Conference Papers

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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

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Author: search.filters.author.Gunetilleke, M.B.Has files: No

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    Perioperative outcome following establishment of deceased donor liver transplantation: A single center experience in Ragama, Sri Lanka
    (Sri Lanka Medical Association, 2018) Withanachchi, A.D.; Thalagala, T.A.E.S.; Liyanage, I.K.; Dassanayake, A.S.; de Silva, A.P.; Gunetilleke, M.B.; Siriwardana, R.C.; Niriella, M.A.
    INTRODUCTION AND OBJECTIVES: Liver transplant (LT) perioperative mortality is a good performance indicator among transplant centres. Colombo North Teaching Hospital (CNTH) is the first LT program in Sri Lanka. We aimed to evaluate the perioperative (30 day) outcomes and complications of patients who underwent deceased donor liver transplantation (DOLT) at CNTH between the first 9 DDLTs that were carried out before 2016 (Tl) and the last 10 DDLTs after 2016 (T2). METHODS: Retrospective analysis of pre-operative records, operation notes, discharge and follow up notes were carried out on all patients who underwent DOLT at CNTH. RESULTS: A total of 19-DDLTs were performed during this period. Mean age of the recipients was 50.3 (Tl :52.9, T2:47.9) years: Indications (n) for DDLT were: advanced cirrhosis with high MELD (12), other complications of cirrhosis (3),."cirrhosis with hepatocellular carcinoma (3) and acute liver failure (1 ). Aetiology of cirrhosis (n) were: cryptogenic (13), alcohol (3), autoimmune hepatitis (1), other (1). Pre transplant MELD was 16 in Tl and 18 in T2. Average hospital stay was 11.1 days (7.4 days in the intensive care). Perioperative mortality was 4/9 (44%) in Tl and 2/10 (20%) in T2. Mortality was due to PNF (3), sepsis (2) and post-operative reperfusion syndrome (1). Other post-operative complications (in Tl and T2) were: hepatic artery thrombosis (0,0), cholestasis (0, 1 ), acute cellular rejection (0,2), hydrothorax (0,3), clinically significant tacrolimus toxicity (1,o) and acute renal failure (4,2). CONCLUSION: Perioperative mortality has reduced and outcomes improved in the second half indicating success of the CNTH LT program.
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    A study of the relationship between the internal jugular vein and carotid artery assessed under direct vision and ultrasonically in surgical patients and in cadavers
    (Sri Lanka Medical Association, 2017) Munasinghe, B.N.L.; de Silva, M.T.D.; Gunetilleke, M.B.
    INTRODUCTION & OBJECTIVES: Use of anatomical landmarks to cannulate the internal jugular veins is fraught with danger due to variations in the relative positions of the common carotid artery (CCA) and the internal jugular vein (IJV). Objective of the study was to identify anatomical variations of the relative positions of the IJV and CCA. METHODS: This was a descriptive cross-sectional study carried out from October 2012 to July 2014 at the NCTH, Ragama. The anatomy was evaluated either ultrasonically or under direct vision. Relationship of the IJV to the CCA was recorded at three levels (sternoclavicular junction-SCJ, cricoid cartilage-CC and upper border of thyroid cartilage lamina-TCL), on the right (R) and left (L) sides. RESULTS: A total of 216 participants (60 male: 156 female; median age 48 years, range 16 to 75) consisting 192 patients (89%) and 24 cadavers (11%) were included. Patients were undergoing either neck USS at the radiology department (144, 67%), central venous catheterisation under USS guidance (22, 10%) or thyroidectomy (30, 14%). At all three levels IJV was lateral to the CCA in a majority (SCJ level: R 66.5%, L 29%; CC level: R 80%, L 85%; TCL level: R 89%, L 76%). IJV was anterior to the CCA at the SCJ level in a proportion of the sample (R 11.5%, L 22%) and antero-lateral in another proportion (R 20%, L 48%). CONCLUSION: Aberrant anatomical relations between the IJV and CCA are not uncommon. Reliance solely on a technique which assumes normal anato y can lead to damage to the CCA.
