Browsing by Author "Tillakaratne, S.B."

Now showing 1 - 5 of 5

Image guided naso-jejunal tube placement in paediatric liver transplant patients in low resource settings: Feasibility, technique, and outcome
(Sri Lanka College of Paediatricians, 2024) Appuhamy, W.N.D.P.C.; Fernando, M.; Tillakaratne, S.B.; Gunathilake, M.B.; Ganewatte, E.; Gishanthan, S.; Jayakody, R.D.C.G.; Siriwardana, R.C.
No abstract available
The long-term quality of life following liver transplantation in a developing country with a free health care system
(The Sri Lanka Medical Association, 2022) Siriwardana, R.C; Gunetilleke, B.; Jayatunge, S.; Weerasooriya, A.; Niriella, M.A.; Dassanayake, A.S.; Ranaweera, S.P.; Tillakaratne, S.B.
INTRODUCTION: Developing countries with limited resources are yet to establish universal liver transplant (LT) services to cater to their population free of charge. In this unique setting, no data are published on the long-term Quality of life (QOL) of LT survivors. OBJECTIVES: Compare the long-term quality of life of post-liver transplant patients with a matching cohort of pretransplant cirrhotic patients and a matching non cirrhotic control group. Methods: Of the 45 liver transplants that were performed there were 24 patients who completed over 6 months of follow-up. Of these, 4 patients died (including one lost to follow-up) after six months. The remaining 20 post-transplant patients were the subjects for QOL assessment. One post-transplant recipient was matched with two pre-transplant cirrhotic patients and non-cirrhotic healthy control group. QOL was evaluated by the SF-36 questionnaire. RESULTS AND CONCLUSIONS: The median age was 54 years (27-67) and 85% (n=17) were male. The median follow up was 24 months (6- 94 months). The median MELD score was 17 (11-22) and 75% (n=15) were due to cryptogenic cirrhosis. Post-operatively three (15%) developed graft rejection, five (25%) had infections and ten (50%) suffered drug related complications. 95% (n= 19) of the population had satisfactory drug compliance. The study population had significantly better QOL compared to control in all eight domains (p<0.05) including physical functioning (76% vs 52.7%), physical health (80% vs 7.9%), emotional problems (93% vs 17.1%), energy (77% vs 47%), emotional wellbeing (80% vs 61.1%), social functioning (86.9% vs 56.9%), pain (82% vs 47.5%) and general health (67.5% vs 37.5%). The study population had similar quality of life compared to the healthy control group with better-perceived emotional well-being. CONCLUSION: Long-term survivors after LT have significantly improved QOL in a setting with limited resources
Reconstruction of the common hepatic artery with right gastro-epiploic graft during Whipple procedure
(College of Surgeons of Sri Lanka, 2017) Siriwardana, R.; Tillakaratne, S.B.; Shilpage, S.; Amaraweera, C.; Gunetilleke, B.
Solid pseudopapillary tumour of the pancreas: an uncommon pancreatic tumour in Sri Lanka
(The college of surgeons of Sri Lanka, 2024) Tillakaratne, S.B.; Cooray, S.; Gunetilleke, B.; Siriwardana, R.
INTRODUCTION AND OBJECTIVES Solid pseudopapillary tumour of the pancreas (PST) is a rare exocrine pancreatic tumour commonly involving the body and the tail of the pancreas. It's seen predominantly in young women. Even patients who present with metastatic disease have good survival after resection. We looked at our experience with this rare tumour. METHODS Prospectively collected proforma-based data were analysed.RESULTS 14 patients underwent surgery for PST from November 2011 to October 2022. 13 (93%) were females. The median age was 28 years (15-50). Nine (64.3%) patients presented with abdominal pain, and 3(21.4%) had an abdominal mass at presentation. Only 2(14.3%) patients were incidentally detected. The median tumour diameter was 7.2cm (218).7(50%) had involvement of the pancreatic body, 6(43%) had involvement of the head of the pancreas, and one had involvement of both the head and the body of the pancreas. Only one patient (7.14%) had liver metastasis at presentation. Distal pancreatectomy was performed in 6(43%), Whipple's pancreaticoduodenectomy in 6(43%), enucleation in 1(7.14%) and total pancreatectomy in 1(7.14%). In addition, liver metastasectomy was done in 1(7.14%) patient. There were no major complications. None received adjuvant treatment. At a median follow-up of 22 months, there were no recurrences. CONCLUSIONS PST in our cohort were in young females who had excellent survival after surgical resection. Involvement of the head of the pancreas was common compared to the predominantly distal disease in the available literature.
The long-term impact of postcholecystectomy major bile duct injury on liver stiffness
(BioMed Central, 2024-11) Jayasekara, A.; Tillakaratne, S.B.; Dasanayake, U.; Gishanthan, S.; Siriwardana, R.C.
INTRODUCTION Iatrogenic bile duct injuries (BDI) are a devastating complication. Long-term impact of corrective hepaticojejunostomy (HJ) for such injuries on post -surgery liver stiffness is lacking. Hence the aim of this study was to explore the extent of hepatic fibrosis in a cohort of patients with Strasberg E bile duct injuries who underwent HJ after a minimum follow-up of six months.METHODS Out of 50 BDI presented over a period of 10-years, 19 patients with Strasberg type E, injuries that underwent HJ and completed a minimum 6-month follow-up [65.5 (7 -108)] period were selected. Data were prospectively collected on liver functions and liver stiffness was assessed using a Fibroscan. Their liver stiffness and degree of fibrosis was compared with (n = 38) age, gender and comorbidity matched controls.RESULTS The median age was 47 (30-70) years, with 63% females. Primary HJ was performed in 84%, with a median time from injury to HJ of 7 (1-39) days. The total bilirubin was 16.5 (11.2) µmol/L, Alkaline Phosphatase was 102 (27.2) U/L, and Platelet count was 256 (77) x 103. Liver stiffness (median 6.4 kPa) did not significantly differ from controls (5.3 kPa). Fibrosis assessment revealed comparable distribution of F0 to F3 fibrosis between the study and control groups (F0/F1: 68.4% vs. 84.4%, F2: 10.5% vs. 9.4%). However, all three patients with right hepatic artery injury (p = 0.003) and three of five patients with bile duct stricture had F3/F4 fibrosis.CONCLUSIONS Major BDI repair demonstrates comparable liver fibrosis in the absence of artery injury and anastomotic strictures. Measuring liver fibrosis could be valuable in the presence of arterial injuries or anastomotic strictures.