Browsing by Author "Bandara, L.M.P.M."

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Bile reflux and quality of life after modified retrocolic posterior gastric gastrojejunostomy in whipple procedure
(College of Surgeons of Sri Lanka, 2015) Rajapaksha, R.W.M.A.L.; Liyanage, C.A.H.; Hewavisenthi, S.J.D.S.; Liyanage, S.K.; Bandara, L.M.P.M.; Siriwardana, R.C.
INTRODUCTION: Perioperative outcome of Whipple surgery has greatly improved. Quality of life has become an important issue in long-term survivors. Delayed gastric emptying and bile reflux are common concerns. Modified retrocolic posterior gastric gastrojejunostomy with mesocolic stich has been unit's standard practice. Study was designed to assess macro and microscopic bile reflux and dyspepsia related quality of life in long-term survivors. MATERIAL AND METHODS: Out of 42 patients operated from June 2012, twenty long-term survivors were selected after excluding once with recurrence and ones who had chemotherapy during last six months. All underwent gastroscopy. Macroscopic bile reflux was grouped in to four categories. Six gastric biopsies were taken from standard sites. Microscopic bile reflux index (BRI) was calculated in stained specimens. BRI score of more than 14 was considered significant. Validated Nepean dyspepsia index-short form (NDI-SF) was used to assess the severity of dyspepsia related quality of life and compared with age and gender matched control. RESULTS: The median age was 48.5 years (21- 69). Median survival of the group was 37 months (6-40). Endoscopically, 18/20 (90%) had macroscopic bile reflux (83.3% yellowish bile lake, 16.7% greenish bile lakes). None had stomal ulcers or macroscopic inflammation. Mean Bile reflux index score was 13.22 (SD: 9.46). Mean dyspepsia score of Whipple group was 23.1 (SD 8.88). In controls, mean dyspepsia score was 20 (SD 8.2), showing no significant difference (p =0.245). CONCLUSION: Though there was macroscopic bile reflux, clinical symptoms and microscopic changes were minimal. Modified technique had good long-term results.
Factors affecting Post- Embolization fever and liver failure after Trans- Arterial Chemo-Embolization in a cohort without background infective hepatitis- A prospective analysis.
(College of Surgeons of Sri Lanka, 2015) Bandara, L.M.P.M.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Sirigampala, C.; Upasena, A.; de Silva, H.J.
INTRODUCTION: Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC. MATERIAL AND METHODS: Of 290 patients with HCC(July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: post embolization fever(PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AKI). RESULTS: 84 patients [90.5% males, 89.2% cirrhotics, 89.2% nodular HCC, median age 63(34-84) years] underwent 111 TACE sessions. All were Child class A [69.4% sessions(n=77)] or B; ascites and portal vein invasion was present in 18(16.2%) and 15(13.6%), respectively. 42 (38.2%) TACE procedures resulted in complications [PEF 28(25.2 %), NV 4(3.6%), abdominal pain 9(8.1%), infection 7(6.3%), AHD 13(11.7%), AKI 3(2.7%)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p=0.046) and low serum albumin (p=0.035) predicted PEF while low serum albumin (p=0.021) and low platelet counts (p=0.041) predicted AHD. In the multivariate model, factors with p 5 cm (p=0.049,OR=2.410)and elevated serum bilirubin (p=0.036,OR=1.517) predicted AHD. CONCLUSIONS: In NASH and alcoholic cirrhosis related HCC patients pre- procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5cm with elevated bilirubin predicted AHD post-TACE.
Hilar cholangiocarcionoma; Is aggressively answered
(College of Surgeons of Sri Lanka, 2015) Bandara, L.M.P.M.; Jayarathne, V.S.; Siriwardana, R.C.; Nawarathna, N.M.M.; Liyanage, C.A.H.
INTRODUCTION: Cholangiocarcinoma (CCA) is a malignant disease involving the billiary system with majority occurring in the hilar region. CCA demands prompt management because of its aggressive nature. MATERIALS AND METHODS: Patients who presented to Gastroenterology and hepatobiliary unit at NHSL and the Professorial Surgical Unit of NCTH from January 2011 to June 2015 were included in this study. Diagnosis was made by CT imaging, MRCP and ERCP. RESULTS: Total of 120 patients were diagnosed with CCA. The median age of presentation was 64 years (31-85) with 51.2% being males. Majority of 63 patients (52.1%) of CCA occurred in the hilar region with rest involving the common bile duct. Out of 63 hilar CCA 44 were classified according to the bismuth classification. 13/44 were type I, 7/44 were type II, 9/44 were of type III and 15/44 were of type IV. While 5 patients (7.9%) underwent hepatic resection, Majority of 40 patients (63.5 %) were stented with 9 (14.2%) being treated with Radiofrequency ablation (RFA). Survival was significant following surgery (P=0.027). Four patients who underwent surgery are currently followed up at NCTH. CONCLUSIONS: Surgery appears to be the effective treatment for CCA. Aggressive palliation with stenting seems beneficial.
