Browsing by Author "Kumarage, S.K."

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Adapting surgical services at a tertiary care unit amidst the COVID19 pandemic: a Sri Lankan perspective
(College of Surgeons of Sri Lanka, 2020) Chandrasinghe, P.C.; Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, B.; Weerasuriya, A.; Munasinghe, N.M.; Thilakarathne, S.T.; Pinto, D.; Fernando, R.F.
No Abstract available.
Anatomical variations of the vasculature in suprarenal glands in Sri Lankans
(College of Surgeons of Sri Lanka, 2007) Salgado, L.S.S.; Abeysuriya, V.; Kumarage, S.K.
INTRODUCTION: Anatomical variations of vascular patterns in the suprarenal glands have not been very well studied..METHOD: A descriptive study was performed in 40 human cadavers to identify the anatomical variations in the vasculature of the suprarenal gland. RESULTS: Superior, middle and inferior groups of arteries supplied the suprarenal glands, superior and inferior groups were present in all while the middle group was found in only 94.5%. The superior group had 3 arteries in males and 4 in females on each side. The middle had 01 artery on each side in both sexes. The inferior group had 2 arteries in males and 1 in females on each side. The superior group originated from the posterior branch of the ipsilateral inferior phrenic artery in 85.5% +/- 6.3 on the right and 82% +/- 7.5 on the left. With regard to the middle group, the aortic origin was the most frequent; 55.4%+/- 8.1 on the right and 44.6%+/- 8.1 on the left. The origin of the middle group from the trunk of the inferior Phrenic artery on both sides were, 25.6%+/-8.4 on the right and 38.57% +/- 8.6 on the left. The arteries of the inferior group arose from the ipsilateral renal artery in 75% +/- 8.5 on the right and 53% +/- 8.7 on the left. CONCLUSION: The most number of variations were found in relation to the middle group of suprarenal arteries, whilst superior and inferior groups were constant.
Assessment of 'nucleation time' as a predictor of cholelithiasis
(Lippincott Williams And Wilkins, 2008) Abeysuriya, V.; Deen, K.I.; Kumarage, S.K.; Navarathne, N.M.
INTRODUCTION: In the formation of gallstones, crystal nucleation is a key step, which is followed by precipitation and gradual growth of cholesterol crystals. MATERIALS AND METHODS: A case-control study was carried out among 60 patients (30 patients, 14 males and 16 females, median age of 36 years, range 33-71 years, body mass index (BMI)=25.1+/-0.33 kg/m, who underwent laparoscopic cholecystectomy; 30 control individuals, 15 males and 15 females, median age of 38 years, range 33-70 years, BMI=24.5+/-0.23 kg/m, who underwent laparotomy and who had normal ultrasound scans of the gallbladder and no demonstrable stones). Bile aspirated from the common bile duct was ultrafiltered and anaerobically incubated at 37 degrees C. Incubated bile was examined daily by polarized light microscopy, for appearance of cholesterol crystals. Nucleation time (NT) of bile was assessed as the time taken for the first crystals to appear under polarized light microscopy. RESULTS: Age and BMI of control individuals were not different to those of cases studied. The overall mean NT was significantly shorter in patients versus controls (mean NT+/-SEM: patients, 1.76+/-0.2 days; vs. controls, 12.74+/-0.4 days, P=0.001). Of control individuals, females demonstrated a shorter NT compared with males (mean NT+/-SEM: females, 11.4+/-0.36 days; vs. males, 14.1+/-0.46 days, P=0.006). In contrast, there was no sex difference in NT in patients (mean NT+/-SEM: females, 1.7+/-0.24 days; vs. males, 1.8+/-0.2 days, P=0.7). CONCLUSION: NT in control individuals without gallstones was significantly prolonged compared with the NT in patients with established gallstone disease. Among the control individuals, females had a significantly shorter NT than males. Hence, the assessment of NT is predictor of cholelithiasis.
