Browsing by Author "Tillakaratne, S."

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An ABO-incompatible living donor liver transplant in an infant with acute liver failure in the Sri Lankan setting
(The Sri Lanka Medical Association, 2023) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Dissanayake, J.; Siriwardana, R.
Liver transplant (LT) is the standard therapy for medically refractory acute liver failure (ALF). Finding a deceaseddonor graft in an emergency is challenging and often overcome by living-donation. Blood group matching is practised for LT though ABO-incompatible liver transplant (ABOi-LT) is performed inselected circumstances. We report an infant who underwent successful ABOincompatible living donor LT for ALF of unknown aetiology. This being the country’s first ABOi-LT, the youngest LT recipient to date and the youngest receiving emergency LT for ALF; we describe the novel experience at a resource-limited setting in Sri Lanka (SL).
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in a hepatocellular carcinoma patient with inadequate remnant liver volume
(College of Surgeons of Sri Lanka, 2017) Siriwardana, R.; Tillakaratne, S.; Kumarasinghe, P.; Gunetilleke, B.
Burden of functional gastrointestinal disorders in a surgical clinic in Sri Lanka
(College of Surgeons of Sri Lanka, 2020) Priyantha, A.; Tillakaratne, S.; Gamage, P.K.W.; Nagalingam, S.; Dombagahapathirage, E.P.
INTRODUCTION: Making a positive diagnosis of functional gastrointestinal disorders based on the patterns of symptoms allows the clinician to manage the patients without further investigations (treat and test strategy) to exclude an organic disorder (test and treat strategy). The objectives were to diagnose and classify the functional gastrointestinal disorders according to Rome III criteria among the patients attending to a Gastrointestinal surgery clinic and to assess the effectiveness of the treat and test strategy. METHODOLOGY: In a prospective study data were collected from consecutive patients who were likely to have functional gastrointestinal disorders. Diagnosis and classification were performed by an interviewer administered Rome III questionnaire. They were then treated according to their symptoms and considered for further investigations or only follow up depending on the response. RESULTS: There were 103 patients with “likely FGID” among 665 clinic patients (15.4%) over six-month period. Eighty-two patients fulfilled the Rome III criteria (79.6 %). Forty-nine patients had single FGID (59.7%) whereas 33(40.2%) patients had overlap symptoms. Eighty-one patients (78.6 %) have been followed up for a mean duration of 12.3 months. Sixty-five patients (80.2 %) underwent investigations whereas sixteen patients had only followed up (19.8 %). Three patients (3.7 %) were diagnosed with organic illness during the follow up. CONCLUSION: Functional gastrointestinal disorders are common among our patients. Making a positive diagnosis initially can avoid unnecessary investigations. Close follow up is necessary to avoid false negatives if empirical treatment (algorithmic approach) is used in the initial management. KEYWORDS: Follow up, functional gastrointestinal disorders, Rome III, symptoms
Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service
(Wiley, 2024) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Uragoda, B.; Welikala, N.; Ranaweera, L.; Ganewatte, E.; Dissanayake, J.; Mudalige, A.; Siriwardana, R.
ABSTRACT: BACKGROUND: Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS: A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS: There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS: Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.
Immediate outcome of microwave ablation for liver tumours in a single cohort of patients in Sri Lanka.
(The College of Surgeons of Sri Lanka, 2022) Appuhamy, C.; Ganewatte, E.; Ranaweera, L.; Dassanayake, A.S.; Gunetilleke, M.B.; Tillakaratne, S.; Gunawardena,H.P.; Niriella,M.A.; Siriwardana,R.C.
Introduction and Objectives Microwave ablation (MWA) is an emerging treatment modality for hepatocellular carcinoma (HCC) and other liver tumours. We aimed to assess the immediate success and complications of MWA in a cohort of patients. Method Patients were assessed retrospectively, using an intervieweradministered questionnaire and a follow-up CECT/MRI at, 6-week.Result 55 patients underwent MWA from October 2021-May 2022, at Colombo-North Teaching Hospital, Ragama, Sri Lanka, and selected private hospitals( Durdans Hospital, Colombo, Nawaloka Hospital, Colombo, Lanka Hospital, Colombo).The median age was 64 (40-82) years, with a male preponderance (n=45, 81.1%). The indication was HCC in 54 (98.1%) and metastatic tumour in one (1.8%). The median tumour size was 28 (10-80) mm. Segment VII was the commonest site to be involved (n=18, 34.6%). The majority (n=40, 72.7%) was a single lesion. No participant underwent the procedure twice. The mean post-procedural hospital stay was 12 hours (95%CI=11.4-12.5, SD=2.0).In the 6-week follow-up, 2 recurrences (3.6%) and single death (1.8%) with no relation to the procedure, were reported. Another 2 (3.6%) denied the follow-up. Complete ablation was reported in 46 patients (83.7%), comparable to the rates in literature (95-97%), with only 7 patients (12.7%) having residual tumours. No major complications were reported. 9 patients (16.4%) developed 'Post ablation syndrome', not as common as in literature (34%). They presented with abdominal pain (7.3%), vomiting (7.3%), and fever (3.6%).Conclusion MWA is a successful and safe treatment option for primary liver tumours in Sri Lanka, with ablation rates comparable to the western world.
