Browsing by Author "Samarasekera, D.N."

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Anatomy of the gall bladder in Sri Lankan population : a warning to the laparoscopic surgeon.
(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Welgama, U.
INTRODUCTION : Minimally invasive surgery has advanced rapidly to involve resection of almost all abdominal organs. Out of all these procedures, laparoscopic cholccystectomy has become the operation of choice for the removel of gall bladder and has stood the test of time. AIM : Since we started laparoscopic cholecystectomy procedure in our unit, this study was designed to document the possible variations that we may encounter in the Sri Lankan population. MATERIAL AND METHODS : Seventy five fresh non selected adult cadavers (within 24 hours of death) were dissected, Exclusion criteria were those with crush injuries to the liver and previous hcpato-biliary surgery. Findings were documented according to a standard proforma. FINDINGS : Normal anatomy was seen in 22 ( 29.3%) bodies. Documented abnormalities given in the text books were seen in 45 (60% ). Eight (10.6%) new abnormalities were detected in our study GB - 0, cystic duct - 5, cystic artery - 7). CONCLUSIONS : Altogether nearly seventy percent of the cadavers showed developmental anomalies. Therefore a thorough knowledge of all these anomalies is essential for the surgeon performing laparoscopic cholecystectomy to avoid iatrogenic injury.
The distribution of the anal glands and the variable regional occurrence of fistula-in-ano: is there a relationship?
(Springer Nature, 2010) Abeysuriya, V.; Salgado, L.S.S.; Samarasekera, D.N.
BACKGROUND: Fistula in ano is a rather common condition, but the disease process is not yet fully understood. The aim of our study was to determine how the distribution of anal glands contributes to the variable occurrence of fistula-in-ano in the perineum. METHODS: we conducted a blinded two-phase prospective study. In the first phase, the perineum of the patients with primary fistulae was anatomically divided into right upper and lower and left upper and lower quadrants in the lithotomy position. The fistulae were classified according to what quadrant the external and internal openings and the tract pathway were in. In the second phase, using 10 human cadaver specimens, full thickness tissue samples were taken from each quadrant of the anus. Samples were histologically evaluated for the volume fractions of the anal glands in each quadrant. RESULTS: The new classification system we propose revealed that the largest number of fistulae 43% (17/39) were in the right lower quadrant, and 22% (9/39), 12% (5/39) and 8% (3/39) were in the left lower, right upper and left upper quadrants, respectively. It was also observed that 14% (5/39) of fistulae were in more than one quadrant. The volume fractions of each quadrant showed that the largest volume fraction of the anal glands was in the right lower quadrant (right lower quadrant: 0.64, left lower quadrant: 0.35, right upper quadrant: 0.26 and left upper quadrant: 0.22, P = 0.001). CONCLUSIONS: To the best of our knowledge, this is the first study that has objectively shown that the distribution of the anal glands is variable, and the highest density of anal glands is in the right lower quadrant of the anus. This variable distribution may be associated with the variable occurrence in fistula in ano.
The Distribution of the anal glands and the variable regional occurrence of fistula-in-ano: is there a relationship?
(Springer-Verlag, 2010) Abeysuriya, V.; Salgado, L.S.S.; Samarasekera, D.N.
BACKGROUND: Fistula in ano is a rather common condition, but the disease process is not yet fully understood. The aim of our study was to determine how the distribution of anal glands contributes to the variable occurrence of fistula-in-ano in the perineum. METHODS: we conducted a blinded two-phase prospective study. In the first phase, the perineum of the patients with primary fistulae was anatomically divided into right upper and lower and left upper and lower quadrants in the lithotomy position. The fistulae were classified according to what quadrant the external and internal openings and the tract pathway were in. In the second phase, using 10 human cadaver specimens, full thickness tissue samples were taken from each quadrant of the anus. Samples were histologically evaluated for the volume fractions of the anal glands in each quadrant. RESULTS: The new classification system we propose revealed that the largest number of fistulae 43% (17/39) were in the right lower quadrant, and 22% (9/39), 12% (5/39) and 8% (3/39) were in the left lower, right upper and left upper quadrants, respectively. It was also observed that 14% (5/39) of fistulae were in more than one quadrant. The volume fractions of each quadrant showed that the largest volume fraction of the anal glands was in the right lower quadrant (right lower quadrant: 0.64, left lower quadrant: 0.35, right upper quadrant: 0.26 and left upper quadrant: 0.22, P = 0.001). CONCLUSIONS: To the best of our knowledge, this is the first study that has objectively shown that the distribution of the anal glands is variable, and the highest density of anal glands is in the right lower quadrant of the anus. This variable distribution may be associated with the variable occurrence in fistula in ano.
Electrogastrography (EGG) and gastric motility: an investigation to evaluate gastric emptying in those who undergo oesophago -gastric anastomosis without a pyloroplasty
(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Suraweera, P.H.R.; de Silva, H.J.; Dissanayake, A.S.