Biofeedback with and without surgery for fecal incontinence improves maximum squeeze pressure, saline retention capacity and quality of life
(Springer India, 2008) Munasinghe, B.N.L.; Rathnayaka, M.M.G.; Parimalendran, R.; Kumarage, S.K.; de Zylva, S.; Ariyaratne, M.H.J.; Deen, K.I.
Botulinum toxin injection to the puborectalis in the management of pelvic floor dyssynergia
(College of Surgeons of Sri Lanka, 2015) Pradeep, H.D.S.; Chandrasinghe, P.C.; Siriwardana, S.A.S.R.; Kumarage, S.K.
No abstract available
Colorectal cancer burden and trends in a South Asian cohort: experience from a regional tertiary care center in Sri Lanka
(Biomed Central, 2017) Chandrasinghe, P.C.; Ediriweera, D.S.; Hewavisenthi, J.; Kumarage, S.K.; Fernando, F.R.; Deen, K.I.
OBJECTIVE: Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. RESULTS: Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000-61, 2000 to 2004-178, 2005 to 2009-190, 2010 to 2014-250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided preponderance, younger age at presentation and advanced stage at presentation was observed. CRC disease pattern in the South Asian population may vary from that observed in the western population which has implications on disease surveillance and treatment.
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.
Hardware interface for haptic feedback in laparoscopic surgery simulators
(Institute of Electronics and Electrical Engineers(IEEE), 2014) Kannangara, S.M.; Ranasinghe, S.C.; Kumarage, S.K.; Nanayakkara, N.D.
Minimally Invasive Surgeries (MIS) such as laparoscopic procedures are increasingly preferred over conventional surgeries due to many different advantages. Laparoscopic surgical procedures are very complex compared to open surgeries and require high level of experience and expertise. Hybrid surgery simulators available for training using physical phantoms are expensive and not readily available in majority of health care facilities around the world. Therefore, computer simulation or Virtual Reality (VR) is a better way to obtain skills for MIS. A VR simulator incorporated with haptic feedback provides a comprehensive training closer to real world experience. In this paper, we present a novel approach to incorporate force feedback to VR laparoscopic surgery training. The proposed interface incorporates force feedback in all three axes to provide three levels of force feedback. Computational models of abdomen organs were generated using the cryosection data of Visible Human Project of the National Library of Medicine, USA. The organ models were developed with three basic force categories: soft, mild and hard. A hardware interface is developed to provide the force feedback for the interaction of virtual tools with the said organ models while generating the tool navigation information for the VR simulator. © 2014 IEEE.
Hepaticocystic duct and a rare extra-hepatic cruciate arterial anastomosis: a case report
(BioMed Central, 2008) Abeysuriya, V.; Salgado, S.; Deen, K.I.; Kumarage, S.K.
INTRODUCTION: The variations in the morphological characteristics of the extra-hepatic biliary system are interesting. CASE PRESENTATION: During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis. CONCLUSION: Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.
Heterotopic salivary gland tissue in the gastro-oesophageal junction: a rare entity
(College of Pathologists of Sri Lanka, 2021) Dharani, K.; Medagoda, K.; Kumarage, S.K.; Mahendra, B.A.G.G.
Introduction: Gastric and pancreatic heterotopia are the two most common types of heterotopias seen in the gastrointestinal tract (GIT). These are the two most common types of heterotopias seen in the oesophagus as well. The occurrence of heterotopic salivary gland tissue (HSGT) in the GIT is rare, and most reported cases are colorectal and anal lesions with only a few cases involving the oesophagus. Case report: A 69-year-old man presented with a seven-month history of gastro-oesophageal reflux disease (GORD). The upper gastrointestinal endoscopy showed a moderate hiatus hernia with a pale pink mucosal patch close to the gastro-oesophageal junction. The biopsy showed oesophageal tissue with morphological changes of mild reflux oesophagitis. The submucosal tissue contained organized glandular structures with mucinous glands and intercalated ducts resembling mature salivary gland tissue. There was no evidence of Barrett oesophagus, dysplasia or neoplasm. Discussion and conclusion: HSGT is most commonly seen in the head and neck region of the body, and its occurrence in the GIT is rare. Occurrence of oesophageal HSGT is extremely rare and most cases have presented with symptoms of GORD. Although HSGT is usually benign and a rare phenomenon, clinicians and pathologists need to be aware of this condition to prevent a delay in diagnosis and inappropriate management.