Long- term glycemic control after pancreatectomy- prospective study
(College of Surgeons of Sri Lanka, 2015) Ekanayake, C.S.; Bandara, L.M.P.M.; Liyanage, C.A.H.; Siriwardena, R.C.
INTRODUCTION: Pancreatic resection leads to loss of functional pancreatic tissue. The study evaluates the glycemic control and factors affecting the glycemic control in long-term survivors after pancreatic resection. MATERIAL AND METHODS: Patients who survived for three months or more after pancreatectomy were selected. Baseline parameters were collected with an interviewer administered questionnaire. All patients had a fasting blood sugar (FBS) and HbA1C. Previous non diabetics had oral glucose tolerance test (OGTT) at one and two hours. There were 49 Whipple procedures and 6 distal pancreatectomies. 20 Whipple procedure patients and 5 distal pancreatectomy patients consented. Sixteen (64%) participants were females. Median age was 47 (15-70) years. Eleven (44%) were previously known diabetic patients. The median Body Mass Index (BMI) was 18.28 kg/m3 (11.36-30.07). The median time since surgery was 16 (3-37) months. There was one (4%) newly diagnosed diabetic patient. Out of non-diabetics, one had more than 200 mg/dl OGTT at 2 hours. Nine diabetics had HbA1c elevation more than 7%. Mean post-surgical FBS in diabetic patients (136.9 mg/dl) were significantly (p<0.05) higher than pre-surgical FBS (109.4 mg/dl). BMI (p=0.006), waist to hip ratio (p=0.039) and percentage of pancreas removed (p=0.002) showed a significant correlation to worsening of post-surgical sugar control. CONCLUSIONS: Pancreatectomy leads to worsening of blood sugar control in known diabetics. New onset diabetes is rare. Close follow-up and strict control is needed in known diabetics with high BMI and high waist to hip ratio.
Post hepatectomy adjuvant trans-arterial chemotherapy- A pilot study
(College of Surgeons of Sri Lanka, 2015) Ekanayake, C.S.; Bandara, L.M.P.M.; Liyanage, C.A.H.; Niriella, M.A.; Dassanayake, A.S.; Siriwardena, R.C.
INTRODUCTION: Hepatic micro metastases lead to early recurrence after surgery for hepatocellular carcinoma (HCC). Trans arterial therapy (TAT) without selective embolization may be an effective treatment that induces tumour necrosis. This potential has not been investigated before. This study looks in to the tolerability of TAT in patients after major hepatectomy. MATERIAL AND METHODS: Consented patients were offered trans arterial chemotherapy after normalization of liver functions following surgery. Through the femoral artery, right and left hepatic arteries were selectively cannulated. Doxorubicin 50mg was mixed with 10ml of Lipidol and injected. Post procedure biochemistry and complications were assessed at day 3, 7 and 14 intervals. RESULTS: 11 Patients consented (81% males, median age 61y [range 47y-76y]. There were 7(63.6%) cirrhotics. Four (36.3%) were extended right or left hepatectomies while others were bisegmentectomies. The median time period from surgery to chemotherapy was 25 weeks (range 4-60weeks). Post procedure, 1 (9%) had right hypochondrial pain, 2 (18.1%) had fever, 4(36.3%) had nausea, 2(18.1%) had vomiting within 48 hours. All were discharged at 48 hours. One patient developed a transient bradycardia during procedure. There was no clinical evidence of liver failure. Two patients had three-FOLD rise in transaminase levels at day3 and 7. All recovered by day 14. None of the patients had significant rise in prothrombin time or bilirubin levels. CONCLUSIONS: Post hepatectomy adjuvant trans –arterial chemotherapy is a well-tolerated procedure in the view of short term complications.
Short and medium term glycaemic control after pancreaticoduodenectomy
(College of Surgeons of Sri Lanka, 2016) Siriwardana, R.C.; Bandara, L.M.P.M.; Atulugama, N.; Gunetilleke, M.B.; Ekanayake, C.S.
Introduction: Perioperative outcomes of pancreaticoduodenectomy (PD) have improved over the years. Glycaemic control in longterm survivors is a matter of concern. Materials and methods: 48 surviving patients of 66 patients who underwent Whipple surgery from 2011 to 2015 were evaluated. Patients with recurrences, who had chemotherapy within three months and patients who had not completed a minimum six months follow-up were excluded. 25 patients were selected. Patients' demographic data, HbA1c level, fasting blood sugar level, physical activity index and waist to hip ratio were calculated. Volume of the pancreatic specimen was calculated. Non diabetics underwent oral glucose tolerance test (OGTT). Results: There were 6 (24%) pre-existing diabetics, 3 new onset diabetics and two patients with impaired glucose tolerance (20%). Median preoperative BMI, body fat distribution, calculated median pancreatic volumes resected or underlying pancreatic pathology did not differ in diabetic and non-diabetic groups. In non-diabetics, HbA1c level or two hour OGTT did not associate with age, preoperative BMI, waist to hip ratio and resected pancreatic volumes. Conclusion: Significant proportion of patients develop diabetes immediately after PD. Reliable prediction of this group pre-operatively is difficult due to many interacting, confounding factors. They need close monitoring in immediate perioperative period.