http://dr.lib.sjp.ac.lk/handle/123456789/97 2026-01-07T05:59:38Z 2026-01-07T05:59:38Z Gamage, B.D. Harivallavan, N. http://dr.lib.sjp.ac.lk/handle/123456789/4664 2022-02-24T05:29:38Z 2015-01-01T00:00:00Z

Laparoscopic Adrenalectomy for Adrenal Tumours in Adults - Initial Experience Gamage, B.D.; Harivallavan, N. Introduction In the management of adrenal tumors the open adrenalectomy has almost being replaced by the laparoscopic adrenalectomy. Currently this has become the gold standard surgical treatment for most adrenal tum ours. The benefits of the laparoscopic adrenalectomy such as decreased hospital stay, shorter recovery time and improved patient satisfaction are widely accepted. The aim of this study was to present our experiences on laparoscopic adrenalectomies done during the period of 2013 to 2015. Material and Methods Retrospective analysis of the data of all the laparoscopic adrenalectomies done by a single surgeon was performed. Results Total number of patients underwent laparoscopic adrenalectomy was nine (9). There were five males and 4 females. The age range was 21-62 years. Five of these patients had presented with uncontrolled blood pressure while 3 others had come with loin pain and only one case presented with hypokaleamia. Four of them had adrenal tumour on the left side while five had right side tumours. All patients were managed with lateral trans peritoneal approach while all of them needed 4 port access with three 5mm ports and one 10mm port. Blood loss was minimal in all cases and no complications were noted. None were converted to open surgery while all had shorter hospital stay (mean days=2). Out of nine, 6 had adrenocortical adenoma , 2 had phaeochromocytoma and one had an inflammatory pseudo tumour. Conclusion Laparoscopic adrenalectomy gives better outcomes when compared to open adrenalectomy, in blood loss and short hospital stay and cosmetic effects.

2015-01-01T00:00:00Z Gamage, B.D. Ranatunga, R.M.A.S.N. Harivallavan, N. http://dr.lib.sjp.ac.lk/handle/123456789/4660 2022-02-24T05:29:00Z 2015-01-01T00:00:00Z

Enhance Recovery after Elective Colorectal Surgery-Six Year Sri Lankan Experience Gamage, B.D.; Ranatunga, R.M.A.S.N.; Harivallavan, N. Introduction The enhance recovery after elective colorectal surgery (ERAS) protocol is used to achieve fast return to normal physiological status. Adherent to this protocol is not common in Sri Lankan practice. We have continued modified ERAS which have shown safe in the initial experience. This study is to evaluate success in each component of ERAS protocol. Materials and Methods Retrospective study data was collected from 52 patients who had undergone elective colorectal resection in our unit during 2009- 2015. Each component of ERAS protocol was analyzed using a structured proforma. Results There were 31 males and 21 females with mean age of 56.83 years. 14 patients underwent for neo-adjuvant radiotherapy. Twenty seven (51.9%) patients underwent laparoscopic (including one 3D) surgery. Commonest surgery was anterior resection (50%) while other include; 10 abdominal perineal resection, 13 colectomies and 3 Hartmann reversal. Mobilization within 3 days was achieved in 44(84.6%) patients while 67.3% were started on oral feeding same day of the operation. Hospital less than 5 days was seen in 26 patients (laparoscopic surgery 16). The post-operative complications noted were; 2 chest infection, 7 surgical site infections (clevian dindo class 2). When compared with calculated (CR-POSSUM) average mortality of 6.26 (range 0.68 -20.02) the 30 day mortality with ERAS protocol was Zero. Conclusions ERAS protocol in colorectal surgery is feasible and successful to our local settings.

2015-01-01T00:00:00Z Weerasekera, D.D. Pathirana, A.A. Wijeratne, T. Gamage, B.D. Duminda, H.K.K.T. Kamaladasa, A. Harivallavan, N. http://dr.lib.sjp.ac.lk/handle/123456789/4656 2022-02-24T05:29:00Z 2015-01-01T00:00:00Z

Total Mesocolic Excision and Central Vascular Ligation in Tertiary Care Center Weerasekera, D.D.; Pathirana, A.A.; Wijeratne, T.; Gamage, B.D.; Duminda, H.K.K.T.; Kamaladasa, A.; Harivallavan, N. Introduction Total mesocolic excision (TME) and central vascular ligation (CVL) is the potential curative surgical technique in stage II and III colonic adenocarcinoma. Minimum numbers of lymph nodes are defined as 12. The lymph node ratio is a better prognostic indicator than the number of positive lymph nodes. This study is to identify lymph node yield and ratio in technique of TME and CVL. Material and Methods Prospective descriptive study, data were collected over period of 8 months. All patients underwent TME and CVL objectively. Results 13 patients underwent surgery which includes 4 female and 9 males. The mean age of cohort was 60 years (range 40-86). There were 6 right hemicolectomies, 3 extended right hemicolectomies and 4 sigmoid colectomies. Majority of patients had moderately differentiated adenocarcinoma one had mucinous adenocarcinoma and two had poorly differentiated tumour. The average of lymph node harvested was 20 while average positive lymph node was 1.3. The lymph node ratio was 0.06. In pathological staging, 8 (61.5%) had Dukes C and 38.5% of patients had Dukes B tumour. None of patients had clinical anastomotic leak. Conclusions The TME and CVL is emerging trend in colonic surgery for adenocarcinoma. Further studies are needed to define adequate number of lymph nodes to be harvested and need long term follow up to assess the prognosis following in TME and CVL.

2015-01-01T00:00:00Z Gamage, B.D. Ranatunga, R.M.A.S.N. Harivallavan, N. Lambiyas, P. http://dr.lib.sjp.ac.lk/handle/123456789/4649 2022-02-24T05:28:51Z 2015-12-03T00:00:00Z

Enhanced Recovery after Elective Colorectal Surgery—Firsthand Experience from a Developing Country Gamage, B.D.; Ranatunga, R.M.A.S.N.; Harivallavan, N.; Lambiyas, P. The Enhanced Recovery After elective colorectal Surgery (ERAS) protocol is used to achieve fast return to normal physiological status post operatively. ERAS protocol was not practiced in Sri Lanka till 2009. We have been practicing modified ERAS protocol since 2009 in our unit. The aim of this study is to evaluate the success of the modified ERAS protocol. Methods: Retrospective study of prospectively collected data of 62 elective colorectal surgeries was carried out by a single surgeon in our unit from August 2009 to September 2015. In all 62 patients each component of the modified ERAS protocol was analyzed using a structured Performa. Results: There were 35 males and 27 females. Out of all, 16 patients underwent surgery following neo-adjuvant therapy. Out of 62 patients laparoscopic surgeries were performed in 35 (56.5%). The commonest surgery performed under this protocol was anterior resection (51.6%). In 53 patients post-operative mobilization was achieved within 3 days, while 71% were started on oral feeding on the same day of the operation. In 31 patients hospital stay was less than 5 days. The postoperative complications noted were only two chest infection and two postoperative pyrexia and seven surgical site infections (clevian dindo class 2) and one anastomotic leakage. When compared with calculated (CR-POSSUM) average mortality of 5.91 (range 0.68-20.02) the 30-day mortality with ERAS protocol was zero. Conclusion: ERAS protocol in elective colorectal surgery can be successfully used with relevant modifications to suit a developing country.

2015-12-03T00:00:00Z