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Papers by Chandika Liyanage

Research paper thumbnail of Duodenum-preserving local excision of a gastrointestinal stromal tumor

Hepatobiliary & pancreatic diseases international: HBPD INT

Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the ... more Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision. The surgery was facilitated by preoperative mapping with Indian ink and navigation by endoscopy to assess the adequacy of resection and to avoid injury to the ampulla. Reconstruction was successful with a duodenojejunostomy and protected by a nasoduodenal drain. The patient had no postoperative complications and the tumor was confirmed to be a GIST of the duodenum successful with an adequate resection margin.

Research paper thumbnail of Multiple choice questions as a ranking tool: a friend or foe?

Research paper thumbnail of Eversion thrombectomy for partial portal vein thrombosis during living donor liver transplantation

Sri Lanka Journal of Surgery, 2012

Research paper thumbnail of Major hepatectomy for hepatoma invading the main portal vein

Sri Lanka Journal of Surgery, 2013

Research paper thumbnail of A new technique for suture rectopexy without resection for rectal prolapse

Techniques in Coloproctology, 2009

before surgery to 79±4.77 mmHg (35-157 mmHg) after surgery (p=0.001).. Transit was unchanged in 1... more before surgery to 79±4.77 mmHg (35-157 mmHg) after surgery (p=0.001).. Transit was unchanged in 18 of 20 patients (90%) who were evaluated before and after surgery; none was constipated after surgery. At 56 months, prolapse had recurred in five patients (7%). Conclusion Abdominal suture rectopexy with a left pararectal approach without sigmoid resection in those with normal preoperative transit resulted in an improvement in anal incontinence and satisfactory long-term control of prolapse. The operation did not alter transit and did not result in significant constipation.

Research paper thumbnail of Obstructive jaundice caused by a biliary mucinous cystadenoma in a woman: a case report

Journal of Medical Case Reports, 2013

Introduction: Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition... more Introduction: Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition is more common in young women and accounts for non-specific symptoms. Cyst adenomas commonly affect the intrahepatic system (90%) and are rarely found in the extrahepatic biliary system or affecting both the systems. Case presentation: A 39-year-old Sinhalese woman presented with features of obstructive jaundice and was found to have a biliary neoplasm on imaging. In the absence of a definitive diagnosis despite extensive imaging she underwent preoperative endoscopic biliary drainage followed by a left hemihepatectomy with Roux-en-Y hepaticojejunostomy. A pathological examination of the specimen revealed an obstruction of the bile duct caused by a biliary mucinous cystadenoma affecting both the intrahepatic and extrahepatic systems. Conclusions: Biliary mucinous cystadenoma rarely present with obstructive jaundice affecting both intrahepatic and extrahepatic ducts. Exhaustive investigation might not help in the diagnosis and may need to be treated based on clinical judgment. The definitive treatment modality is surgery due to its malignant potential. The operative procedure is technically demanding and is best performed at specialist centers to minimize complications.

Research paper thumbnail of Prevention of iatrogenic bile duct injuries in difficult laparoscopic cholecystectomies: is the naso-biliary drain the answer?

Journal of Hepato-biliary-pancreatic Surgery, 2009

Background Prevention of iatrogenic injuries is of paramount importance in difficult laparoscopi... more Background Prevention of iatrogenic injuries is of paramount importance in difficult laparoscopic cholecystectomies (LC). The objective of this study was to analyze the effectiveness of cholangiography using a pre-inserted endoscopic naso-biliary drain (ENBD) for navigation during difficult cholecystectomies. Methods The study design was a retrospective case analysis. In 508 patients who underwent LC in a tertiary referral university hospital from 1996 through 2007, difficult cholecystectomy was anticipated in 26 patients due to possibly aberrant biliary anatomy (four patients), unclear cystic duct anatomy during magnetic resonance cholangiopancreatography (MRCP) and/or endoscopic retrograde cholangiopancreatography (ERCP) (three patients), and acute cholecystitis (19 patients). An ENBD was inserted during ERCP prior to LC for cholangiography (ENBDC) to facilitate safe dissection during LC. Prevalence of biliary complications was assessed as the main outcome measurement. Results ...

Research paper thumbnail of Intramural incision technique: do we know enough to continue?

Gastrointestinal Endoscopy, 2008

Research paper thumbnail of A structured training programme in laparoscopic cholecystectomy

Ceylon Medical Journal, 2009

Research paper thumbnail of Locating an insulinoma by surgical exploration

Ceylon Medical Journal, 2011

The case of a 79-year old man who was suspected to have an insulinoma is presented. Although clin... more The case of a 79-year old man who was suspected to have an insulinoma is presented. Although clinically and biochemically an insulinoma was the most probable diagnosis there was no supportive radiological evidence. Open surgery and exploration revealed a lesion which was confirmed to be an insulinoma. The patient's hypoglycaemia improved immediately following surgery. In the Sri Lankan setting where sophisticated imaging procedures are not freely available, open exploration of the pancreas is a good alternative to locate a suspected insulinoma.

