Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
13 results
Search Results
Item Anatomy of the thoracic duct: a cadaveric study(The College of Surgeons of Sri Lanka, 2025-01) Abeysuriya, V.; Nuwantha, A.A.S.; Kumarage, S.No abstract availableItem A cadaveric study on superior hypogastric plexuses(The College of Surgeons of Sri Lanka, 2024) Abeysuriya, V.; Akalanka, H.G.L.; Kumarage, S.INTRODUCTION The superior hypogastric plexus (SHP) is found around the level of aortic bifurcation. It is important in surgical procedures in the pelvis. Methods Ten (5; M & 5; F) fresh intact adult human cadavers were dissected. Following the initial dissection, all of them were further sectioned sagittal in the midline and separated in to half pelvises, and assessed. The study was carried out in the Department of Anatomy, Faculty of medicine Ragama, Sri Lanka from 2022 to 2024. The ethical clearance was obtained. RESULTS In all specimens, left connecting fibers from the inferior mesenteric plexuses (IMA) crossed the left common iliac artery and joining to the superior hypogastric plexuses. In 80%, right connecting nerve fibers from the inferior mesenteric plexuses crossed the right common iliac artery and joined the superior hypogastric plexus (SHP). Eighty percent of the specimens had, well-defined nerve strands, whereas 20% contained a delicate and irregular meshwork. In all of the specimens, the median root, or a nerve root from abdominal aortic plexus from the IMA were present. In 80% specimens, the SHP was located between the aortic bifurcation and the sacral promontory. In 20%, it extended across the pelvic brim and ended on the body of the S1 vertebra. CONCLUSION The majority of the SHP were located below the aortic bifurcation and had well-defined nerve strands, rest traversed the pelvic brim and terminated on the body of the S1 vertebra. Further larger sample studies are recommended.Item Attempted one anastomosis gastric bypass converted to a sleeve gastrectomy in an adult patient with asymptomatic intestinal malrotation: A case report(SAGE Publications, 2024) Jayarajah, U.; Sathasivam, K.; Kumarage, S.; Wijeratne, T.Unexpected encounters during surgery for obesity such as midgut malrotation cause specific technical challenges to the surgeon. We present a rare case of asymptomatic complete intestinal malrotation midway during a one anastomosis gastric bypass procedure. A 62-year-old male with a body mass index of 49 kg/m2 and metabolic syndrome was planned for one anastomosis gastric bypass. A gastric tube was created along the lesser curvature. During the attempt to identify the suitable small bowel loop, an unexpected completely malrotated gut was noted. Due to the intraoperative difficulty in identifying the correct loop to anastomose to the gastric tube an intraoperative decision was taken to convert the procedure to a sleeve gastrectomy. The created gastric tube was re-anastamosed to distal stomach, and the redundant stomach was resected. Postoperative recovery was uneventful, and weight loss was satisfactory. Attempted one anastomosis gastric bypass converted to a sleeve gastrectomy was a successful bailout procedure.Item Translation, cross-cultural adaptation, and validation of the duke activity status index (DASI) to Sinhala language(BioMed Central, 2024) Ranasinghe, C.; Kariyawasam, K.; Liyanage, J.; Walpita, Y.; Rajasinghe, U.; Abayadeera, A.; Chandrasinghe, P.; Gunasekara, M.; Kumarage, S.; De Silva, M.; Ranathunga, K.; Deen, K.; Ismail, H.BACKGROUND Duke Activity Status Index (DASI) is a widely used tool to assess functional capacity among patients, but there is no Sinhala version validated for patients in Sri Lanka. This study aimed to cross-culturally adapt and test the validity and reliability of the Sinhala version of DASI (DASI-S).METHODS The translation and cross-cultural adaptation of the DASI questionnaire were conducted following the standard guidelines. It was pre-tested on ten pre-operative patients and further modified. The construct validity and reliability of DASI-S were evaluated by administering the modified final DASI-S, which comprised 12 items, along with the physical functioning sub-scale of the 36-item short-form health survey (SF-36), consisting of 10 items to eighty-one patients who were awaiting non-cardiac surgeries at university surgical wards, National Hospital of Sri Lanka (NHSL), and Colombo North Teaching Hospital (CNTH), Sri Lanka. Reliability was assessed through Cronbach alpha, while the validity was evaluated using factor