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.
A prospective study on drain fluid amylase as an indicator of clinical outcome in patients undergoing Whipple surgery
(Sri Lanka Medical Association, 2023) Gishanthan, S.; Tillakaratne, S.; Bulathsinhala, B.S.K.; Uragoda, B.; Siriwardana, R.C.
INTRODUCTION: Post-Whipple pancreatic fistula is defined as having a high drain fluid amylase (DFA) (>3 times of normal value). In our observation, DFA levels did not influence the clinical outcome. OBJECTIVES: To determine the drain fluid amylase levels on the outcome of patients METHODS: 48 patients who underwent the Whipple procedure from May 2015 to September 2019 were included. Serum amylase and DFA levels were assessed on days 1,3 and 5. Amylase levels were compared with the patient’s outcome and the nature of the pancreas. RESULTS: 20 patients had DFA over three times on day 1. Their median hospital stay (HS) and ICU stay did not differ from others (HS 8 vs. 9 days, p=0.545; ICU stay 3 vs. 3 p=0.95). On day three 15 patients had DFA rise and their hospital stay (HS) and ICU were comparable. (HS 8 vs. 9 days (p=0.083), ICU stay 3 vs 3 p=0.26). On day five 5 patients had DFA over three times and their median hospital stay (HS) and ICU stay were similar. Nature of the pancreas also did not correlate significantly with DFA more than 3 times. Although patients with DFA more than 3 times of normal value on day 1,3, and 5 had smaller duct diameter (D1 2.78mm vs 4.25mm p=0.86; D3 2.08mm vs 4.42mm p=0.165; D5 4.10mm vs 1.86mm p=0.44) non was statistically significant. CONCLUSIONS: DFA > 3 times on Day1,3 and 5 did not significantly alter the outcome of patients.
Role of interventional radiology in paediatric liver transplantation
(Sri Lanka Medical Association, 2023) Fernando, M.; Gunetilleke, B.; Tillakaratne, S.; Siriwardana, R.C.; Appuhamy, W.N.D.P.C.; Padmasiri, U.G.M.
INTRODUCTION: Interventional radiology advances have rendered it attainable to treat many of the complications of liver disease in a minimally invasive manner, and they play a major role in liver transplantation. OBJECTIVES: We aimed to assess the role of interventional radiology in a cohort of paediatric liver transplant patients. METHODS: Thirteen paediatric patients underwent liver transplantations from July 2020–February 2023 at Colombo-North Teaching Hospital, Ragama. Seven patients (53.84%) required special interventional radiological procedures. The need for an interventional radiological procedure was decided by a multidisciplinary team. A retrospective database was maintained with demographic and liver transplant data. RESULTS: Four patients (57.14%) requiring radiological intervention underwent procedures involving the thoracic cavity, and 5 patients (71.42%) who required radiological intervention underwent procedures involving the abdominal cavity. Two patients (28.57%) out of the seven who had interventional radiological procedures went through both abdominal and thoracic radiological interventions. As abdominal radiological interventions, splenic artery embolization (20%), hepatic venous stenting (20%), subhepatic drain placement (20%), and two abdominal pigtail drain insertions (40%) have been done. Four patients underwent pigtail insertion, which was performed as a thoracic radiological intervention. CONCLUSIONS: Interventional radiology plays a crucial role in the management of paediatric post-liver transplantation patients
Umbilical vein herniating as a hernia in a cirrhotic: a tale of complexity
(Wiley-Blackwell Publishing Asia, 2024-10) Shanthamoorthy, G.; Siriwardana, R. C.; Tillakaratne, S.; Ahamed, M. A. A.; Serasinghe, S.G.S.
No abstract available