Browsing by Author "Uragoda, B."

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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.
Presence of fatty liver disease leads to unusual rise of liver enzymes in patients with common bile duct colic
(Korean Association of Hepato-Biliary-Pancreatic Surgery, 2021) Uragoda, B.; Ediriweera, D.; Paranahewa, L.; Ekanayake, C.; Tillakarathna, S.; Siriwardana, R.
INTRODUCTION: This study compares liver enzymes, inflammatory markers and bilirubin levels in patients with and without fatty liver disease (FLD) presenting with common bile duct (CBD) obstruction. METHODS: CBD colic was diagnosed based on clinical, radiological and biochemical criterion. Presence of FLD was diagnosed by ultra sound scan and the macroscopic appearance of liver during surgery. Liver enzymes, inflammatory markers and bilirubin levels were prospectively assessed and compared between the two groups. RESULTS: Out of 42, there were 22 (52.3%) patients with FLD. Median body mass index was 26.9 (24.1–30.8) in fatty liver group compared to 25.7 (23.5–26.2) in others. Individuals with FLD showed high aspartate transaminase (558.5 vs. 247.0, p = 0.005), alanine trasaminase (467 vs. 228.5, p = 0.005) and bilirubin (3.8 vs. 2.2, p = 0.015) levels compared to those without FLD. According to multiple linear regression models, high AST and ALT levels showed significant associations with FLD after adjusting for age, gender, body mass index, amylase and C reactive protein levels. The median enzyme level at two weeks did not show a difference among patients with and without FLD. CONCLUSIONS:Presence of FLD causes unusual rise of AST and ALT levels in patients with CBD stones. This rise is transient.
Primary squamous cell cancer of the liver- a rare complex cystic liver lesion
(College of Surgeons of Sri Lanka, 2021) Fernando, K.J.D.; Jayathilake, H.; Uragoda, B.; Tillakerathne, S.; Siriwardana, R.C.
No abstract available
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.