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    Liver transplantation - initial experience at Colombo North Liver Transplantation Service
    (Sri Lanka Medical Assosiation, 2012) Bogamuwa, M.M.M.P.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Wijesuriya, S.R.E.; Liyanage, C.A.H.; Gunetilleke, M.B.; de Silva, H.J.
    INTRODUCTION: Liver transplantation (LT) is the treatment of choice for end stage liver diseases. LT is still in its infancy in Sri Lanka. AIMS: To describe the initial experience of the Colombo North Liver Transplantation Service (CNLTS) METHODS: The study population included all patients referred for LT to CNLTS. All cases were evaluated for the indication and medical, social and psychological suitability for LT. Decision to list patients for LT was reached by a multidisciplinary team consisting of surgeons, physicians and anaesthetists. All data were collected prospectively. RESULTS: 52 patients were referred for LT over a period of 7 months. 48/52[92.3%) were males. The median age at referral was 52(range 13-66) years. The median Child-Turcotte-Pugh(CTP) score at referral was 9/15(range 5-13/15). Median Model for End Stage Liver Disease (MELD) score at referral was 17(range 9-26). 3/52(5.8%) had hepatocellular carcinoma and 9/52(17.3%) had a low MELD score (<14) but with life threatening complications of cirrhosis as indication. 4/9(44.4%) of those being upper gastrointestinal bleeds from varices. 28/52(53.8%) of the referrals had cryptogenic cirrhosis (CC), 18/52(34.6%) had alcoholic cirrhosis, 2/52(3.8%) each had metabolic, congenital and other causes for cirrhosis. 7/52(13.5%) transplants were performed [3 Live Donor LTs(LDLT) and 4 Deceased Donor LTs(DDLT)]. 5/7(71.4%)[2 - LDLT, 3 -DDLT] had a successful LT outcome. 11/45(24.4%) patients died while on the LT waiting list. CONCLUSIONS: High MELD CC was the commonest reason for referral for LT in our group. There was a high waiting list mortality highlighting the need for an efficient DDLT service.
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    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.
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    Risk factors for post operative complications, prolong ICU and hospital stay in patients with colorectal surgery
    (Sri lanka Medical Association, 2015) Gunetilleke, M.B.; Jayatunge, D.S.P.; Munasinghe, A.H.E.; Jayarathne, K.D.V.S.; Liyanage, C.A.H.; Siriwardana, H.D.R.C.; Kumarage, S.K.; Deen, K.I.
    INTRODUCTION AND OBJECTIVES: Identifying predictors for development of post-operative complications and prolong hospital stay will improve outcome of colorectal surgery. METHOD: Colorectal surgeries from May 2012 -February 2015 at NCTH were assessed for post¬operative complications, prolong ICU and hospital stay RESULTS: Out of 101 patients [43.6 % males, median age 52, 54.3% ASA class ll/lll ] 19 patients suffered complications (11 Sepsis, 10 respiratory complications and 4 ACS). Prolong hospital in 33 and prolong ICU stay in 14 were noted. On univariate analysis higher intra-operative fluid usage (IOFU), usage of blood products (UBP), increase blood loss and reduce usage of epidurals (RUE) predicted respiratory complications. Females, higher IOFU for sepsis and higher IOFU, UBP for ACS were predictors. Higher IOFU , higher ASA class, females, longer duration of anaesthesia ( LDOA ) for prolong ICU stay and UBP , LDOA , higher IOFU for prolong hospital stay were predictors. In multivariate model a higher IOFU, RUE for cardiorespiratory complications and low albumin & haemoglobin, female gender for sepsis were independent predictors. For prolonged ICU/ hospital stay higher IOFU (> 20 ml/kg), LDOA (> 240 min), higher ASA class were independent predictors. Patient without intra-operative vasopressors had a higher IOFU and no significance in development of complications. CONCLUSION: Patients without intra-operative vasopressor had higher IOFU. IOFU >20ml/kg is a major contributor for post-operative cardio¬respiratory complications, prolong ICU and hospital stay.
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    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.