analysis and Spearman's correlation. The ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo, Sri Lanka.RESULTS The mean age of the participants was 46.2 (± 16.6) years and the majority were females (54.3%). The mean height, weight, and body mass index of the sample were 160.5 (± 9.6) cm, 60.3 (± 11.9) kg, and 23.4 (± 4.5) kgm-2 respectively. The Cronbach's alpha coefficient for the internal consistency of DASI-S was 0.861. The concurrent validity of DASI-S was substantiated by positively correlating (p < 0.01, rs = 0.466) with the physical sub-scale of SF-36. There was a significant difference (p < 0.01) in the total score of DASI-S between the two age groups.CONCLUSIONS Sinhala version of the DASI appears to be a valid, reliable and easy-to-administer tool to assess functional capacity among patients who are awaiting non-cardiac surgeries.Item Fish bone migration through a sigmoid colon diverticulum causing an anterior abdominal wall abscess(The College of Surgeons of Sri Lanka, 2024) Ekanayaka, E.M.M.; Gunasekara, K.; Fernando, R.; Chandrasinghe, P.C.; Kumarage, S.No abstract availableItem North Colombo diverticular disease snap shot audit (VISTA study): a collaborative research initiative(The College of Surgeons of Sri Lanka, 2023) Chandrasinghe, P.; Ediriweera, E.P.D.S.; Niriella, M.; Ranwaka, C.; Fernando, A.; Gunawardena, H.; Kumarage, S.INTRODUCTION Diverticulosis and diverticular disease (DD) is a common occurrence in clinical practice in the local setting with a lack of documented literature. A snapshot audit was conducted at North Colombo Teaching Hospital (NCTH) to ascertain the disease burden in clinical practice as a pilot study to assess feasibility and response rate for a nation wide snapshot audit. METHODOLOGY All surgical and gastroenterology units at NCTH were requested to enter the data between 1st January 2022 to 30th of June 2022 on all patients presenting with DD or those detected with diverticulosis during screening colonoscopy. Prospective data collection was done using RedCap© data capturing platform. RESULTS Out of the 8 units invited (general surgery – 5, GI surgery – 1, gastroenterology – 2), 5 units participated (general surgery – 2, GI surgery – 1, gastroenterology – 2); response rate is 62%. A total of 46 patient records (median age- 68 years; range 29- 86; female 51%) were received within 6 months. Of the total 54.3% had symptomatic uncomplicated diverticular disease (SUDD) while 33% were detected with diverticulosis at screening. Only 13% (n=6) required inward care (bleeding – 3, diverticulitis – 2, perforation – 1) and detected using colonoscopy in 4 and CT scan in 2. In the DD group, 20% (6/31) had complicated DD while 80% had Symptomatic Uncomplicated Diverticular Disease (SUDD). CONCLUSION In this pilot study, a majority of the patients with DD presented with SUDD while around 20% came with complicated DD. The response rate from collaborators was satisfactory. The secure online database usage is feasible and will be used for a national level study in the future to assess the disease burden in the healthcare setting in Sri Lanka.Item Trends in early onset colorectal cancer (EOCRC) in a South Asian cohort: data from a specialized tertiary care center in western Sri Lanka(The College of Surgeons of Sri Lanka, 2022) Chandrasinghe, P.; Godahewa, S.; Mahendra, G.; Hewavissenthi, J.; Kumarage, S.Introduction Early onset colorectal cancer [EOCRC] has significantly increased during the past decade globally. It is defined as cancers diagnosed in those aged 50 years or less. Most research on EORC are from western populations where the tumour biology and risk factors may differ from other regions. Evidence on EOCRC from the South Asian region is particularly scarce. This study presents the basic trends in presentation and overall survival [OS] pattern of EOCRC using data from a single specialized tertiary care institution over two decades. Methods A total of 723 patients treated at the University surgical unit of the North Colombo teaching hospital from 1995 to 2020 were included in the analysis. Overall survival of the EOCRC was compared with that of the older population using Kaplan- Meier survival curves. Survival patterns over two time periods [pre-2010 vs post-2010] were also compared between the two populations. The stage at presentation, family history of colorectal or related cancers, tumour site, and tumour stage were also compared. Results The proportion of EOCRC in this cohort has not shown a significant increase over