Browsing by Author "Siriwardhana, R."

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    Bile Reflux and Quality of Life after Retro gastric Retro colic Gastrojejunostomy in Whipple Procedure
    (Staff Development Center, University of Kelaniya, 2015) Siriwardhana, R.
    Introduction: Whipple surgery is a complex procedure done for pancreatic cancer. Main problem in long term survivors is delayed gastric emptying and bile reflux which is to cause chronic gastritis, gastric ulcers, reflux oesophagitis and Barrett’s oesophagus As our preferred technique we have adapted a technique of performing retro colic posterior gastrojejunostomy over the last 2 years. In this technique the small bowel loop is anastomosed to the posterior wall of the stomach. Then the distal stomach with the gastro jejunostomy is pulled through a window in the transverse mesocolon and anchored. This study was designed to assess the macro and microscopic outcome. Methods: All patients who had undergone Whipple procedure from June 2012 to June 2014 will be included. Patients with recurrence, ones who had chemotherapy within last three months, and ones who have undergone the surgery within the last 3 months will be excluded. Informed written consent will be obtained All will undergo endoscopy observing the appearance of gastric mucosa and severity of bile reflux objectively. Five punch-biopsy specimens will be taken from the stomach in accordance to the recommended biopsy sites. Specimens will be fixed and stained in H & E and modified Giemsa stains. Bile reflux index (BRI) will be calculated using a standard formula. Severity of dyspeptic symptoms will be calculated with the “Nepean Dyspepsia Index- Short form (NDI-SF)” Questionnaire. Based on the findings we will be able to objectively evaluate the clinical and histological outcome of the procedure.
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    Hilar cholangiocarcinomas - from nihilism to aggressive treatment
    (The College of Surgeons of Sri Lanka, 2012) Liyanage, C.; Nawaratne, M.; Pathirana, A.; Gunasekara, D.; Pranahewa, L.; Prasad, R.; Wijeratne, T.; Bogammana, M.; Wijesooriya, R.; Siriwardhana, R.
    INTRODUCTION: Hllar-Cholangio-carcinomas (HCC) are aggressive tumours with a dismal prognosis. The general tendency amongst all specialities is to palliate them. As response to adjuvant therapy is marginal we have embarked on aggressive management of these patients with the available surgical and endoscopic expertise. METHODS: Patients presenting to the North Colombo Teaching hospital· and the Gastrointerology unit of the National hospital in 2011 were included . All had Tri phasic CT , MRCP or ERCP prior to be discussed at MDT with all the above authors regarding further management. Patients with Bismuth 1 v lesions and unfit for surgery underwent Combination ERCP/doublestenting/RFA of lesion/Rendezvous procedure/Percutaneous, stenting or PTC. RESULTS: 32 patients were treated .5/32 had radical surgical resections (2 extended right hepatectomy with bile duct resecton and lymphadenectomy (BDR+LA), 2 extended left hepatectomy +BDR+LA, and 1 extended heft hepatectomy with BDR+LA+Reconstruction of Right hepatic artery and right portal vein. I underwent segment iii bypass. 7 patients underwent ERCP and serial RFA with stenting. 3/5 patients are alive and disease free at 6-12 months. CONCLUSIONS: Where possible HCC patients should be offered a curative resection. RFA gives longer and better palliation compared to standard stenting. These patients should be managed by a specialized team as aggressive management may improve their survival.