Research paper thumbnail of Endoscopic management of a difficult common bile duct stone

Ceylon Medical Journal, 2008

Research paper thumbnail of Clopidogrel and Surgical Intervention: A point to ponder

Sri Lanka Journal of Surgery, 2011

Research paper thumbnail of Duodenum-preserving local excision of a gastrointestinal stromal tumor

Hepatobiliary & pancreatic diseases international: HBPD INT

Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the ... more Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision. The surgery was facilitated by preoperative mapping with Indian ink and navigation by endoscopy to assess the adequacy of resection and to avoid injury to the ampulla. Reconstruction was successful with a duodenojejunostomy and protected by a nasoduodenal drain. The patient had no postoperative complications and the tumor was confirmed to be a GIST of the duodenum successful with an adequate resection margin.

Research paper thumbnail of Multiple choice questions as a ranking tool: a friend or foe?

Research paper thumbnail of Eversion thrombectomy for partial portal vein thrombosis during living donor liver transplantation

Sri Lanka Journal of Surgery, 2012

Research paper thumbnail of Major hepatectomy for hepatoma invading the main portal vein

Sri Lanka Journal of Surgery, 2013

Research paper thumbnail of A new technique for suture rectopexy without resection for rectal prolapse

Techniques in Coloproctology, 2009

before surgery to 79±4.77 mmHg (35-157 mmHg) after surgery (p=0.001).. Transit was unchanged in 1... more before surgery to 79±4.77 mmHg (35-157 mmHg) after surgery (p=0.001).. Transit was unchanged in 18 of 20 patients (90%) who were evaluated before and after surgery; none was constipated after surgery. At 56 months, prolapse had recurred in five patients (7%). Conclusion Abdominal suture rectopexy with a left pararectal approach without sigmoid resection in those with normal preoperative transit resulted in an improvement in anal incontinence and satisfactory long-term control of prolapse. The operation did not alter transit and did not result in significant constipation.

Research paper thumbnail of Obstructive jaundice caused by a biliary mucinous cystadenoma in a woman: a case report

Journal of Medical Case Reports, 2013

Introduction: Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition... more Introduction: Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition is more common in young women and accounts for non-specific symptoms. Cyst adenomas commonly affect the intrahepatic system (90%) and are rarely found in the extrahepatic biliary system or affecting both the systems. Case presentation: A 39-year-old Sinhalese woman presented with features of obstructive jaundice and was found to have a biliary neoplasm on imaging. In the absence of a definitive diagnosis despite extensive imaging she underwent preoperative endoscopic biliary drainage followed by a left hemihepatectomy with Roux-en-Y hepaticojejunostomy. A pathological examination of the specimen revealed an obstruction of the bile duct caused by a biliary mucinous cystadenoma affecting both the intrahepatic and extrahepatic systems. Conclusions: Biliary mucinous cystadenoma rarely present with obstructive jaundice affecting both intrahepatic and extrahepatic ducts. Exhaustive investigation might not help in the diagnosis and may need to be treated based on clinical judgment. The definitive treatment modality is surgery due to its malignant potential. The operative procedure is technically demanding and is best performed at specialist centers to minimize complications.

Research paper thumbnail of Prevention of iatrogenic bile duct injuries in difficult laparoscopic cholecystectomies: is the naso-biliary drain the answer?

Journal of Hepato-biliary-pancreatic Surgery, 2009

Background Prevention of iatrogenic injuries is of paramount importance in difficult laparoscopi... more Background Prevention of iatrogenic injuries is of paramount importance in difficult laparoscopic cholecystectomies (LC). The objective of this study was to analyze the effectiveness of cholangiography using a pre-inserted endoscopic naso-biliary drain (ENBD) for navigation during difficult cholecystectomies. Methods The study design was a retrospective case analysis. In 508 patients who underwent LC in a tertiary referral university hospital from 1996 through 2007, difficult cholecystectomy was anticipated in 26 patients due to possibly aberrant biliary anatomy (four patients), unclear cystic duct anatomy during magnetic resonance cholangiopancreatography (MRCP) and/or endoscopic retrograde cholangiopancreatography (ERCP) (three patients), and acute cholecystitis (19 patients). An ENBD was inserted during ERCP prior to LC for cholangiography (ENBDC) to facilitate safe dissection during LC. Prevalence of biliary complications was assessed as the main outcome measurement. Results ...

Research paper thumbnail of Intramural incision technique: do we know enough to continue?

Gastrointestinal Endoscopy, 2008

Research paper thumbnail of A structured training programme in laparoscopic cholecystectomy

Ceylon Medical Journal, 2009

Research paper thumbnail of Locating an insulinoma by surgical exploration

Ceylon Medical Journal, 2011

The case of a 79-year old man who was suspected to have an insulinoma is presented. Although clin... more The case of a 79-year old man who was suspected to have an insulinoma is presented. Although clinically and biochemically an insulinoma was the most probable diagnosis there was no supportive radiological evidence. Open surgery and exploration revealed a lesion which was confirmed to be an insulinoma. The patient's hypoglycaemia improved immediately following surgery. In the Sri Lankan setting where sophisticated imaging procedures are not freely available, open exploration of the pancreas is a good alternative to locate a suspected insulinoma.

Research paper thumbnail of Endoscopic management of a difficult common bile duct stone

Ceylon Medical Journal, 2008

Research paper thumbnail of Clopidogrel and Surgical Intervention: A point to ponder

Sri Lanka Journal of Surgery, 2011