Idiopathic pancreatitis: is it a consequence of an altering spectrum of bile nucleation time?
(BMJ Publishing, 2009) Abeysuriya, V.; Deen, K.I.; Navarathne, N.M.M; Kumarage, S.K.
INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case–control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 ¡ 0.33 kg/m2 ; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 ¡ 0.23 kg/m2 ; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 ¡ 0.2 kg/m2 ) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 ¡ 0.23 kg/m2 , undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULTS: Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 ¡ 0.2 vs controls, 12.74 ¡ 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 ¡ 0.24 days vs controls, 12.74 ¡ 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 ¡ 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 ¡ 0.2 days, p = 0.002, t test). CONCLUSION: NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.
Idiopathic pancreatitis: Is it a consequence of an altering spectrum of bile nucleation time?.
(BMJ Publishing Group, 2009) Abeysuriya, V.; Deen, K.I.; Navaratne, N.M.M.; Kumarage, S.K.
INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case-control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 +/- 0.33 kg/m2; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 +/- 0.23 kg/m2; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 +/- 0.2 kg/m2) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 +/- 0.23 kg/m2, undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULT(S): Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 +/- 0.2 vs controls, 12.74 +/- 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 +/- 0.24 days vs controls, 12.74 +/- 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 +/- 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 +/- 0.2 days, p = 0.002, t test). CONCLUSION(S): NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.
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
Intraoperative visualization of biliary anatomy using Indocyanine green (ICG) fluorescence in a Sri Lankan patient cohort
(The College of Surgeons of Sri Lanka, 2024) Kumarage, S.K.; Lakshani, D.H.J.P.U.; Pinto, M.D.P.; Chandrasinghe, P.C.
INTRODUCTION: Bile duct injury (BDI) is a complication with high morbidity, associated with laparoscopic cholecystectomy (LC). The risk of BDI can be reduced by accurate visualization of the biliary tree with the use of indocyanine green fluorescence (ICG). This study describes the use of this non-invasive technique in a cohort of Sri Lankan patients to visualize the biliary anatomy intraoperatively. METHOD: A total of 121 consecutive patients undergoing LC were included. All received 5 mg of ICG intravenously, 30 minutes prior to induction of anesthesia. The Stryker 1588 laparoscope was used to visualize the anatomical landmarks, both pre and post-dissection of the Calot's triangle, using visible light and near-infrared imaging (NIR). RESULT: In 121 patients (female - 64.5%, median age - 42 years; range of 18-82) included in the study, biliary colic was the commonest indication (70%) for LC. ICG fluorescence resulted in significantly better visualization of the extrahepatic biliary tract (p=<0.001), both pre-dissection (95%CI = 91.7% [85.3%-96.0%]) and post-dissection (95% CI=71.1% [62.1%-79.0%]) of the Calot's triangle. Furthermore, the hepatic ducts were only visualized with ICG. Visualization of the Cystic duct common bile duct junction (CDCBDJ) improved from 6% to 88% (P<0.001) predissection with ICG. Fluorescence enabled the visualization of CDCBDJ post-dissection in all cases compared to 54% without it (P<0.001). ICG enhanced visualization of the Common bile duct (CBD) from 34% to 88% (P<0.001) predissection and 100% visibility post-dissection compared to 62% under visible light (P<0.001). No adverse effects of ICG or bile duct injuries were reported during the study. CONCLUSION: The use of ICG during LC significantly enhanced the identification of biliary landmarks in this cohort. Identification of anatomy can help reduce inadvertent BDI. This safe and effective modality may be considered a routine step in LC.
