Browsing by Author "Wijesuriya, S.R.E."

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Aortic patch reconstruction of superior mesenteric and celiac axis in a deceased donor liver transplantation
(Sri Lanka Medical Association, 2012) Marasinghe, N.C.; Siriwardana, R.C.; Wijesuriya, S.R.E.; Liyanage, C.A.H.; de Silva, H.J.
No Abstract available
Clinical outcome of patients having neo-adjuvant therapy(NAT) for rectal cancer: a case control study
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Wijesuriya, S.R.E.; Deen, K.I.; Hewavisenthi, J.; Ratnayake, G.
INTRODUCTION: From July i 999 we have employed NAT on a selective basis in the management of rectal cancer. OBJECTIVE: To explore the value of NAT in patients with rectal cancer in the short term. To study the effect of Neo Adjuvant Therapy for rectal carcinoma in the short term. METHODS: Two abdomino perineal resections and 24 anterior resections were done in the NAT group and 5 and 2 l in the no NAT group. There were 2 perioperative deaths in NAT group and one in the no NAT group (P 0.75). There were 7 Cancer related deaths in the NAT group and 6 in the no NAT group (P = l). The survival was 15 month (5 -45) for the NAT group and 16 (3 -54) for the non NAT group (P = I). There were no difference in the recurrences (2 vs 4 P ""0.67) metastasis (4 vs 4 P = 1) or complication (8 vs 2 p =0.08) abdomino perineal resections were performed in 2 patients in the NAT group and 5 in the no NAT group. Anterior resections were performed in 24 patients and 24 patients in NAT and no NAT groups. CONCLUSION: Overall there was no significant difference in the clinical out come between those given NAT and those not given.
Complete pancreatic transection in a child treated by drainage and sphincterotomy
(Lippincott Williams & Wilkins, 2010) Siriwardana, R.C.; Wijesuriya, S.R.E.; Marasinghe, A.; de Silva, M.; Deen, K.I.
Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: A prospective clinical audit
(Pergamon Press, 2008) Rathnayake, M.M.; Kumarage, S.K.; Wijesuriya, S.R.E.; Munasinghe, B.N.L.; Ariyaratne, M.H.J.; Deen, K.I.
INTRODUCTION: Patients who have a temporary loop ileostomy have impaired quality of life. Complications associated with a loop ileostomy orileostomy closure will impair patients' quality of life further and require extended enterostomal therapy. We performed a prospective audit of loop ileostomy to ascertain the nature of the workload that may be created with ileostomy-related complications. PATIENTS AND METHODS: One hundred and forty patients (67 males, 73 females, median age 50 years, range 5-90 years) who received a temporary loop ileostomy were analysed after completion of proformas on a prospective basis between 1999 and 2006. RESULTS: Operation was performed for rectal cancer 100 (71%), familial adenomatous polyposis 14 (10%), ulcerative colitis 21 (15%) and for trauma or Hirchsprung's disease 5 (3%). Complications of loop ileostomy were: retraction 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), parastomal hernia 1 (0.7%), paraileostomy abscess 4 (3%) and severe skin excoriation 9 (6%). The loop ileostomy was reversed in 117 (83%) at a median (range) of 13 weeks (1-60). Ileostomy closure-related complications were: small bowel fistula 1 (0.9%), small bowel obstruction 5 (4.3%) and a stitch sinus in 1 (0.9%). Five women developed recto-vaginal fistula (n=3; 2.6%), pouch-vaginal fistula (n=1; 0.9%) and pouch-anal fistula (n=1; 0.9%) that required extended enterostomal therapy, after loop ileostomy reversal. CONCLUSION: Nineteen percent of patients following creation of a loop ileostomy and 10.5% of patients after reversal of the ileostomy requiredextended enterostomal care by a specialized enterostomal therapist, which supported resumption of a normal life.
Cryptogenic cirrhosis is the leading cause for listing for liver transplantation in Sri Lanka
(Springer India, 2013) Siriwardana, R.C.; Niriella, M.A.; Liyanage, C.A.H.; Wijesuriya, S.R.E.; Gunetilleke, B.; Dassanayake, A.S.; de Silva, H.J.
