Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Single incision laparoscopic surgery (SILS) as surgical option in Crohn’s disease: our experience(Wiely-Blackwell, 2016) Leo, A.; Samaranayake, S.F.; Hodgkinson, J.D.; Santorelli, C.; Chandrasinghe, P.C.; Warusavitarne, J.H.AIM: Single Incision Laparoscopic Surgery (SILS) is a newer mini-invasive. Benefits of SILS in complex Crohn’s disease (CCD), which includes a significant cohort of young patients sometimes needing multiple operations has not been comprehensively assessed. This study analyses our early experience. METHOD: Data were collected prospectively from January 2013 to December 2015. Ileocolic resections, right hemicolectomy, small bowel stricturoplasties and resections SILS were included in the CCD cohort. Primary and re-do surgeries were analysed separately. RESULTS: A total of 45 patients were included: 39 ileocolic resections, 6 small bowel stricturoplasty/resections. Median hospital stay was 8 days (Range - 3 days – 28 days). Three patients from primary (11%) and 2 from re-do group (11%) had to be converted to open surgery. Total complication rate was 35.5% including 31.1% ClavienDindo 1 and 2. In term of operating time, average blood loss, conversion rates, complication rate and hospital stay, there was no significant difference between the groups. Six months follow-up showed no major complications. CONCLUSION: We have demonstrated the feasibility of SILS in patients with CCD. There were no significant differences between primary and re-do surgeries. More robust data and longer follow-up is needed in future studies to evaluate this further.Item Single incision laparoscopic surgery (SILS) for primary surgery in medically refectory ulcerative colitis: a case series(Wiely-Blackwell, 2016) Chandrasinghe, P.C.; Leo, C.A.; Samaranayake, S.F.; Santorelliei, C.; Strouhal, R.; Warusavitarne, J.INTRODUCTION: Medically refractive ulcerative colitis (UC) requires surgical intervention. Due to the ongoing inflammation in the colon this patient group is considered as high risk. Primary surgery includes subtotal colectomy (STC) as the first step of a staged restorative procedure, restorative proctocolectomy (RPC) or panproctocolectomy (PPC) with end ileostomy. Single incision surgery is gaining popularity in this group of patients. METHOD: Patients who underwent single incision surgery for medically refractory UC from 2013 January to 2015 December were prospectively followed up. Demographics, hospital stay and early complications were analyzed. Mann-Whitney U test was used to compare the medians. RESULTS: A total of 34 patients (male – 24, median age – 41.5 years; range 17–69 years) were included. There were 21 STCs, 9 PPCs and 4 RPCs done as primary surgery for medically refractory UC. The median hospital stay was 7 days (4–41 days). Four out of 34 patients had a complication with Clavien-Dindo score above 3; (2-re-operation for obstruction (5%), 2 required intensive care for sepsis (5%). Two procedures (5.8%) had to be converted strategically to open. Three patients had cancer in the resected specimen. The median age of those who had PPC was significantly higher compared to those who had restorative procedures (48 years: range 17–69 Vs 38 years: range 34–64; P < 0.005). CONCLUSION: Single incision surgery for medically refractory UC is safe with an acceptable complication profile in this group of medically unwell patients. The quality of life implications of this procedure require further evaluation.Item Single Incision Laparoscopic Surgery (SILS) as surgical option in Crohn's disease: our experience(Wiely-Blackwell, 2016) Leo, C.A.; Samaranayake, S.F.; Hodgkinson, J.D.; Santorelli, C.; Chandrasinghe, P.C.; Warusavitarne, J.AIM :Single Incision Laparoscopic Surgery (SILS) is a newer technique which is increasing in popularity. The benefit of SILS in complex Crohn's disease (CCD), which includes a significant cohort of young patients sometimes needing multiple operations has not been comprehensively assessed. This study analyses our early experience with this technique. METHOD: Patients who underwent SILS for CCD were included. Data were collected prospectively from Januray 2013 to December 2015. Ileocolic