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
Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial
(Springer, 2019) Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, M.B.; Thilakarathne, S.B.; Wijesinghe, J.S.
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 3-5 ml of 0.25% bupivacaine. The test group received additional laparoscopic-guided TAP block with 20 ml of 0.25% bupivacaine subcostally, 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 6 h (P = 0.043) and opioid requirement at 6 h (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 using plain bupivacaine does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores.
Morphological characteristics of appendix vermiformis in human: a pilot study to establish regional norms with special interest on its position
(Sri Lanka Medical Association, 2007) Salgado, L.S.S.; Abeysuriya, V.; Kumarage, S.K.; Rupasinghe, D.K.
INTRODUCTION: Regional variations of morphology of the appendix vermiformis have been observed, especially with reference to its position, but due to the scarcity of scientific studies on its regional anatomy, achieving norms for its morphology is difficult. OBJECTIVE: To describe morphological characteristics of human cadaveric appendices. Design, setting and methods: A descriptive, prospective, cross sectional study was carried out among 30 patients who underwent laparoscopic appendicectomy in Colombo North Teaching Hospital, and 60 dissected cadavers in Departments of Anatomy in the Medical Faculties of Ragama and Sri Jayewardenepura. Results: The mean length of appendix was 65mm, ranging from 35mm to 110mm. 96.6% (58/60) of appendices were attached to the postero-medial surface and 3.4%(2/60) to the apex of the cecum. In all cadavers, the shape of the cecum was found to be ampullary. The mean outer diameter of appendices were 5.2mm, ranging from 3mm to 10mm. 41.6% (22/90) were retrocecal, 6.6% (6/90) pelvic (subcecal and promonteric 3.3% each), and 51.6% (46/90) were ileal (consisting 30% (27/90) post ileal and 21.6% (19/90) pre-ileal). 96.6% (58/60) of appendices were supplied by the inferior division of ileo-cecal artery, and 1.6% (1/60) by the posterior cecal artery. The mean distance between the opening of the appendix to cecum and to the opening of ileo cecal opening was 2i.2mm (range 13mm to 24mm). The mean length of the appendicular artery was 35mm (range 25mm to 40mm). CONCLUSION: Regional variations of morphological characteristics of appendix are numerous, especially with regard to its position. Therefore to establish norms for a population, further extensive studies are needed.
Morphological variations of cystic artery in triangle of calot in laparoscopic cholecystectomy: experience in tertiary care surgical unit in South Asian country.
(Quest Journals Inc., 2016) Abeysuriya, V.; Kumarage, S.K.; Hasan, R.; Wijesinghe, J.A.A.S.
INTRODUCTION: The knowledge and realization of the frequency and multiplicity of abnormalities of the cystic artery is a perquisite for safe laparoscopic cholecystectomy. OBJECTIVE: To describe the morphological characteristics of the cystic artery in the triangle of Calot. METHODS: Descriptive-prospective cross sectional study was performed in 200 patients, who underwent laparoscopic cholecystectomy for symptomatic gallbladder disease, to observe variations cystic artery. RESULTS: Eighty-nine percent (178/200) of the cystic arteries originated as a single artery from the right branch of the hepatic artery. Five percent (10/200) had two cystic arteries originating separately from right hepatic artery while 5 % (10/200) of cystic arteries passed anterior to the common hepatic duct and 1%(2/200) traversed over cystic duct. Majority, 41%(82/200) of the patients right hepatic artery was ling in the triangle of Calot’s. Two percent (4/200) of the patients had right hepatic artery running over the common hepatic duct. CONCLUSION: It has been observed that the variation of the cystic artery in the triangle of Calot is not infrequent and this knowledge will enhance the safe laparoscopic cholecystectomy.
Neoadjuvant chemoradiation for rectal cancer achieves satisfactory tumour regression and local recurrence - result of a dedicated multi-disciplinary approach from a South Asian Centre
(BioMed Central, 2023) Deen, R.; Ediriweera, D.S.; Thillakaratne, S.; Hewavissenthi, J.; Kumarage, S.K.; Chandrasinghe, P.C.
