Browsing by Author "Tillakaratne, M.S.B."

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An Audit on completeness of reporting Whipple's specimens
(College of Surgeons of Sri Lanka, 2020) Pelzom, T.; Tillakaratne, M.S.B.; Jaleel, M.S.A.; Pathirana, A.; Siriwardana, R.C.
INTRODUCTION: This Audit is focused on assessing the completeness of vital information in traditional reports of Whipple's procedure, using the Royal College of Pathologists data sets for pancreatic cancer reporting as the benchmark. We believe a standardized reporting system will take into account significant variables that may impact treatment quality. METHODOLOGY: This is a descriptive cross sectional study. A hundred and forty-three Whipple's histopathological reports were examined and compared to The Royal College of Pathologists data set for reporting of carcinomas of pancreas, ampulla of Vater and common bile duct. RESULTS: The length of the reports varied markedly with the shortest report having 156 words and the longest report having 1095 words. The median word count was 385 words. The frequency of reporting the variables varied too. Type of tumour was documented in 100% of reports whereas variables such as nodal stage and superior mesenteric artery resection margin were reported in only 76.9% and 35% of reports respectively, both having direct implications on prognosis. Further the frequency of reporting of the background pathology was low as 24.5%. CONCLUSIONS: Due to the descriptive nature of the traditional pathological reporting system, some of the significant variables can be missed while converting what is observed in to a report. This may impact adversely in planning adjuvant treatment and evaluation of prognosis after surgery. Adherence to a standardized synoptic reporting system may help to overcome this drawback. KEYWORDS: Whipple's, histopathology, synoptic reporting, pancreatic cancer, survival
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.
Standard local infiltration vs. additional laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: interim analysis of double blinded randomized control study
(Sri Lanka Medical Association, 2017) Tillakaratne, M.S.B.; Gunetilleke, B.; Kumarage, S.; Siriwardana, R.C.
INTRODUCTION & OBJECTIVES: Transverse abdominal plane block (TAP) is a new technique used in perioperative analgesia. It has shown a clear benefit in long laparoscopic procedures. Current trial evaluates its efficacy in uncomplicated laparoscopic cholecystectomy. METHODS: A single centre double blinded randomized control trial was designed with 45 patients to each group based on 80% power at a p<0.01. Patients who underwent elective uncomplicated laparoscopic cholecystectomy were randomized in to local port site infiltration of bupivacaine and additional TAP block groups. Primary efficacy variables were postoperative pain score and requirement for opioids measured every six hourly. Duration of immobilization and hospital stay were some of the secondary variables. An interim analysis was done at 8 months. RESULTS: Thirty eight patients were randomized to two groups. Twenty-two (58%) were given TAP blocks. The male:female ratio (p=0.24), age (p=0.4), indication for surgery (p=0.34), ASA (p=0.45) and BMI (p=0.58) were similar in the two groups. There was no difference in operating time (p=0.28), intraoperative findings (p=0.4) and the difficulty index (p=0.26). Six hourly pain scores till the time of discharge, total and six hourly opioid dose, number of vomiting episodes, total hospital stay (p=0.98) and time to mobilize out of the bed (p=0.63) were similar in the two groups. CONCLUSION: TAP block does not have an added advantage over standard port site infiltration in uncomplicated laparoscopic cholecystectomy.
Unequal distribution of liver fat warrants careful selection of biopsy site during donor assessment
(Sri Lanka Medical Association, 2017) Siriwardana, R.C.; Sivasundarama, T.; Tillakaratne, M.S.B.; Paranahewa, L.
INTRODUCTION & OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a major health concern. Liver fat deposition seems to have a segmental variation. This can affect invasive, and non-invasive detection of NAFLD. The present study evaluates the pattern of fat distribution of the liver using liver computed tomogram (CT) attenuation index. METHODS: Two radiologists evaluated 517 non-contrast CT abdomen and pelvis images. Two 40mm2 regions of interest (ROIs) were selected from each segment. The hepatic segmental densities were obtained by calculating the mean densities of areas of corresponding liver segments. The mean hepatic attenuation (MHA) was quantified by obtaining the mean segmental densities. Densities were compared among segments and with the MHA. RESULTS: The median age was 58 years (min-max: 9-88; IQR: 45-67) and 276 (53.4 %) were males. The overall median hepatic density (i.e. grand median) was 53.05 (95% CI 52.95-53.15) Hounsfield units (HU). Lowest median density was observed in segment IVb, significantly lower compared with other segments (p<0.05). Highest median segmental density was observed in segment V compared to other segments (p<0.05). Segments V, VI and VIII had higher median densities compared with grand median hepatic density (i.e. 53.05; whereas median densities of segments II, III and VII were not significantly different from the grand median. CONCLUSION: Liver biopsy taken from segments II, III and VII are likely to be the most representative of overall fat deposition.
Use of a rectus abdominis muscle cube to seal presacral venous haemorrhage
(College of Surgeons of Sri Lanka, 2014) Tillakaratne, M.S.B.; Ekanayake, C.S.; Wijenayake, W.; Deen, K.I.