S.J.D.S.; Liyanage, S.K.; Bandara, L.M.P.M.; Siriwardana, R.C.
    INTRODUCTION: Perioperative outcome of Whipple surgery has greatly improved. Quality of life has become an important issue in long-term survivors. Delayed gastric emptying and bile reflux are common concerns. Modified retrocolic posterior gastric gastrojejunostomy with mesocolic stich has been unit's standard practice. Study was designed to assess macro and microscopic bile reflux and dyspepsia related quality of life in long-term survivors. MATERIAL AND METHODS: Out of 42 patients operated from June 2012, twenty long-term survivors were selected after excluding once with recurrence and ones who had chemotherapy during last six months. All underwent gastroscopy. Macroscopic bile reflux was grouped in to four categories. Six gastric biopsies were taken from standard sites. Microscopic bile reflux index (BRI) was calculated in stained specimens. BRI score of more than 14 was considered significant. Validated Nepean dyspepsia index-short form (NDI-SF) was used to assess the severity of dyspepsia related quality of life and compared with age and gender matched control. RESULTS: The median age was 48.5 years (21- 69). Median survival of the group was 37 months (6-40). Endoscopically, 18/20 (90%) had macroscopic bile reflux (83.3% yellowish bile lake, 16.7% greenish bile lakes). None had stomal ulcers or macroscopic inflammation. Mean Bile reflux index score was 13.22 (SD: 9.46). Mean dyspepsia score of Whipple group was 23.1 (SD 8.88). In controls, mean dyspepsia score was 20 (SD 8.2), showing no significant difference (p =0.245). CONCLUSION: Though there was macroscopic bile reflux, clinical symptoms and microscopic changes were minimal. Modified technique had good long-term results.
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    Comparison of Mucin Patterns in Colonic Pathologies by Histochemistry.
    (College of Pathologists of Sri Lanka, 2019) Ratnayake, R.M.U.S.; Epitakaduwa, C.; Jayatunge, D.N.U.; Ediriweera, D.; Hewavisenthi, S.J.D.S.
    INTRODUCTION: High Iron Diamine Alcian blue (HID-AB) is a well-established technique for demonstrating colonic acid mucins namely sulphomucins (brown- black) and sialomucins (blue). In certain colonic pathologies expression of sulphomucin, the predominant mucin in normal colonic epithelium is altered. OBJECTIVE: To compare the changes in the pattern of mucin staining in, adenocarcinoma (AC), normal colonic epithelium, solitary rectal ulcer (SRU), transitional zone mucosa (TZ) (i.e.: normal non dysplastic mucosa adjacent to adenocarcinoma) and in ulcerative colitis (UC). METHOD: AC-21, normal colonic epithelium-30, SRU-23, TZ-20, UC-29 biopsies were stained with the HID-AB stain. Two investigators assessed the percentages of mucin staining by counting the number of cells staining for sulphomucin and sialomucin in an area of colonic epithelium measuring 1mm in length. The differences in these 5 categories were assessed for statistical significance using the one-way ANOVA test and a Post Hoc Comparison of the mean values was carried out to establish which groups were different. RESULTS: ACs showed no sulphomucin or sialomucin staining while normal colonic epithelium showed nearly 100% sulphomucin staining. The percentage mean value for sulphomucin staining was AC-12.47%, normal colonic epithelium - 96.7%, SRU-35.7%, TZ-48.98%, and UC –75.43%. Hence the differences between these categories reached a level of statistical significance except between TZ and SRU. CONCLUSION: The patterns of mucin staining observed with HID/AB staining included relatively similar changes in mucin staining in the TZ and SRU, the loss acid mucin staining in AC and the relatively mild degree of sulphomucin loss in UC. Though there are significant differences in mucin staining between some of these colonic pathologies practical problems were encountered in using HID/AB as a diagnostic tool.