Browsing by Author "Pathirana, A.A."

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Resection of the large bowel suppresses hunger and food intake and modulates gastrointestinal fermentation
(John Wiley & Sons, 2016) Hettiarachchi, P.; Wickremasinghe, A.R.; Frost, G.S.; Deen, K.I.; Pathirana, A.A.; Murphy, K.G.; Jayaratne, S.D.
OBJECTIVE: To assess appetite and gut hormone levels in patients following partial (PR) or total resection (TR) of the large bowel. METHODS: A comparative cross sectional study was carried out with healthy controls (n = 99) and patients who had undergone PR (n = 64) or TR (n = 12) of the large bowel. Participants consumed a standard (720 kcal) breakfast meal at 0830 (t = 0) h followed by lactulose (15 g) and a buffet lunch (t = 210 min). Participants rated the subjective feelings of hunger at t = -30, 0, 30, 60, 120, and 180 min. Breath hydrogen (BH) concentrations were also evaluated. In a matched subset (11 controls, 11 PR and 9 TR patients) PYY and GLP-1 concentrations were measured following breakfast. The primary outcome measure was appetite, as measured using visual analogue scales and the buffet lunch. The secondary outcome was BH concentrations following a test meal. RESULTS: PR and TR participants had lower hunger and energy intake at the buffet lunch meal compared to controls. PR subjects had higher BH concentrations compared to controls and TR subjects. BH levels correlated with circulating GLP-1 levels at specific time points. CONCLUSIONS: PR or TR of the large bowel reduced feelings of hunger and energy intake, and PR increased gastrointestinal fermentation.
Role of the different parts of large bowel in influencing appetite
(Sri Lanka Medical Association, 2007) Hettiarachchi, P.; Wickremasinghe, A.R.; Frost, G.S.; Jayaratne, S.D.; Deen, K.I.; Pathirana, A.A.
OBJECTIVE: To determine the role of the different parts of the large bowel in influencing appetite DESIGN, SETTING AND METHODS: Seventy six colectomised subjects, age-sex matched with 76 healthy adults, were given a standard breakfast meal followed by a buffet lunch after 210 minutes. Hunger and satiety levels were determined at selected time points in patients and controls. Peptide YY (PYY) and glucagon likepolypeptide-1 (GLP-1) concentrations were determined in a sub sample of subjects. RESULTS: In proctocolectomised subjects at 180 minutes, a lower (p=0.035) hunger level and a higher (p=0.038) satiety level than controls were observed. The hunger ieveis of subjects with total removal of the rectum were lower at 60 min (p=0.048), 180 min (p=0.027), and 330 min (p=0.041) but higher at 240 min. The satiety levels were lower in subtotal/hemi-colectomised subjects at 300 (p=0.028) and 330 min (p=0.031). In subjects with remova! of the rectum, significantly lower hunger levels and higher satiety levels were observed at 180 minutes as compared to controls. In proctocolectomised patients, PYY concentrations were significantly lower than controls at 180 min (p=0.044). There was no difference in the GLP-1 concentrations between patients and controls. CONCLUSIONS: As subjects with removal of the rectum had significantly lower hunger levels and higher satiety levels at 180 minutes, a phenomenon not seen among subtotai/hemi-colectomised subjects, we surmise that the rectum has a significant role to play in controlling hunger and satiety levels. PYY is likely to be secreted from the large intestine and/or the rectum and GLP-1 from the small intestine.
Shunt surgery in acute variceal bleeding
(College of Surgeons of Sri Lanka, 2005) Abeysuriya, V.; de Silva, A.P.; Pathirana, A.A.
Abstract Available
SLHPBA Guidelines for the management of hepatocellular carcinoma in Sri Lanka - consensus statement
(College of Surgeons of Sri Lanka, 2018) Siriwardana, R.C.; Pathirana, A.A.; Siriwardana, A.K.; Espat, N.J.; Anya Adiar
Sri Lanka guidelines for the management of hepatic metastases from colorectal cancer.
(The Sri Lanka Journal of Surgery., 2018) Dharmapala, A.D.; Siriwardana, R.C.; Chan, A.; Adair, A.; Shrikhande, S.; Jeyarajah, R.; Jegatheeswaran, S.; Jagannath, P.; Siriwardhane, M.; Sivaganesh, S.; Pathirana, A.A.; Siriwardena, A.K.
ABSTRACT: Guidelines to manage liver metastases were developed at a meeting jointly organized by the Sri Lanka Hepato Pancreato Biliary Association (SLHPBA) and the International Hepato Pancreato Biliary Association (IHPBA). Existing evidence was used in the development of guidelines, as recommended by the AGREE II consortium. Guidelines are provided for diagnosis, pre-operative workup, multi-disciplinary team review, surgery, anaesthesia, post-operative care and follow up. Consideration was given to the limitations of facilities available in the country.