Hepatitis B and C are rare in Sri Lanka. Nonalcoholic fatty liver disease is increasing in the country. Eighty-one patients referred for liver transplantation (LT) over a period of 18 months were prospectively evaluated. Ninety-two percent (n = 74) were males. Cryptogenic cirrhosis was the leading indication for LT (58%, n = 47) followed by alcohol in 27% (n = 33). Hepatitis B and C were not seen in our cases. The liver biochemistry and clinical status of cirrhosis were similar in cryptogenic and alcoholic cirrhotics. Fourteen patients died while waiting for transplant, and nine transplants were performed. Cryptogenic cirrhosis is the leading cause for LT in Sri Lanka.
Detection of micrometastases in lymph nodes using reverse transcription polymerase chain reaction (RT-PCR) for cytokeratin 20 (CK-20)--a pilot study
(Sri Lanka Medical Association, 2010) Wijesuriya, S.R.E.; Kuruppuarachchi, K.G.; Weerasinghe, A.; Hewavisenthi, J.; Deen, K.I.
OBJECTIVES: The aim of the study was to detect micrometastases in lymph nodes in patients with rectal cancer following neoadjuvant therapy, staged node negative by routine histology. PATIENTS AND SETTING: Mesenteric lymph nodes from patients who have undergone neoadjuvant therapy for rectal cancer were harvested during surgery. Nodes were bisected and one half was sent for haematoxylin and eosin (H&E) staining and evaluated by a single pathologist. The other half was examined for CK20 by RT-PCR. The technique was validated by testing mesenteric lymph nodes with known metastases and nodes from patients without cancer. Twenty one lymph nodes from 6 patients (median age 46 years, range 25- 55) which were negative for tumour deposits by H&E stain were assessed for micro-metastases. RESULTS: All 21 nodes which were histologically negative for metastases were positive for micrometastases. Two nodes with known metastases were positive for CK20 and 3 nodes from non cancer patients were negative for CK20.CONCLUSIONS: Detection of CK20 is accurate in identification of rectal cancer micro-metastasing to lymph nodes. Assessment of nodes by H & E histology risks under staging
Detection of micrometastasis in LYMPH nodes using reverse transcription polymerase chain reaction (RT-PCR) for Cytokeratin 20 (CK-20): are we under staging rectal cancer
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Wijesuriya, S.R.E.; Kuruppuarachchi, K.O.R.; Deen, K.I.; Weerasinghe, A.; Ramesh, R.; Hewavisenthi, J.
INTRODUCTION: Postoperative adjuvant chemotherapy in rectal cancer is determined by the presence of metastases in lymph nodes. Detection of LYMPH node metastases is routinely performed by light microscopy. Conventional histology may not detect all metastases especially following neoadjuvant therapy (NAT). CK-20 is a cytokeratin known to be specific to colonic epithelium which may help detection of rectal cancer metastases in lymph nodes. OBJECTIVE: To detect micro metastases in lymph nodes in patients with rectal cancer. staged node negative by routine histology. METHODS: Mesenteric lymph nodes from patients who have undergone NAT for rectal cancer were harvested during surgery. Nodes were bisected and one half sent for Haernatoxylin and eosin (H&E) staining and evaluated by a single pathologist, while the other half was examined for CK 20 by RT-PCR. The technique was validated by testing lymph nodes with known metastases and nodes from patients without cancer. 21 lymph nodes from 6 patients (median age 46 years, range 25-55) which were negative for tumour deposits by H&E stain were assessed for micro metastases. RESULTS: All 2 l nodes which were histologically negative for metastases were positive for micro metastases (positive predictive value l 00%) whilst 2 nodes with known metastases were positive for CK-20, 3 nodes from non-cancer patients were negative for CK-20. CONCLUSION: Detection of CK-20 is accurate in identification of micro metastases of rectal cancer to lymph nodes. Assessment of nodes by H&E histology risks under staging lymph node micro metastases in rectal cancer.
Education and imaging. hepatobiliary and pancreatic: carcinoid tumor with cystic liver metastases
(Wiley-Blackwell, 2010) Wijesuriya, S.R.E.; Siriwardana, R.; Deen, K.I.
No Abstract Available
Eversion thrombectomy for partial portal vein thrombosis during living donor liver transplantation
(College of Surgeons of Sri Lanka, 2012) Siriwardana, R.C.; Wijesuriya, S.R.E.; Liyanage, C.A.H.