INTRODUCTION: EGG is a non-invasive technique of recording gastric myoelectrical activity by placing electrodes on the abdomen. Objectives : The aim of this study was to assess the myoclcctrical activity of the stomach following ocsophago-gastric anastomosis without a pyloroplasty and also to correlate the values with those who develop symptoms of gastric stasis. DESIGN,SETTING AND METHODS : We present the initial results of an ongoing study. EGG results of six patients (M:F=5: 1) with carcinoma of the oesophagus who underwent transhiatal oesophagectomy were analysed. Mean age was 56y (range 45-76). EGG was performed preoperatively and three months after surgery using computerised digitrapher EGG (Syncctics, UK). One patient complained of symptoms of gastric stasis and reflux and did not respond to therapy with prokinetic agents. She underwent subsequent pyloroplasty and is asymptomatic at present. RESULTS : All patients showed normal preoperative myoelectrical activity (mean - + 131.17 mv) and motility. Postopcratively all patients showed bradygastria and low myoelectrical activity. Postoperative myoelectrical activity in the asymptomatic group showed a value which was positive (mean - +94.12mv) compared to the symptomatic patient who had a persistent mean negative value (- 89.34 mv). CONCLUSIONS : Persistent negative amplitude in the EGG postoperatively may indicate severe gastric stasis. This may be due to poor contractiliy of the denervatcd stomach in some patients. Therefore pyloroplasty should be considered before these patients develop complications of stasis and reflux.
Eosinophilic granulomatous vasculitis mimicking a gastric neoplasmn
(Blackwell Scientific Publications, 1999) Premaratna, R.; Saparamadu, A.; Samarasekera, D.N.; Warren, B.; Jewell, D.P.; de Silva, H.J.
No Abstract available
Gastroesophageal reflux disease in Sri Lanka: An island-wide epidemiological survey assessing the prevalence and associated factors
(Public Library of Science, 2024) Wickramasinghe, N.; Thuraisingham, A.; Jayalath, A.; Wickramasinghe, D.; Samarasekera, D.N.; Yazaki, E.; Devanarayana, N.M.
Gastroesophageal reflux disease (GERD) is commonly encountered in clinical practice in Sri Lanka. However, its prevalence in Sri Lanka is unknown. Our objective was to study the island-wide prevalence of GERD symptoms in Sri Lanka and its associated factors. A total of 1200 individuals aged 18-70 years (male: female 1: 1.16, mean age 42.7 years [SD 14.4 years]). were recruited from all 25 districts of the country, using stratified random sampling. An interviewer-administered, country-validated questionnaire was used to assess the GERD symptom prevalence and associated factors. Weight, height, waist, and hip circumference were measured. Heartburn and/or regurgitation at least once a week, an internationally used criterion for probable GERD was used to diagnose GERD. In this study, GERD symptom prevalence was 25.3% (male 42.1% and female 57.9%). Factors independently associated with GERD were inadequate sleep, snacking at midnight, sleeping within two hours of consuming a meal, skipping breakfast, increased mental stress, and certain medications used such as statins, and antihypertensive medications (p<0.001, univariate and logistic regression analysis). 38.4% of the study population have been using medication for heartburn and regurgitation in the past 3 months and 19.8% were on proton pump inhibitors. To conclude, the prevalence of GERD symptoms in Sri Lanka (25.3%) is higher than its estimated global prevalence of 13.8%. Several meal-related lifestyle habits, mental stress, and the use of some medications are significantly associated with GERD, indicating the importance of lifestyle modification and stress reduction in its management.
Hepatic venous drainage : are we Sri Lankans different from rest of the world ?
(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Welgama, U.; Kumara, G.M.C.J.
OBJECTIVES : As there is no documented study for the Sri Lankan population, our study was mainly aimed at re-evaluating the hepatic venous drainage. DESIGN,SETTING AND METHODS : Seventy five non selected fresh adult cadavers (within 24 hours of death) were dissected. Those with crush injuries to the liver, abdominal scars or previous hepatobiliary surgery were excluded. Findings were documented according to a standard proforma. All abnormalities were photographed, RESULTS : Male to female ratio was 65 : 10. All three communities were represented in the study (Sinhalese:Tamil,Muslim - 63:3:2). Mean age was 49 years (range 18-81). Normal pattern of hepatic venous drainage as given in the text books was not seen in any of the cadavers. Altogether 70 (93.3%) cadavers revealed major abnormalities. Most striking abnormality was a separate vein draining the caudate lobe directly into the JVC in 47 (62.8%) cadavers. CONCLUSION : Our study indicates that the surgeon should not expect the "normal anatomy" when dealing with hepatic veins. Since the majority of our patients had a separate vein draining the caudate lobe directly into the IVC, this may be considered the norm rather than a variation. Whether it is found only in our population can only be confirmed by conducting multi ethnic and multi national studies.vOBJECTIVES : As there is no documented study for the Sri Lankan population, our study was mainly aimed at re-evaluating the hepatic venous drainage. DESIGN,SETTING AND METHODS : Seventy five non selected fresh adult cadavers (within 24 hours of death) were dissected. Those with crush injuries to the liver, abdominal scars or previous hepatobiliary surgery were excluded. Findings were documented according to a standard proforma. All abnormalities were photographed, RESULTS : Male to female ratio was 65 : 10. All three communities were represented in the study (Sinhalese:Tamil,Muslim - 63:3:2). Mean age was 49 years (range 18-81). Normal pattern of hepatic venous drainage as given in the text books was not seen in any of the cadavers. Altogether 70 (93.3%) cadavers revealed major abnormalities. Most striking abnormality was a separate vein draining the caudate lobe directly into the JVC in 47 (62.8%) cadavers. CONCLUSION : Our study indicates that the surgeon should not expect the "normal anatomy" when dealing with hepatic veins. Since the majority of our patients had a separate vein draining the caudate lobe directly into the IVC, this may be considered the norm rather than a variation. Whether it is found only in our population can only be confirmed by conducting multi ethnic and multi national studies.
