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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item 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 availableItem We report you decide(The College of Surgeons of Sri Lanka, 2023) Siriwardana, R.C.No abstract availableItem 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 patientsItem 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.Item The hidden threat of uncontrollable bleeding from the gallbladder bed during laparoscopic cholecystectomy(Elsevier, 2023) Rajeeth, G.; Tilakaratne, S.; Siriwardana, R.C.INTRODUCTION AND IMPORTANCE: Laparoscopic cholecystectomy is the treatment for symptomatic gallstone disease. However, a potential complication during this procedure is intraoperative bleeding resulting from vascular injuries, affecting around 0.9-1.9 % of cases. The most common bleeding site is the gallbladder bed, predominantly due to bleeding from the middle hepatic vein and its major branches. CASE PRESENTATION: This article presents an illustrative case of a superficial middle hepatic vein encountered during cholecystectomy during a donor hepatectomy. CLINICAL DISCUSSION: Safe dissection of the Calot triangle is crucial in cholecystectomy to prevent bile duct injuries. Attention is drawn to the proximity of middle hepatic vein to the gallbladder bed during dissection, which can lead to complication. Recent studies highlight significant anatomical variations, emphasizing the need for caution, especially in the patients with specific conditions. CONCLUSION: The careful surgical technique and awareness of anatomical variations, particularly regarding the proximity of the middle hepatic vein to the gallbladder bed during laparoscopic cholecystectomy. Surgeons are cautioned to maintain the focus throughout the procedure, even after achieving the critical view of safety. Preoperative evaluation of this anatomy with USS Venous Doppler and CT scan is minimize the risk of complications.Item Genetic and metabolic aspects of non-alcoholic fatty liver disease (NAFLD) pathogenicity(Springer, 2023) Samarasinghe, S.M.; Hewage, A.S.; Siriwardana, R.C.; Tennekoon, K.H.; Niriella, M.A.; de Silva, S.BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease showing a risingprevalence globally. Genetic predisposition plays a key role in the development and progression of the disease pathogenicity. MAIN BODY: This paper summarizes genetic associations based on their influence on several metabolic aspects such as lipid metabolism, glucose metabolism, hepatic iron accumulation and cholesterol metabolism toward the NAFLD pathogenicity. Furthermore, we present variations in some epigenetic characters and the microRNA profile with regard to NAFLD. CONCLUSION: As reported in many studies, the PNPLA3 rs738409 variant seems to be significantly associated with NAFLD susceptibility. Other gene variants like TM6SF2 rs58542926, MBOAT7 rs641738 and GCKR variants also appear to be more prevalent among NAFLD patients. We believe these genetic variants may provide insights into new trends in developing noninvasive biomarkers and identify their suitability in clinical practice in the future.Item Massive spontaneous haematoma of the liver following laparoscopic cholecystectomy(The College of Surgeons of Sri Lanka, 2023) Gunathunga, H.; Vishwajith, P.; Buddhika, U.A.; Tillalakaratne, S.; Siriwardana, R.C.No abstract availableItem Moral thinking and moral questioning(University of Kelaniya, Sri Lanka, 2021) Siriwardana, R.C.Item Local infiltration versus Laparoscopic e guided transverse abdominis plane block in laparoscopic cholecystectomy e double blinded randomized control trial(Elsevier, 2018) Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, M.B.; Thilakarathne, S.B.BACKGROUND: Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. METHODS: This randomized control trial was designed to compare the effectiveness of additional laparoscopic guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions - Both groups received standard port site infiltration with 3-5ml of 0.25% bupivacaine. The test group received additional laparoscopic guided TAP block with 20ml of 0.25% bupivacaine subcostaly, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. RESULTS: The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at six hours (P = 0.043) and opioid requirement at six hours (P =0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. CONCLUSION: Laparoscopic-guided transverses abdominis plane block does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores