Browsing by Author "Munasinghe, B.N.L."

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Biofeedback with and without surgery for fecal incontinence improves maximum squeeze pressure, saline retention capacity and quality of life
(Springer India, 2008) Munasinghe, B.N.L.; Rathnayaka, M.M.G.; Parimalendran, R.; Kumarage, S.K.; de Zylva, S.; Ariyaratne, M.H.J.; Deen, K.I.
Clnical presentation, characteristics and surgical outcome of retrosternally extending goitres versus goitres confined to neck: results from a case control study
(Sri Lanka Medical Association, 2016) Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Rathnayake, R.M.G.K.; Pinto, M.D.P.; Kumarasinghe, K.A.P.R.; Fernando, F.R.
INTRODUCTION: Goitres that extend beyond the thoracic inlet are defined as retro-sternally extending (RSE) goitres. These RSE goitres are a surgical challenge and their characteristics could be different to the goitres confined to the neck. METHOD: A retrospective case-control study. Patients were selected from the thyroid database maintained in our unit (from November 2002 to February 2016). Patients with RSE goitres (confirmed by imaging) were selected as study group (SG). Control group (CG) patients (with goitres confined to the neck) were systematically selected in a 1:2 ratio. The end points were: (i) incidence of RSE goitres, (ii) clinical presentation, (iii) degree of RSE (iv) thyroid status, (v) post operative complications and (vi) histological pattern. RESULTS: 527 consecutive patients (465 female: 62 male; median age 45 years, range 17 years to 71 years) were studied. For the case control study, there were 51 patients in the study group and 102 patients in the control group. Compression symptoms were not significantly high in the SG (27% vs 17%, p value <0.17). Majority had RSE of both lobes (78%). The median depth of extension into the mediastinum was 41.6mm (range 12mm - 95mm). A majority were euthyroid (SG 78% vs CG 82%). Post operative stridor was significantly high in the SG (7% vs 2%; P value = 0.015). Although a majority was colloid goitres, papillary carcinoma was significantly high in the CG (P value < 0.05). CONCLUSIONS: A majority of RSE goitres did not present with compression symptoms, but had significantly high post-operative stridor (p value <0.05). Incidence of cancer is not high in SG.
Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: A prospective clinical audit
(Pergamon Press, 2008) Rathnayake, M.M.; Kumarage, S.K.; Wijesuriya, S.R.E.; Munasinghe, B.N.L.; Ariyaratne, M.H.J.; Deen, K.I.
INTRODUCTION: Patients who have a temporary loop ileostomy have impaired quality of life. Complications associated with a loop ileostomy orileostomy closure will impair patients' quality of life further and require extended enterostomal therapy. We performed a prospective audit of loop ileostomy to ascertain the nature of the workload that may be created with ileostomy-related complications. PATIENTS AND METHODS: One hundred and forty patients (67 males, 73 females, median age 50 years, range 5-90 years) who received a temporary loop ileostomy were analysed after completion of proformas on a prospective basis between 1999 and 2006. RESULTS: Operation was performed for rectal cancer 100 (71%), familial adenomatous polyposis 14 (10%), ulcerative colitis 21 (15%) and for trauma or Hirchsprung's disease 5 (3%). Complications of loop ileostomy were: retraction 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), parastomal hernia 1 (0.7%), paraileostomy abscess 4 (3%) and severe skin excoriation 9 (6%). The loop ileostomy was reversed in 117 (83%) at a median (range) of 13 weeks (1-60). Ileostomy closure-related complications were: small bowel fistula 1 (0.9%), small bowel obstruction 5 (4.3%) and a stitch sinus in 1 (0.9%). Five women developed recto-vaginal fistula (n=3; 2.6%), pouch-vaginal fistula (n=1; 0.9%) and pouch-anal fistula (n=1; 0.9%) that required extended enterostomal therapy, after loop ileostomy reversal. CONCLUSION: Nineteen percent of patients following creation of a loop ileostomy and 10.5% of patients after reversal of the ileostomy requiredextended enterostomal care by a specialized enterostomal therapist, which supported resumption of a normal life.
Does the retrosternal extension of a goitre and its relationghip to the aortic arch determines the surgical approach
(Sri Lanka Medical Association, 2016) Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Abeyrathne, I.G.K.P.; Amaraweera, P.C.; Fernando, R.
INTRODUCTION: Retrosternal extension (RSE) is defined as the enlargement of the thyroid below the thoracic inlet. The greatest challenge in embarking on surgery in RSE is to decide whether to involve an intra-thoracic approach (sternotomy or thoracotomy) or not, as this approach accounts for added morbidity & mortality. OBJECTIVES: The aim of this study is to analyse whether the relationship of the retrosternal component of a goitre to the aortic arch decides the surgical approach of total thyroidectomy. METHOD: A total of 527 thyroidectomies were performed at Colombo North Teaching Hospital professorial unit during the period from November, 2002 to February, 2016. There were 51 patients with radiological evidence of retrosternal goitre (6.27%). These patients were categorized into 2 groups according to the degree of RSE. Groups were defined as extension of goitre above the arch of aorta (AA) and below AA. RESULTS: 50 (98%) patients had RSE above the AA and 1 patient had RSE below the AA. RSE was seen on the right side of the mediastinum in 3 (5.88%) patients, on the left in 8 (15.68%) patients and bilaterally in 40 (78.43%). Total thyroidectomy was undertaken in all 50 patients with RSE above the AA, through cervical approach without an added morbidity. The patient with RSE beyond the AA underwent total thyroidectomy with axillary thoracotomy. CONCLUSIONS: Majority of the RSE is above the AA, which can be dealt with a cervical approach and extension below the AA may need an intra-thoracic approach.