Irritable bowel syndrome
(State Pharmaceuticals Corporation, 1996) de Silva, H.J.; Samarasekera, D.N.
Management of chronic constipation
(1998) Samarasekera, D.N.
No abstract available
Oesophago-gastrectomy in a patient with haemophilia A
(Wiley-Blackwell, 2007) Nanayakkara, P.R.; Samarasekera, D.N.; Gamage, H.N.; Abayadeera, A.U.; de Silva, H.J.
No Abstract Available
Prolapsed haemorrhoids and anorectal manometry - do haemorrhoids prolapse due to reduction in the anorectal pressures ?
(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Suraweera, P.H.R.
Abstract Available
Prospective clinical and functional audit of emergency and elective haemorrhoidectomy
(College of Surgeons of Sri Lanka, 1999) Deen, K.I.; Paris, M.A.S.; Ariyaratne, M.H.J.; Samarasekera, D.N.
Background Traditionally, prolapsed thrombosed haemorrhoids have been treated conservatively because of the popular belief that the incidence of complications are greater after emergency operation compared with elective operation for haemorrhoids. An audit comparing emergency operation for prolapsed thrombosed haemorrhoids with elective operation for third and fourth degree haemorrhoids is presented. Patients and methods 104 patients (82 male, median age 47 years, range -18 to 80 years) undergoing emer- gency (65) or elective haemorrhoidectomy (39) were evaluated for complications after operation, hospital stay and postoperative bowel function which was assessed at 3 months by mailed questionnaire. Results Trainees performed as many operations as consultants (trainee 48 (46 percent) vs. consultant 56 (54 percent) although consultants performed more emergency operations (trainee-20, consultant-45). Postoperative complications were seen in 13 (12percent) ; emergency-9 versus elective-4 (p=0.69). There was no difference in complications after trainee performed operation (8) compared with operation by consultant (5). Median (range) duration of hospital stay after emergency operation was 2 days (1-17) compared with elective operation -2 days (1-10). A subset of 41 patients responded to a questionnaire on bowel function at 3 months: 5 of twenty five (20 percent) after emergency haemorrhoidectomy and 2 of sixteen (12.5 percent) after elective haemorrhoidectomy reported transient incontinence to gas or stool up to 3 weeks after operations but none were incontinent at 3 months. After emergency haemorrhoidectomy, 9 (36 percent) reported a sense of anal narrowing compared with 2 (12.5 percent) after elective haemorrhoidectomy (p=0.13). None required corrective surgery for anal stenosis. Conclusion There were no significant differences in complications, hospital stay and postoperative bowel function in patients after emergency and elective haemorrhoidectomy. Emergency haemorrhoidectomy is likely to result in low morbidity when undertaken by trained persons.
Role of oesophageal manometry and pH studies in the diagnosis of endoscopy negative upper gastrointestinal disorders
(Sri Lanka Medical Association, 1999) Samarasekera, D.N.; Gunawardena, P.A.H.A.; de Silva, H.J.
Dysphagia and symptoms of gastro-oesophageal reflux disease (GOPD) are common upper gastrointestinal (Gl) symptoms. However a significant proportion of these patients do not have any endoscopic or radiological abnormalities. Therefore, they are most often labeled as having a "motility disorder" or sometimes as "functional", without any objective assessment OBJECTIVES: To assess the oesophageal motility and the pH in symptomatic patients with normal upper Gl endoscopy results. METHODS: Twelve patients with dysphagia and four patients with symptoms of GORD were assessed (n=16) over a period of 20 months {1.1.97 to 30.8.98). Measurements were recorded using a computerized oesophageal pressure/pH transducer (Synectics, UK). RESULTS: Male:Femaie = 7:9. Median age was 52 (range 42-75) years. MotiNty studies indicated oesophageal hypomotility in 3 (19%), early achalasia 2 (13%), and normal motility in 7 (43%) patients. Twenty four hour pH monitoring revealed marked GO reflux in 2 (13%) patients and normal values in 2 (13%) patients.CONCLUSIONS: Since a significant proportion (44%) of our patients showed a positive result, we conclude that manometry and pH studies of the oesophagus are mandatory in the diagnosis of patients with persistent dysphagia and reflux symptoms as most motility disorders cannot be diagnosed only on endoscopy or radiology alone.