the past two decades [2001-2010: 24% vs 2011-2020: 21%]. The advanced tumour stage at presentation and the presence of significant family history are also comparable. EOCRC cohort demonstrates a better OS for the entire study period [Median survival: < 50 years – not reached; >50 years – 91 months; 95%CI – 72-132; P<0.001]. However, this survival advantage is only observed during the pre-2010 period [Median survival: < 50 years – 160 months; 95%CI – 120 – not reached; >50 years – 84 months; 95%CI – 62-132; P=0.01] and becomes comparable in the 2010-2020 period [P=0.16]. OS of the EORC has not also improved over the two decades from 2001 to 2020 [P=0.51]. Conclusion There is no significant increase in the EOCRC rates in this population over time although the rate has remained high throughout. The OS of the EOCRC population is better compared to the older population. A significantly better OS is observed during the pre-2010 period in the EOCRC but is not present in the post-2010 period. Advancement in therapy may have improved the survival of the older population during the latter part but not that in the EOCRC due to its inherently aggressive nature. This paper provides preliminary data on EOCRC from Sri Lanka. The South Asian population may have a different disease pattern with younger age at onset compared to the western populations and needs to be further explored.Item Ectopic pancreatic rest in the stomach(College of Surgeons of Sri Lanka, 2020) Pinto, D.; Kumarage, S.; Mahendra, G.No abstract availableItem Double single-port pan-proctocolectomy with transanal total mesorectal excision [TaTME] and ileal pouch-anal anastomosis [IPAA]: improvisation under limited resources(College of Surgeons of Sri Lanka, 2020) Chandrasinghe, P.; Kumarage, S.ABSTRACT: Novel surgical techniques fail to reach all parts of the world equally due to financial constraints. Non-availability of high-cost equipment in the developing world hinders progress. Transanal total mesorectal incision [TaTME] is a novel technique becoming popular world over due to many perceived benefits. Some of the equipment requirements prevent surgeons in resource-limited environments from taking up this technique. We describe the performance of a double single port panproctocolectomy with TaTME and ileal pouch-anal anastomosis for a patient with colitis-associated rectal cancer under improvised conditions at a tertiary care centre in Sri Lanka. Standard practice requires two laparoscopic stacks and an integrated air insufflator both of which are not available in the local setting. A flexible endoscope was used to replace the need for a second laparoscopic stack and a simple drainage bag connection to the standard insufflator to provide a stable pneumo-peritoneum. The patient had a rapid uneventful recovery. KEYWORDS: TaTME, Double single port, Innovation, Pouch surgeryItem Place for elective cholecystectomy for patients with severe thalassaemia: a retrospective case control study.(BioMed Central,London, 2019) Premawardhena, A.; Fernando, R.; Kumarage, S.; Nishad, N.; Goonatilleke, D.; Silva, I.; Mettananda, S.OBJECTIVE:At present, cholecystectomy is carried out for thalassaemia patients with gall stone disease only if they develop symptoms of cholecystitis, except in the rare instance where an un-inflammed gall bladder is removed simultaneously with splenectomy. We carried out this retrospective analysis of case records to examine if patients with thalassaemia have a higher rate of peri operative complications compared to non-thalassaemics with gall stone disease, warranting a change of policy to justify elective cholecystectomy.RESULTS:Case records of 540 patients with thalassaemia were retrospectively analysed of which 98 were found to have gallstones. Records of 62 patients without thalassaemia with gall stone disease too were used for comparison. 19 of patients with thalassaemia and 52 of non-thalassaemic who had gallstones had undergone cholecystectomy. In all but 5 patients with thalassaemia cholecystectomy was done following attacks of acute cholecystitis as was the case in the non-thalassaemic controls. A significantly higher proportion of early and late complications had occurred in thalassaemia patients compared to non-thalassaemic patients post operatively. Six deaths related to sepsis following acute cholecystitis in the peri operative period were reported among 19 thalassaemia patients whereas no deaths were reported among 55 non-thalassaemic patients who underwent cholecystectomy for gallstones.