No Abstract Available
Gall bladder cancer and Mirizzi syndrome: alternative explanation to the common belief
(Wiley-Blackwell Pub. Asia, 2010) Wijesuriya, S.R.E.; Delriviere, L.; Mitchell, A.
No Abstract Available
Inflammatory pseudotumour of the liver caused by a migrated fish bone
(Sri Lanka Medical Association, 2007) Perera, M.T.P.R.; Wijesuriya, S.R.E.; Kumarage, S.K.; Ariyaratne, M.H.J.; Deen, K.I.
No Abstract Available
Liver transplantation - initial experience at Colombo North Liver Transplantation Service
(Sri Lanka Medical Assosiation, 2012) Bogamuwa, M.M.M.P.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Wijesuriya, S.R.E.; Liyanage, C.A.H.; Gunetilleke, M.B.; de Silva, H.J.
INTRODUCTION: Liver transplantation (LT) is the treatment of choice for end stage liver diseases. LT is still in its infancy in Sri Lanka. AIMS: To describe the initial experience of the Colombo North Liver Transplantation Service (CNLTS) METHODS: The study population included all patients referred for LT to CNLTS. All cases were evaluated for the indication and medical, social and psychological suitability for LT. Decision to list patients for LT was reached by a multidisciplinary team consisting of surgeons, physicians and anaesthetists. All data were collected prospectively. RESULTS: 52 patients were referred for LT over a period of 7 months. 48/52[92.3%) were males. The median age at referral was 52(range 13-66) years. The median Child-Turcotte-Pugh(CTP) score at referral was 9/15(range 5-13/15). Median Model for End Stage Liver Disease (MELD) score at referral was 17(range 9-26). 3/52(5.8%) had hepatocellular carcinoma and 9/52(17.3%) had a low MELD score (<14) but with life threatening complications of cirrhosis as indication. 4/9(44.4%) of those being upper gastrointestinal bleeds from varices. 28/52(53.8%) of the referrals had cryptogenic cirrhosis (CC), 18/52(34.6%) had alcoholic cirrhosis, 2/52(3.8%) each had metabolic, congenital and other causes for cirrhosis. 7/52(13.5%) transplants were performed [3 Live Donor LTs(LDLT) and 4 Deceased Donor LTs(DDLT)]. 5/7(71.4%)[2 - LDLT, 3 -DDLT] had a successful LT outcome. 11/45(24.4%) patients died while on the LT waiting list. CONCLUSIONS: High MELD CC was the commonest reason for referral for LT in our group. There was a high waiting list mortality highlighting the need for an efficient DDLT service.
Locally advanced breast cancer as a possible portal of entry in a patient with tetanus
(Sri Lanka Medical Association, 2007) Wijesuriya, S.R.E.; Wijesuriya, M.T.W.; Perera, M.T.P.R.; de Zylva, S.T.U.; Deen, K.I.
No Abstract Available
Long distance travel prior to major surgical procedure: Does it have an impact on post operative pulmonary embolism
(Springer Nature, 2009) Wijesuriya, S.R.E.; Delriviere, L.D.; Mitchell, A.W.
BACKGROUND: Long distance travel is a known risk factor for venous thrombo-embolism. In our hospital approximately 15% of surgical procedures are performed on patients from the country, needing prolong travel. The purpose of this study is to evaluate whether prolong travel prior to a surgical procedure increases the risk for post operative pulmonary embolism (PE). METHODS AND MATERIALS: Thirty patients with post operative pulmonary embolism confirmed by Computed Tomography Pulmonary Angiogram (CTPA), perfusion scan or by post-mortem, diagnosed during the same hospital admission were evaluated. Patients were categorised in to two groups, who travelled from the country or from metropolitan area in view of hospital admission. RESULTS: Operations in 25 metropolitan patients (12 males, 13 females, median age:71years, range:25-97, median distance:26km, range:5-55), and in five country patients (four males, one female, median age:65, range:33-73, median distance:183km, range:133-425) were complicated by post operative PE. Whilst 17 of 25 metropolitan patients (68%) received peri-operative prophylaxis against DVT/PE (pre-operatively or within 24hours of procedure), four of five patients (80%) from the country received prophylaxis. CONCLUSIONS: Long-distance travel prior to hospital admission seems to have no impact on the incidence of postoperative PE, as the proportion of country patients with postoperative PE (15%) is comparable to the proportion of country patients operated in a metropolitan hospital. Therefore the current policy of perioperative prophylaxis is adequate. Extended prophylaxis prior to initiation of travel seems unnecessary. © 2009 Indian Association of Cardiovascular-Thoracic Surgeons. AUTHOR KEYWORDS: Computed tomography; Pulmonary embolism; Surgery
Neoadjuvant therapy for rectal cancer down-stages the tumor but reduces lymph node harvest significantly
(Springer International, 2005) Wijesuriya, S.R.E.; Deen, K.I.; Hewavisenthi, J.; Balawardana, J.; Perera, M.