Incidence of carcinoma among THY3 lesions of the thyroid
(Sri Lanka Medical Association, 2016) Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Abeyrathne, I.G.K.P.; Amaraweera, P.C.; Fernando, R.
INTRODUCTION AND OBJECTIVES: Ultra Sound Scan (USS) and Fine Needle Aspiration Cytology (FNAC) of thyroid nodules are carried out in patients with goitre. THY3 lesions cause diagnostic difficulty and risk of malignancy in such lesions is 20%. The objective of this study was to determine the incidence of carcinoma among THY3 lesions and to relate the findings to the size of the nodule. METHOD: All the patients who underwent thyroidectomy at the University Surgical Unit, Colombo North Teaching Hospital from November 2002 to December 2015 were analysed retrospectively. Histological and ultrasonic data in patients with THY3 lesions were analysed. RESULTS: There were 29 (5.68%) THY3 patients among 510 patients who had thyroidectomy. Only 6 (20.7%) patients were histologically proven to be malignant (follicular carcinoma – 3, papillary carcinoma - follicular variant- 2, mixed medullary papillary carcinoma - 1). All patients were females (age range 17y -52y). Pre-operative USS nodule size in the malignant group ranged from 2.6 cm to 6.8 cm (average - 4.25cm). 20 patients (68.9%) had benign histology (MNG - 18, thyroiditis-2). USS nodule size in the benign group ranged from 2.3 cm to 2.5 cm. Three patients (8.7%) were lost to follow up. CONCLUSIONS: About 20.7% of THY3 lesions had thyroid carcinoma. Lesions larger than 4.25 cm were more likely to harbour a malignancy.
Incidental thyroid carcinoma in benign thyroid disease: a longitudinal descriptive study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Pinto, M.D.P; Pradeep, I.H.D.S.; Amaraweera, P.C.; Munasinghe, B.N.L.; Kumarasinghe, K.A.P.R.; Dissanayake, D.M.C.D.; Fernando, R.
BACKGROUND: An incidental thyroid carcinoma (ITC) is a thyroid malignancy that is not clinically or cytologically detected preoperatively. The incidence of ITC is between 10% - 20% in the literature. OBJECTIVES: The study was undertaken to assess the incidence of ITC in patients presenting with benign disease of the thyroid to University Surgical Unit, Colombo North Teaching Hospital, Sri Lanka. METHODS: A longitudinal descriptive study was conducted spanning from November, 2002 to October, 2015 on a cohort of all patients who underwent total thyroidectomy with cytologically benign thyroid disease. FNAC was performed on all palpable lesions to detect presence of malignancy. Presence of autoimmune thyroiditis was taken as an exclusion criterion due to its known association with malignancy of the thyroid. Post-thyroidectomy histopathological diagnoses were provided by Department of Pathology, University of Kelaniya, Sri Lanka and were collected prospectively. Statistical analysis was done by Fisher’s exact test using SPSS software, version 20. RESULTS: Hundred and sixty seven patients (n=167) underwent total thyroidectomy (Male – 2, Female – 17, Median age = 40.25 years, Range 28 – 62 years). ITC was found in 11.38% (19/167) with a female preponderance (13/19). A majority (89.4%) were euthyroid. CONCLUSIONS: Incidence of ITC in benign thyroid disease is 11.38% which may have implications for the management in benign thyroid disease.
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.
Medical students' perception and attitudes on operating theatre learning experience in Sri Lanka
(Elsevier, 2023) Wijesinghe, K.; Lunuwila, S.; Gamage, H.; Gooneratne, T.; Munasinghe, B.N.L.; Harikrishanth, S.; Nandasena, M.; Perera, N.; Jayarajah, U.
