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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 The long-term impact of postcholecystectomy major bile duct injury on liver stiffness(BioMed Central, 2024-11) Jayasekara, A.; Tillakaratne, S.B.; Dasanayake, U.; Gishanthan, S.; Siriwardana, R.C.INTRODUCTION Iatrogenic bile duct injuries (BDI) are a devastating complication. Long-term impact of corrective hepaticojejunostomy (HJ) for such injuries on post -surgery liver stiffness is lacking. Hence the aim of this study was to explore the extent of hepatic fibrosis in a cohort of patients with Strasberg E bile duct injuries who underwent HJ after a minimum follow-up of six months.METHODS Out of 50 BDI presented over a period of 10-years, 19 patients with Strasberg type E, injuries that underwent HJ and completed a minimum 6-month follow-up [65.5 (7 -108)] period were selected. Data were prospectively collected on liver functions and liver stiffness was assessed using a Fibroscan. Their liver stiffness and degree of fibrosis was compared with (n = 38) age, gender and comorbidity matched controls.RESULTS The median age was 47 (30-70) years, with 63% females. Primary HJ was performed in 84%, with a median time from injury to HJ of 7 (1-39) days. The total bilirubin was 16.5 (11.2) µmol/L, Alkaline Phosphatase was 102 (27.2) U/L, and Platelet count was 256 (77) x 103. Liver stiffness (median 6.4 kPa) did not significantly differ from controls (5.3 kPa). Fibrosis assessment revealed comparable distribution of F0 to F3 fibrosis between the study and control groups (F0/F1: 68.4% vs. 84.4%, F2: 10.5% vs. 9.4%). However, all three patients with right hepatic artery injury (p = 0.003) and three of five patients with bile duct stricture had F3/F4 fibrosis.CONCLUSIONS Major BDI repair demonstrates comparable liver fibrosis in the absence of artery injury and anastomotic strictures. Measuring liver fibrosis could be valuable in the presence of arterial injuries or anastomotic strictures.Item Intraoperative visualization of biliary anatomy using Indocyanine green (ICG) fluorescence in a Sri Lankan patient cohort(The College of Surgeons of Sri Lanka, 2024) Kumarage, S.K.; Lakshani, D.H.J.P.U.; Pinto, M.D.P.; Chandrasinghe, P.C.INTRODUCTION: Bile duct injury (BDI) is a complication with high morbidity, associated with laparoscopic cholecystectomy (LC). The risk of BDI can be reduced by accurate visualization of the biliary tree with the use of indocyanine green fluorescence (ICG). This study describes the use of this non-invasive technique in a cohort of Sri Lankan patients to visualize the biliary anatomy intraoperatively. METHOD: A total of 121 consecutive patients undergoing LC were included. All received 5 mg of ICG intravenously, 30 minutes prior to induction of anesthesia. The Stryker 1588 laparoscope was used to visualize the anatomical landmarks, both pre and post-dissection of the Calot's triangle, using visible light and near-infrared imaging (NIR). RESULT: In 121 patients (female - 64.5%, median age - 42 years; range of 18-82) included in the study, biliary colic was the commonest indication (70%) for LC. ICG fluorescence resulted in significantly better visualization of the extrahepatic biliary tract (p=<0.001), both pre-dissection (95%CI = 91.7% [85.3%-96.0%]) and post-dissection (95% CI=71.1% [62.1%-79.0%]) of the Calot's triangle. Furthermore, the hepatic ducts were only visualized with ICG. Visualization of the Cystic duct common bile duct junction (CDCBDJ) improved from 6% to 88% (P<0.001) predissection with ICG. Fluorescence enabled the visualization of CDCBDJ post-dissection in all cases compared to 54% without it (P<0.001). ICG enhanced visualization of the Common bile duct (CBD) from 34% to 88% (P<0.001) predissection and 100% visibility post-dissection compared to 62% under visible light (P<0.001). No adverse effects of ICG or bile duct injuries were reported during the study. CONCLUSION: The use of ICG during LC significantly enhanced the identification of biliary landmarks in this cohort. Identification of anatomy can help reduce inadvertent BDI. This safe and effective modality may be considered a routine step in LC.