resections, right hemicolectomy, small bowel stricturoplasties and resections were included in the CCD cohort. Primary and re-do surgeries were analysed separately. RESULTS: A total of 45 patients were included: 39 ileocolic resections, 6 small bowel stricturoplasty/resections. Of the total, 27 were primary resections and 18 were re-do resections. In overall, the median age was 41 years (Range – 14 years–72 years), the median hospital stay was 8 days (Range - 3 days–28 days). Three patients from primary (11%) and 2 from re-do group (11%) had to be converted to open surgery. Total complication rate was 35.5% including 31.1% Clavien Dindo 1 and 2. In term of operating time, average blood loss, conversion rates, complication rate and hospital stay, there was no significant difference between the groups. Six months follow-up showed no major complications. CONCLUSION:We have demonstrated the feasibility of SILS in patients with CCD undergoing both primary and re-do surgeries. There were no significant differences between the two groups. More robust data and longer follow-up is needed in future studies to evaluate this further.Item Single incision laparoscopic surgery (SILS) for primary surgery in medically refectory ulcerative colitis: a case series(Wiely-Blackwell, 2016) Chandrasinghe, P.C.; Leo, C.A.; Samaranayake, S.F.; Santorelli, C.; Strouhal, R.; Warusavitarne, J.AIM:Medically refractive ulcerative colitis (UC) requires surgical intervention. Primary surgery includes subtotal colectomy (STC), restorative proctocolectomy (RPC) or panproctocolectomy (PPC) with end ileostomy. Single incision surgery is gaining popularity in this group of patients. METHOD: Patients who underwent single incision surgery for medically refractory UC from 2013 January to 2015 December were prospectively followed up. Demographics, hospital stay and early complications were analysed. RESULTS: A total of 34 patients were included. There were 21 STCs, 9 PPCs and 4 RPCs done as primary surgery for medically refractory UC. The median hospital stay was 7 days (range: 4–41 days). Four out of 34 patients had a complication with Clavien-Dindo score above 3; (2-re-operation for obstruction (5%), 2 required intensive care for sepsis (5%). Two procedures (5.8%) had to be converted strategically to open. Three patients had cancer in the resected specimen. The median age of those who had PPC was significantly higher compared to those who had restorative procedures (48 years: range 17–69 vs 38 years: range 34–64; P < 0.005). CONCLUSION: Single incision surgery for medically refractory UC is safe with an acceptable complication profile. The quality of life implications of this procedure require further evaluation.Item Laparoscopically detected and nonsurgically managed ileal perforation by an ingested fish bone: a case report.(BioMed Central, 2015) Chandrasinghe, P.C.; Pathirana, C.K.INTRODUCTION: Ileal perforation due to fish bone is a rare event. The condition is difficult to diagnose due to lack of specific clinical features and low sensitivity of imaging techniques. We report a case of ileal perforation by a fish bone that was detected laparoscopically and managed nonsurgically. CASE PRESENTATION: A 45-year-old Sinhalese man presented with acute onset right iliac fossa pain and fever for three days. On examination, he had significant right iliac fossa tenderness and guarding. His white cell count and C-reactive protein level were elevated and an ultrasound scan was indicative of a bowel mass formation. A clinical diagnosis of acute appendicitis was made and laparoscopic appendicectomy was scheduled. At initial survey, a thin spike-like structure was retrieved from the bowel mass, which was revealed to be a fish bone. Our patient was managed with antibiotics only and did not develop any complications. CONCLUSIONS: Ileal perforation due to fish bone is a rare condition that can mimic common conditions like appendicitis. Preoperative diagnosis is rarely made. The slow process of fish bone migration results in concomitant sealing of the perforation, reducing contamination. Use of laparoscopy may be useful in diagnosing this condition and preventing the morbidity of laparotomy in these patients.