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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Item Role of interventional radiology in paediatric liver transplantation(Sri Lanka Medical Association, 2023) Fernando, M.; Gunetilleke, B.; Tillakaratne, S.; Siriwardana, R.C.; Appuhamy, W.N.D.P.C.; Padmasiri, U.G.M.INTRODUCTION: Interventional radiology advances have rendered it attainable to treat many of the complications of liver disease in a minimally invasive manner, and they play a major role in liver transplantation. OBJECTIVES: We aimed to assess the role of interventional radiology in a cohort of paediatric liver transplant patients. METHODS: Thirteen paediatric patients underwent liver transplantations from July 2020–February 2023 at Colombo-North Teaching Hospital, Ragama. Seven patients (53.84%) required special interventional radiological procedures. The need for an interventional radiological procedure was decided by a multidisciplinary team. A retrospective database was maintained with demographic and liver transplant data. RESULTS: Four patients (57.14%) requiring radiological intervention underwent procedures involving the thoracic cavity, and 5 patients (71.42%) who required radiological intervention underwent procedures involving the abdominal cavity. Two patients (28.57%) out of the seven who had interventional radiological procedures went through both abdominal and thoracic radiological interventions. As abdominal radiological interventions, splenic artery embolization (20%), hepatic venous stenting (20%), subhepatic drain placement (20%), and two abdominal pigtail drain insertions (40%) have been done. Four patients underwent pigtail insertion, which was performed as a thoracic radiological intervention. CONCLUSIONS: Interventional radiology plays a crucial role in the management of paediatric post-liver transplantation patientsItem A prospective study on drain fluid amylase as an indicator of clinical outcome in patients undergoing Whipple surgery(Sri Lanka Medical Association, 2023) Gishanthan, S.; Tillakaratne, S.; Bulathsinhala, B.S.K.; Uragoda, B.; Siriwardana, R.C.INTRODUCTION: Post-Whipple pancreatic fistula is defined as having a high drain fluid amylase (DFA) (>3 times of normal value). In our observation, DFA levels did not influence the clinical outcome. OBJECTIVES: To determine the drain fluid amylase levels on the outcome of patients METHODS: 48 patients who underwent the Whipple procedure from May 2015 to September 2019 were included. Serum amylase and DFA levels were assessed on days 1,3 and 5. Amylase levels were compared with the patient’s outcome and the nature of the pancreas. RESULTS: 20 patients had DFA over three times on day 1. Their median hospital stay (HS) and ICU stay did not differ from others (HS 8 vs. 9 days, p=0.545; ICU stay 3 vs. 3 p=0.95). On day three 15 patients had DFA rise and their hospital stay (HS) and ICU were comparable. (HS 8 vs. 9 days (p=0.083), ICU stay 3 vs 3 p=0.26). On day five 5 patients had DFA over three times and their median hospital stay (HS) and ICU stay were similar. Nature of the pancreas also did not correlate significantly with DFA more than 3 times. Although patients with DFA more than 3 times of normal value on day 1,3, and 5 had smaller duct diameter (D1 2.78mm vs 4.25mm p=0.86; D3 2.08mm vs 4.42mm p=0.165; D5 4.10mm vs 1.86mm p=0.44) non was statistically significant. CONCLUSIONS: DFA > 3 times on Day1,3 and 5 did not significantly alter the outcome of patients.Item 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