Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item 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.Item 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.Item Quality of life and impact of bile reflux after retro colic retro gastric gastrojejunostomy in Whipple surgery(Biomed Central, 2017) Siriwardana, R.C.; Lokubandara, R.W.M.A.; Hewavisenthi, S.J.de S.; Liyanage, S.K.; Jayatunga, D.S.P.; Liyanage, C.A.H.Background: Delayed gastric emptying and bile reflux are common concerns in long-term survivors after Whipple surgery. The study was designed to assess modified retro colic retro gastric gastrojejunostomy in reducing macro and microscopic bile reflux and impact on dyspepsia related quality of life in long-term survivors. Methods: Out of 43 patients operated, 23 long-term survivors were included. All underwent gastroscopy and bile reflux was grouped as normal, yellowish bile lakes and presence of greenish bile lakes. Six standard gastric biopsies were taken. Microscopic bile reflux index (BRI) was calculated and a score 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 (21–70) years. Median survival of the group was 37 months (6–40). Endoscopically, 20/23 (87%) had macroscopic bile reflux (74% yellowish bile lakes, 13% greenish bile lakes). None had stomal ulcers or macroscopic inflammation. Mean bile reflux index score was 9.7 (range 1.77–34). Mean NDI–SF score of Whipple group was 23.1 (SD 8.88). In controls, mean score was 19.9 (SD 8.23), showing no significant difference (p = 0.245). Conclusions: Though there was macroscopic bile reflux, clinical symptoms and microscopic changes were minimal. The modified technique had good long-term results.Item Long-term survival of stage IV hepatocellular carcinoma treated with multimodal approach:(College of Surgeons of Sri Lanka, 2015) Siriwardana, R.C.; Pathirana, A.; Liyanage, C.A.H.; Rajapaksa, P.M.; Munasinghe, M.Item 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.Item 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 availableItem 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.Item Reconstruction of the middle hepatic vein in live donor liver transplantation: will it improve donor liver function?(College of Surgeons of Sri Lanka,, 2014) Liyanage, C.A.H.Right liver graft with the middle hepatic vein sometimes induces postoperative liver failure in donors due to insufficient functional remnant liver volume. Venous drainage of the graft is important for prevention of congestion and proper function of the graft. Therefore right hepatic veins and the tributaries of the middle hepatic vein need reconstruction. The unique technique of reconstructing the middle hepatic vein, the right hepatic vein and the short hepatic veins using allografts and artificial grafts are discussed. Patients who had right hepatic and middle hepatic vein reconstructions had good graft functions and less hepatic congestion. This technique will be useful for preserving liver function in right liver lobe donors in Sri Lanka where more than 31% of the general population has fatty liver disease.Item 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