PURPOSE: The impact of neoadjuvant therapy (NAT) for rectal cancer on lymph node yield is not well known. This study evaluates the impact of NAT on tumor regression and lymph node harvest. METHODS: The subjects were 40 patients with rectal cancer; 20 receiving high-dose, long-course neoadjuvant therapy, and 20 age- and sex-matched controls who did not receive neoadjuvant therapy. Tumor regression (TRG) was graded from 1 to 5 as: TRG1, no residual tumor cells; TRG2, occasional residual tumor cells with marked fibrosis; TRG3, marked fibrosis with scattered tumor cells or groups; TRG4, abundant cancer cells with little fibrosis; TRG5, no tumor regression. We also evaluated the number of lymph nodes retrieved from excised specimens, the size of the largest node, and the extent of lymph node involvement by the tumor. RESULT: Tumor regression was seen in all patients; as TRG1 in 6 (30%), TRG2 in 2 (10%), TRG3 in 3 (15%), and TRG4 in 9 (45%). The median nodal harvest was 4 (range (0-12) in the NAT group vs 9 (range 1-19) in the control (P = 0.001). The median size of the largest lymph node was 5 mm (range 2-12 mm) in the NAT group vs 9 mm (range 4-15 mm) in the control group (P = 0.004). Tumor-positive nodes were identified in 4 of 17 of the NAT group patients and in 9 of the 20 controls (P = 0.308). CONCLUSION: Although NAT down-stages rectal cancer, it results in a significantly low yield of lymph nodes, which are also significantly smaller than those in nonirradiated controls. Therefore, surgeons and histopathologists must ensure adequate sampling and accurate staging is done for patients with irradiated rectal cancer.
Obstructive jaundice caused by a biliary mucinous cystadenoma in a woman: a case report
(BioMed Central, 2013) Chandrasinghe, P.C.; Liyanage, C.; Deen, K.I.; Wijesuriya, S.R.E.
INTRODUCTION: Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition is more common in young women and accounts for non-specific symptoms. Cyst adenomas commonly affect the intrahepatic system (90%) and are rarely found in the extrahepaticbiliary system or affecting both the systems. CASE PRESENTATION: A 39-year-old Sinhalese woman presented with features of obstructive jaundice and was found to have a biliaryneoplasm on imaging. In the absence of a definitive diagnosis despite extensive imaging she underwent preoperative endoscopic biliarydrainage followed by a left hemihepatectomy with Roux-en-Y hepaticojejunostomy. A pathological examination of the specimen revealed an obstruction of the bile duct caused by a biliary mucinous cystadenoma affecting both the intrahepatic and extrahepatic systems. CONCLUSIONS: Biliary mucinous cystadenoma rarely present with obstructive jaundice affecting both intrahepatic and extrahepatic ducts. Exhaustive investigation might not help in the diagnosis and may need to be treated based on clinical judgment. The definitive treatment modality is surgery due to its malignant potential. The operative procedure is technically demanding and is best performed at specialist centers to minimize complications. © 2013 Chandrasinghe et al.; licensee BioMed Central Ltd.
Patients with rectal cancer having neoadjuvant chemoradiation do not have increased complications of ileostomy closure
(Sri Lanka Medical Association, 2010) Wijesuriya, S.R.E.; Hewavisenthi, J.; Deen, K.I.