OBJECTIVE: The operating room is a unique learning experience that has visual, aural, kinesthetic learning stimuli and provides benefits to the medical students such as development of sound clinical knowledge and skills, and gaining personal insight into ones' career choice. However, this can be a challenging place due to the unfamiliar learning environment. We aimed to study the Sri Lankan Medical students' perception and attitudes on operating theatre learning experience. DESIGN AND SETTING: A descriptive cross-sectional survey was carried out among medical students undergoing surgical clinical training on the perspectives of the teaching and learning experience in the operating theatre in Sri Lanka. PARTICIPANTS: Our study group consisted of 390 medical students from four different medical faculties in Sri Lanka representing all levels of surgical clinical rotations. RESULTS: A majority of the students had actively participated in the operating theater. Despite this, the students' clarity of the learning outcomes and expectations in a theatre varied greatly. Majority of the students felt that the surgeons were willingly to teach but also noted that there was no standardization in teaching. This study clearly shows a significant correlation between positive emotions and surgical teams welcoming attitude towards the medical students. Long standing hours were considered a negative emotion by a majority of students. We also observed that theatre environment can be physically and mentally exhausting. CONCLUSIONS: Thus, empathy, feeling welcome and giving breaks to refresh can go a long way in making the learning experience better. Regular feedback to trainers on students' perception of the theatre experience is important to value the students' opinion and improve the quality of the surgical theatre. We strongly recommend initiation of clear induction sessions with introduction of well-structured teaching learning activities in the operating theatre.
Mini incision thyroidectomy: alternative approach to cosmetic thyroidectomy
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Munasinghe, B.N.L.; Fernando, R.; Kumarasinghe, K.A.P.R.; Sandaruwan, C.; Pinto, M.D.P.; Amaraweera, P.C.; Dissanayake, D.M.C.D.
BACKGROUND: Technique of thyroidectomy has evolved from conventional open technique to minimally access techniques over the past few years. Regardless of the technique, outcome depends on meticulous surgical technique used. Mini incision is defined as surgical incision less than 3 cm or less in length. Once the small incision is made, retraction is used and thyroidectomy done in the conventional manner. Main advantage is the superior cosmetic outcome compared to conventional method. Size of the gland is a main factor before deciding on a mini incision thyroidectomy (MIT) and careful patient selection must be done as large glands cannot be retrieved with the mini incision. METHODS: A longitudinal descriptive study was carried out on all patients undergoing MIT between 2008 to 2015 in Professorial Surgical Unit, University of Kelaniya, Sri Lanka. Patients with small sized glands and nodules less than 2cm were included. Skin incision was marked by measuring 3 cm with a sterile measuring tape and Methyline blue dye. The thyroid gland was delivered in to the incision and both pedicles were ligated. Capsular dissection with nerve encountering technique was adhered to. Recurrent laryngeal nerves, external branch of the superior laryngeal nerves and parathyroid glands were demonstrated and preserved. Drains were not used and routine closure was done after absolute haemostasis. RESULTS: Twenty nine MITs were performed (Male -3 , Female – 26, median age 34.26 years, range 22 – 42 years, total thyroidectomy -18, hemi-thyroidectomy -11). The commonest indication for total thyroidectomy was small MNG. None had recurrent laryngeal nerve injuries or significant haematoma formation. Transient hypocalcaemia was seen in 3%. The cosmetic outcome was satisfactory. The longest follow up is 7 years. CONCLUSIONS: MIT is a safe alternative to conventional approach in carefully selected patients and also it gives a superior cosmetic outcome.
A Novel structure for online surgical undergraduate teaching during the COVID-19 pandemic
(BioMed Central., 2020) Chandrasinghe, P.C.; Siriwardana, R.C.; Kumarage, S.K.; Munasinghe, B.N.L.; Weerasuriya, A.; Tillakaratne, S.; Pinto, D.; Gunetilleke, B.; Fernando, F.R.
BACKGROUND: The Covid-19 pandemic necessitated the delivery of online higher education. Online learning is a novel experience for medical education in Sri Lanka. A novel approach to undergraduate surgical learning was taken up in an attempt to improve the interest amongst the students in clinical practice while maximizing the limited contact time. METHOD: Online learning activity was designed involving medical students from all stages and multi consultant panel discussions. The discussions were designed to cover each topic from basic sciences to high-level clinical management in an attempt to stimulate the student interest in clinical medicine. Online meeting platform with free to use basic plan and a social media platform were used in combination to communicate with the students. The student feedback was periodically assessed for individual topics as well as for general outcome. Lickert scales and numeric scales were used to acquire student agreement on the desired learning outcomes. RESULTS: A total of 1047 student responses for 7 questionnaires were analysed. During a 6-week period, 24 surgical topics were discussed with 51 contact hours. Eighty-seven per cent definitely agreed (highest agreement) with the statement 'students benefitted from the discussions'. Over 95% have either participated for all or most sessions. A majority of the respondents (83.4%) 'definitely agreed' that the discussions helped to improve their clinical sense. Of the total respondents, 79.3% definitely agreed that the discussions helped to build an interest in clinical medicine. Around 90% agreed that both exam-oriented and clinical practice-oriented topics were highly important and relevant. Most widely raised concerns were the poor Internet connectivity and limitation of access to the meeting platform. CONCLUSION: Online teaching with a novel structure is feasible and effective in a resource-limited setting. Students agree that it could improve clinical interest while meeting the expected learning outcomes.
Pre and post operative assessment of voice changes in patients undergoing total thyroidectomy
(The Sri Lanka Medical Association, 2017) Dissanayake, D.M.C.D.; Fernando, R.; Munasinghe, B.N.L.; Thilakarathne, S.B.; Pinto, D.P.; Uragoda, U.A.
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.