BACKGROUND: Pre-operative long-course chemoradiotherapy (CRT) for rectal cancer has resulted in improvement in rates of restorative rectal resection and local recurrence by inducing tumour downstaging and downsizing. Total mesorectal excision (TME) is a standardised surgical technique of low anterior resection aimed at the prevention of local tumour recurrence. The purpose of this study was to evaluate tumour response following CRT in a standardised group of patients with rectal cancer. METHODS: One hundred and thirty-one patients (79 male; 52 female, median age 57; interquartile range 47-62 years) of 153 with rectal cancer who underwent pre-operative long-course CRT were treated by standardised open low anterior resection at a median of 10 weeks post-CRT. Sixteen of 131 (12%) were 70 years or older. Median follow-up at the time of analysis was 15 months (interquartile range 6-45 months). Pathology reports were analysed based on AJCC-UICC classification using the TNM system. Data recorded were overall/subgrades of tumour regression; good, moderate or poor, lymph node harvest, local recurrence, disease-free and overall survival using standard statistical methods. RESULTS: 78% showed tumour regression post-CRT; 43% displayed good tumour regression/response while 22% had poor tumour regression/response. All patients had a pre-operative T-stage of either T3 or T4. Post-operation, good responders had a median T stage of T2 vs. T3 in poor responders (P = 0.0002). Overall, the median lymph node harvest was < 12. There was no difference in the number of nodes harvested in good vs. poor responders (Good/moderate-6 nodes vs. Poor- 8; P = 0.31). Good responders tended to have a lesser number of malignant nodes vs. poor responders (P = 0.31). Overall, local recurrence was 6.8% and the anal sphincter preservation rate was 89%. Predicted 5-year disease-free and overall survival were similar between good and poor responders. CONCLUSION: Long-course CRT resulted in satisfactory tumour regression and enabled consideration for safe, sphincter-saving resection in rectal cancer. A dedicated multi-disciplinary team approach achieved a global benchmark for local recurrence in a resource-limited setting.
A Novel structure for online surgical undergraduate teaching during the COVID-19 pandemic
(BioMed Central., 2020) Chandrasinghe, P.C.; Siriwardana, R.C.; Kumarage, S.K.; Munasinghe, B.N.L.; Weerasuriya, A.; Tillakaratne, S.; Pinto, D.; Gunetilleke, B.; Fernando, F.R.
BACKGROUND: The Covid-19 pandemic necessitated the delivery of online higher education. Online learning is a novel experience for medical education in Sri Lanka. A novel approach to undergraduate surgical learning was taken up in an attempt to improve the interest amongst the students in clinical practice while maximizing the limited contact time. METHOD: Online learning activity was designed involving medical students from all stages and multi consultant panel discussions. The discussions were designed to cover each topic from basic sciences to high-level clinical management in an attempt to stimulate the student interest in clinical medicine. Online meeting platform with free to use basic plan and a social media platform were used in combination to communicate with the students. The student feedback was periodically assessed for individual topics as well as for general outcome. Lickert scales and numeric scales were used to acquire student agreement on the desired learning outcomes. RESULTS: A total of 1047 student responses for 7 questionnaires were analysed. During a 6-week period, 24 surgical topics were discussed with 51 contact hours. Eighty-seven per cent definitely agreed (highest agreement) with the statement 'students benefitted from the discussions'. Over 95% have either participated for all or most sessions. A majority of the respondents (83.4%) 'definitely agreed' that the discussions helped to improve their clinical sense. Of the total respondents, 79.3% definitely agreed that the discussions helped to build an interest in clinical medicine. Around 90% agreed that both exam-oriented and clinical practice-oriented topics were highly important and relevant. Most widely raised concerns were the poor Internet connectivity and limitation of access to the meeting platform. CONCLUSION: Online teaching with a novel structure is feasible and effective in a resource-limited setting. Students agree that it could improve clinical interest while meeting the expected learning outcomes.