OBJECTIVES: It is conceivable that reversal of an ileostomy after low anterior resection following neoadjuvant therapy (NAT) may involve anastomosis of small bowel exposed to irradiation. The aim was to evaluate peri-operative complications of ileostomy closure and to compare the histology of ileal mucosa in excised stomas in patients who received NAT with those without NAT. METHODS: Twenty patients who underwent rectal excision following NAT for cancer, were compared with 20 control patients who underwent rectal excision without NAT. All patients received a diverting loop ileostomy which was subsequently reversed with excision of the ileostomy. The clinical outcome and histopathological features after reversal were evaluated. RESULTS: There was no significant difference with regard to peri-operative complications such as post-operative deaths related to ileostomy closure, anastomotic leakage, retraction of stoma or small bowel fistulae. Resection margins revealed no significant difference in crypt distortion, depletion of mucin, acute inflammation, chronic inflammation and infiltration of eosinophils following NAT compared with Controls. CONCLUSIONS: Neoadjuvant therapy for rectal cancer does not result in higher morbidity following closure of diverting loop ileostomy or result in significant inflammatory changes in the ileum. Therefore ileostomy closure is as safe in those with preoperative radiotherapy as in those without neoadjuvant therapy.
Patients' experience and quality of life with a loop ileostomy
(College of Surgeons of Sri Lanka, 2000) Wijesuriya, S.R.E.; Rathnayake, G.; Deen, K.I.
Background: Temporary proximmal faecal diversion has been either loop ileostomy or loop colostomy. Recently, loop ileostomy has been preferred over loop colostomy. This study evaluated patient's quality of life with a temporary diverting loop ileostomy. Patients and methods: Life quality of 25 (8 males, median age 40 years, range 22-70 years) patients who underwent creation of a loop ileostomy at the university surgical unit of North Colombo General Hospital were evaluated using self-administrated structured questionnaire. Responses were obrained for ten life quality questions on visual analogue rating scale (0-100mm) and graded good (71-100), satisfactory (31-70) or poor (0-30). Results: Twenty four (96 percent ) patients were able to purchase their stoma appliances without much difficulty. Almost all patients reported a tolerable ileostomy effluent. Seventeen (94 percent ) of 18 patients reported abstinence from sexual activity. A loop ileostomy had no effect on appetite in 60 percent , travel by public transport on 20 percent , and dress in 8 percent , or activities of daily living in 20 percent of patients. Conclusion: A loop ileostomy seems to impair quality of life in most patients. Strained sexual relationships appear to be the most distressing problem. Most patients are able to bare the cost of their stoma appliances.
The Prevalence of colorectal cancer and survival in patients from the Gampaha District, North Colombo region
(Sri Lanka Medical Association, 2008) Perera, T.; Wijesuriya, S.R.E.; Suraweera, P.H.R.; Wijewardene, K.; Kumarage, S.K.; Ariyaratne, M.H.J.; Deen, K.I.
INTRODUCTION: The prevalence and survival of colorectal cancer in Sri Lankans has not been previously reported. We did a retrospective and a prospective survey, in the region of North Colombo, Sri Lanka between 1992 and 2004. The aim was to study cancer burden, sites of colorectal cancer and survival after surgery. PATIENTS AND METHODS: The records of 175 patients with colorectal cancer between 1992 and 1997 in the selected region of were analysed retrospectively. A prospective study was performed in 220 new patients with colorectal cancer between 1996 and 2004. Data evaluated were demographics, tumour stage and survival. RESULTS: Between 1992 and 1997 the crude annual incidence of colorectal cancer was 1.9 per 100,000, which increased over the years. The current national crude annual incidence is 3.2 per 100,000 in women and 4.9 in men. Median age at presentation was 60 years with similar prevalence of cancer in men and women. In the entire group, 28% of cancers were in those less than 50 years old. Survival at 2 and 5 years was 69% and 52%. The majority of cancer related deaths were within the first 2 years after surgery. CONCLUSION: The burden of colorectal cancer in Sri Lanka is on the rise. Up to a third of cancers occur in those under 50 years, and the majority of cancers are in the rectum or rectosigmoid region. Flexible sigmoidoscopy offers a useful screening tool.
Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy
(Wiley-Blackwell, 2008) Perera, M.T.; Deen, K.I.; Wijesuriya, S.R.E.; Kumarage, S.K.; de Zylva, S.T.U.; Ariyaratne, M.H.J.
INTRODUCTION: The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy. METHOD: Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C). RESULTS: More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream--13%vs 38%, P = 0.001 and 21%vs 21%, P = NS; incontinence--4.2%vs 17%, P = 0.008 and 8%vs 8%, P = NS; hesitancy--13%vs 35%, P = 0.034 and 17%vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men--62.5%, women--25%vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision--50%vs segmental colectomy - 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial