Browsing by Author "Liyanage, C.A.H."

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Acute portal vein thrombosis leading to small bowel stricture
(College of Surgeons of Sri Lanka, 2017) Bulathsinhala, B.K.S.; Siriwardana, R.C.; Liyanage, C.A.H.
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
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.
Clopidogrel and surgery "be aware"
(College of Surgeons of Sri Lanka, 2010) Liyanage, C.A.H.; Jayaweera, K.K.D.G.; Deen, K.I.
INTRODUCTION: Clopidogrel has been used more recently to prevent thrombosis in occlusive arterial disease. It is known that clopidogrel increases bleeding during surgery. We performed a questionnaire survey of surgeons in Sri Lanka regarding their experience with clopidogrel. OBJECTIVES: To share the experience of surgeons from diverse fields regarding surgery on patients on clopidogrel. METHOD: A retrospective descriptive study was performed using a questionnaire. RESULTS: 48 completed questionnaires were received. 21 (44%) Surgeons reported complications relating to clopidogrel. Spontaneous haemorrhage was reported by 8, which manifested as ecchymotic patches in the majority. Most surgeons 36 (75%) preferred aspirin over clopidogrel and 10 (21%) opted for clopidogrel. The majority recommend stopping of clopidogrel at least for 14 days. However, the opinions of the rest varied from 7 to 28 days. CONCLUSIONS: Surgeons felt clopidogrel has the potential to cause complications following surgery. Majority were of the opinion that it is safe practice to stop clopidogrel for at least 14 days which is more than the 5 days recommended by the formularies. A significant majority were comfortable to have the patient on aspirin compared with clopidogrel.
Clopidogrel and surgical intervention: A point to ponder
(College of Surgeons of Sri Lanka, 2011) Chandrasinghe, P.C.; Liyanage, C.A.H.
No Abstract Available
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.
Diffuse and nodular type hepatocellular carcinoma - a comparative study
(Sri lanka Medical Association, 2015) Wickramarathne, S.D.J.; Jayarathne, V.S.; Siriwardana, R.C.; Liyanage, C.A.H.; Niriella, M.A.; Dassanayake, A.S.; Gunetilleke, M.B.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Incidence of hepatocellular carcinoma (HCC) is increasing. Diffuse HCC (dHCC) is rare and data on such tumours are limited. METHOD: Ail consenting patients with HCC referred to Colombo North Liver Unit, Ragama (September 2011-February 2014) were Included. Tumours with diffuse margins on imaging were categorized as dHCC, while tumours with clear nodular morphology were categorized as nodular HCC (nHCC). Baseline parameters, treatment options and survival were compared between the two types. RESULTS: 203 HCCs were included in the study [dHCC=41(20%):87.8% males; nHCC=162(80%) 89.5% males]. The median age at presentation in the two groups was similar [dHCC 63.58(47-76) years, nHCC 62.13(12-88) years]. More patients with dHCC had a significant alcohol intake (68.9% vs. 41.7%, p=0.002). Background cirrhosis was present in 90.2% of dHCC compared to 79.1% in nHCC (p<0.05). Aspartate transaminase, Alanine transaminase, INR, total bilirubin, platelet count and MELD scores were similar in the two groups. Median alfa fetoprotein (AFP) was significantly higher in dHCC (136 vs 31ng/mL, p<0.001). Similar typical enhancement pattern on dynamic imaging was noted in the two groups (80.5% dHCC, 84.4% nHCC). dHCC had high incidence of major vascular invasion(78% vs 23.5%, p<0.001). Seventy six point nine percent of dHCC had only palliative care compared to 28.4% in nHCC was two months compared to 8 months in nHCC. CONCLUSION: 1/5 of HCCs were of the diffuse type. Patients dHCC had a significant alcohol intake. They had higher AFP, advanced disease at presentation with more vascular invasion and a worse prognosis than nHCC.
Diffuse and nodular type hepatoma: a prospective, comparative study
(Sri Lanka Medical Association, 2014) Wickramarathne, S.D.J.; Jayarathne, V.S.; Siriwardana, R.C.; Niriella, M.A.; Liyanage, C.A.H.; Dassanayake, A.S.; Gunetilleke, M.B.; de Silva, H.J.
INTRODUCTIONS: Incidence of hepatocellular carcinoma (HCC) is increasing. Diffuse type HCC is rare and data on such tumors are limited. METHODS: All patients referred to North Colombo Liver Unit with HCC from September 2011 to February 2014 were included. Data were collected prespectively from 206 patients. Tumors with diffuse margin in imaging were categorized as diffuse HCC (n-41, 21%). Baseline parameters, treatment options and survival were compared with nodulartype'HCC. RESULTS: 87.8% of patients in the diffuse HCC group were males compared to 89.54 % in nodular HCC group. The median age in the two groups were similar (nodular 62.13 years (range 12-88), diffuse 63.58 years (range 47-76)). Heavy alcohol use was commoner in the diffuse HCC group (68.9% vs. 41.7 %, p=0.002). 90.2% with diffuse HCC had cirrhosis compared to 79.1% with nodular HCC (p<0.05). Aspartate transaminase (AST), alanine transarninase (ALT), INR, total bilirubin, platelet count, MELD score were similar in two groups. Alfa Feto Protein (AFP) value was significantly higher in diffuse HCC group (p<0.001). 80.5% patients with diffuse type HCC had typical enhancement pattern compared to 84.4% with nodular type. Diffuse HCC group had higher incidence of major vascular invasion (78% vs. 23.5%, p<0.001). 76.9% of diffuse HCC group had only palliative care compared to 28.4% in nodular type (p<0.001). Median survival in diffuse group was 2.0 months compared to 8.0 months in nodular type. CONCLUSIONS: 21% of HCC are diffuse type. Alcohol intake was commoner in this group. Diffuse HCC had poorer prognosis with high AFP level and vascular invasion. Majority had advanced disease at presentation.
Diffuse-Type Hepatoma: A grave prognostic marker
(Karger Medical and Scientific Publishers, 2017) Siriwardana, R.C.; Liyanage, C.A.H.; Gunetilleke, B.; Niriella, M.A.; de Silva, H.J.; Dassanayake, A.S.; Jayatunga, S.P.
BACKGROUND: Data on diffuse-type hepatocellular carcinoma (HCC) are rare. HCC in Sri Lanka is rising, and the majority is related to nonalcoholic fatty liver disease. This study was planned to compare nodular- and diffuse-type HCC in this cohort. METHODS: CT scans of 227 patients with HCC negative for infective hepatitis were analyzed and grouped as nodular and diffuse from July 2011 to July 2014. Diffuse-type cancer was defined as a tumor without convex/distinct margin, diffusely infiltrating the hepatic parenchyma. There were 45 (20%) cases. The baseline liver functions, etiology, treatment, and the outcome were compared with nodular-type cancers. Stage III diffuse cancers were matched with 2 stage III nodular cancers looking at the T stage and background liver. RESULTS: There was no difference in the age (63 vs. 62 years, p = 0.937) and gender. Diffuse cancers had a low BMI (24 vs. 22, p = 0.009), a higher alpha fetoprotein (AFP) level (p < 0.001), a higher incidence of major vascular invasion (14 vs. 80%, p < 0.001), and a history of significant alcohol consumption (39 vs. 67%, p = 0.001). The baseline liver functions were similar in diffuse and nodular cancers. A large proportion (27 vs.77%, p < 0.001) of diffuse cancers were not candidates for active treatment. Overall survival was poor in the diffuse type(4.7 vs. 25 months, p < 0.001). Diffuse-type stage III cancers had a poor survival compared to matched nodular cancers (2.5 vs. 15.8 months, p = 0.001). CONCLUSION: HCC without a background of infective hepatitis were common in our cohort. These tumors are associated with high AFP levels, major vascular invasion, and a poor prognosis.
Duodenum-preserving local excision of a gastrointestinal stromal tumor
(Elsevier, 2008) Liyanage, C.A.H.; Abeygunawardhana, S.; Kumarage, S.; Deen, K.I.
BACKGROUND: Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. METHODS: We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision. The surgery was facilitated by preoperative mapping with Indian ink and navigation by endoscopy to assess the adequacy of resection and to avoid injury to the ampulla. RESULT: Reconstruction was successful with a duodenojejunostomy and protected by a nasoduodenal drain. CONCLUSION: The patient had no postoperative complications and the tumor was confirmed to be a GIST of the duodenum successful with an adequate resection margin
Endoscopic management of a difficult common bile duct stone
(Sri Lanka Medical Association, 2008) Liyanage, C.A.H.; Sadakari, Y.; Lenaga, J.; Tanabe, R.; Takahata, S.; Tanaka, M.
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
Factors affecting the clinical outcome of transarteriai chemo treatment for hepatocellular carcinoma in Sri Lankan patients
(Sri lanka Medical Association, 2015) Jayatunge, D.S.P.; Siriwardana, H.D.R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Gunetilleke, M.B.; Upasena, A.; Sirigampola, C.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: 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. METHOD: Of 290 patients with HCC (July 2011 -December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization fever (PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AK1). 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%), AKl 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<0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p=0.029, OR=1.412), ascites (p=0.030, OR = 1.212), elevated serum bilirubin (p=0.007, OR= 4.357) and large tumour size (p=O.Q36, OR=3.603) were independent risk factors for PEF. Tumour diameter >5cm (p=0.049, OR=2.410) and elevated serum bilirubin (p=0.036, OR=1.517) predicted AHD. CONCLUSION: In NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE, Tumours>5cm with elevated bilirubin predicted AHD post-TACE.
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.
Factors affecting post-embolization fever and liver failure after trans-arterial chemo-embolization in a cohort without background infective hepatitis- a prospective analysis
(BioMed Central, 2015) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Upasena, A.; Sirigampala, C.; de Silva, H.J.
BACKGROUND: 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. METHODS: Of 290 patients with HCC (July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization 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 < 0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p = 0.029, OR = 1.412), ascites (p = 0.030, OR = 1.212), elevated serum bilirubin (p = 0.007, OR = 4.357) and large tumour size (p = 0.036, OR = 3.603) were independent risk factors for PEF. Tumour diameter >5 cm (p = 0.049, OR = 2.410) and elevated serum bilirubin (p = 0.036, OR = 1.517) predicted AHD. CONCLUSION: In NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5 cm with elevated bilirubin predicted AHD post-TACE.
Hepatocellular carcinoma in Sri Lanka - where do we stand?
(College of Surgeons of Sri Lanka, 2013) Siriwardana, R.C.; Liyanage, C.A.H.; Gunetilleke, M.B.
Hepato-cellular carcinoma (HCC) is the sixth commonest cancer and third in cancer-related mortality worldwide. There are no published reports on the pattern of HCC in Sri Lanka. North Colombo Liver Unit maintains a prospective database of 105 HCC patients from September 2011. HCC was diagnosed based on characteristic radiological appearance. Best form of treatment was decided by a multidisciplinary team (MDT). Median age at presentation 63 (12 - 79) years. 87% (n=93) males. 45% (n= 47) had alcohol consumption above safe limits .41% (n=53) had diabetes. Cirrhosis was present in 79% (n=83) .median Model for End Stage Liver Disease (MELD) score 12 (4-22); Childs- Pugh class A 45% (n=37), Childs- Pugh class B or C 55% (n=46)]. A biopsy was necessary in 7 (6.6%) while others were diagnosed on radiology .62.5% had AFP level above the reference range (> 10 ng/ml). 51(49%) had a single modality, 17 (16%) had combined treatment and the rest had no treatment. The overall mean survival was 15 months. Majority of HCCs in Sri Lanka were among males and is likely to be secondary to NASH related cirrhosis. Majority of the tumours were diagnosed at late stage.
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.
An incidental finding of absent gall bladder in laparoscopic exploration - a rare occurrence in extra hepatic biliary anatomy
(College of Surgeons of Sri Lanka, 2015) Pradeep, H.D.S.; Prasad, I.H.D.S.; Wickramarathna, D.; Liyanage, C.A.H.
No abstract available
Intraductal papillary neoplasm of extrahepatic biliary tract with an associated early invasive adenocarcinoma
(EDORIUM Journals, 2014) Jayathilake, K.G.H; Siriwardana, R.C.; Navarathne, N.M.M; Mahendra, B.A.G.G.; Liyanage, C.A.H.
INTRODUCTION: Intraductal papillary neoplasm of the bile duct is a premalignant lesion, which can develop into an adenocarcinoma. If treated early, at the non-invasive stage, it has an excellent prognosis compared to cholangiocarcinoma. CASE REPORT: A 61-year-old female presented with intermittent episodes of fever with chills and rigors, loss of appetite, pruritus, tea colored urine, and pale sticky stools for two years duration. After work up she underwent a left hemihepatectomy with resection of caudate lobe and extrahepatic biliary duct with lymph node clearance. Histology revealed an intraductal papillary lesion with no mucin production, expanding the common hepatic duct and the left hepatic duct, invading the subepithelial connective tissue at a focus near the distal end of the left hepatic duct. The tumor was qualified as an intraductal papillary neoplasia of pancreatobiliary type involving the extrahepatic bile duct with associated early invasive adenocarcinoma. She required no further adjuvant treatment and is disease free for one year on regular followup. CONCLUSION: The objective of this article is to emphasize the necessity of early diagnosis and aggressive and complete surgical resection to achieve maximum patient survival in this curable disease.
Intramural incision technique: do we know enough to continue?
(Elsevier-Mosby, 2008) Liyanage, C.A.H.; Takahata, S.
Comment on: Intramural incision technique: a useful and safe procedure for obtaining ductal access during ERCP. [Gastrointest Endosc. 2008; 67(4):629-33.]; No Abstract Available