Sumudu Kumarage - Academia.edu (original) (raw)
Papers by Sumudu Kumarage
BMC Medical Education, 2020
Background The Covid-19 pandemic necessitated the delivery of online higher education. Online lea... more Background The Covid-19 pandemic necessitated the delivery of online higher education. Online learning is a novel experience for medical education in Sri Lanka. A novel approach to undergraduate surgical learning was taken up in an attempt to improve the interest amongst the students in clinical practice while maximizing the limited contact time. Method Online learning activity was designed involving medical students from all stages and multi consultant panel discussions. The discussions were designed to cover each topic from basic sciences to high-level clinical management in an attempt to stimulate the student interest in clinical medicine. Online meeting platform with free to use basic plan and a social media platform were used in combination to communicate with the students. The student feedback was periodically assessed for individual topics as well as for general outcome. Lickert scales and numeric scales were used to acquire student agreement on the desired learning outcomes....
The Lancet, 2021
Background 80% of individuals with cancer will require a surgical procedure, yet little comparati... more Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494.
Sri Lanka Journal of Surgery, 2020
![Research paper thumbnail of Double single-port pan-proctocolectomy with transanal total mesorectal excision [TaTME] and ileal pouch-anal anastomosis [IPAA]: improvisation under limited resources](https://attachments.academia-assets.com/92253353/thumbnails/1.jpg)
](Sri Lanka Journal of Surgery, 2020
Introduction Novel surgical techniques fail to reach all parts of the world equally due to financ... more Introduction Novel surgical techniques fail to reach all parts of the world equally due to financial constraints. Non-availability of highcost 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 pneumoperitoneum. The patient had a rapid uneventful recovery. The patient was placed in Lloyd-Davies position and a GelPoint port [Applied Medical, Rancho Santo Margarita, California] was placed at the proposed ileostomy site in the RIF [Figure 1], and a GelPoint Path [Applied Medical, Rancho Santo Margarita, California] transanally. A flexible endoscope [Fuji EC-760ZP, Fujifilm, Japan] was used in place of a second laparoscopic stack and a 30-degree
BMC Research Notes, 2019
Objective: At present, cholecystectomy is carried out for thalassaemia patients with gall stone d... more 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.
Gastroenterology research and practice, 2017
There has been a continuous debate on whether elderly patients with colorectal cancer (CRC) fair ... more There has been a continuous debate on whether elderly patients with colorectal cancer (CRC) fair worse. The aim of this study is to assess the thirty-day mortality (TDM) and overall survival (OS) of elderly patients undergoing surgery for CRC. OS between two groups (≥70 versus <70 years) having surgery for CRC was analyzed. Demographics, tumour characteristics, and serological markers were considered as independent factors. Multivariable analysis was done using the Cox proportional hazard model. We also compared overall survival in the elderly versus those <60 and <50 years. 477 patients, 160 elderly (55% male; median age 75, range 70-89) and 317 younger patients (49% male; median age 55, range 16 to 69), were studied. Overall survival in CRC patients ≥70 is comparable to <70 (P = 0.45) and <60 years (P = 0.08). Poor OS was observed in the ≥70 versus <50 years (P = 0.03). TDM in the elderly was poor (P < 0.05). Postoperative cardiac complication was the only det...
Introduction: Lymph node status is important in staging colorectal cancer. Presence of metastatic... more Introduction: Lymph node status is important in staging colorectal cancer. Presence of metastatic nodes differentiates stage III from stage II. The role of adjuvant therapy is still unclear in stage II cancer. Inadequate node sampling may result in inaccurate staging. Methods: Records of 131 patients with stage II and III disease who underwent curative resection between 1997 and 2007 were analysed. Only those with 5 or more lymph nodes harvested from the specimen were included. All patients were prospectively followed up for a minimum of three years. A univariate analysis was used to compare actuarial overall survival by the Kaplan-Meier method based on different lymph node groups. Based on similar studies published statistical significance was assigned to a P value of 0.1. Results: Sixty one cancers were stage II [mean age – 56, male – 55%] and 70 were stage III [mean age -59, male – 52%]. The total population showed improved survival with 14 or more nodes harvested (P= 0.005). Nod...
Sri Lanka Journal of Surgery, 2015
Botulinum toxin injection to the puborectalis in the management of pelvic floor dyssynergia.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Fecal incontinence (FI) impairs quality of life. We performed an audit of biofeedback (BFB) in ma... more Fecal incontinence (FI) impairs quality of life. We performed an audit of biofeedback (BFB) in management of patients with FI. Fifty patients (median [range] age 30 [4-77] years; 28 men) who received BFB for median (range) of 15 weeks (4-28), either postoperatively (n=39), or as the sole treatment (n=11) were evaluated. Cleveland continence score (0-good, 20-poor), anorectal manometry parameters, and patient satisfaction (assessed by Fecal Incontinence Quality of Life Scale [FIQLS]) were evaluated at baseline and after the BFB therapy in all patients. Continence scores improved after intervention. In the surgery + BFB group, mean (SD) continence scores baseline vs. postsurgery + BFB (post-treatment) were 18.2 (3.9) vs. 6 (5.9; p< 0.01). In the BFB alone group, scores were similar at baseline 11.7 (5.9) and 6.1 (5.2) post BFB (p=0.08). Maximum resting anal pressure (MRP) improved from preoperative 12.6 (9.8) mmHg to: vs. 21.1 (11.9) mmHg post-treatment (p< 0.01). In patients wh...
Hepatobiliary & pancreatic diseases international : HBPD INT, 2008
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.
International Journal of Nursing Studies, 2008
Introduction: Patients who have a temporary loop ileostomy have impaired quality of life. Complic... more Introduction: Patients who have a temporary loop ileostomy have impaired quality of life. Complications associated with a loop ileostomy or ileostomy closure will impair patients' quality of life further and require extended enterostomal therapy. We performed a prospective audit of loop ileostomy to ascertain the nature of the workload that may be created with ileostomy-related complications. Patients and methods: One hundred and forty patients (67 males, 73 females, median age 50 years, range 5-90 years) who received a temporary loop ileostomy were analysed after completion of proformas on a prospective basis between 1999 and 2006. Results: Operation was performed for rectal cancer 100 (71%), familial adenomatous polyposis 14 (10%), ulcerative colitis 21 (15%) and for trauma or Hirchsprung's disease 5 (3%). Complications of loop ileostomy were: retraction 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), parastomal hernia 1 (0.7%), paraileostomy abscess 4 (3%) and severe skin excoriation 9 (6%). The loop ileostomy was reversed in 117 (83%) at a median (range) of 13 weeks (1-60). Ileostomy closure-related complications were: small bowel fistula 1 (0.9%), small bowel obstruction 5 (4.3%) and a stitch sinus in 1 (0.9%). Five women developed recto-vaginal fistula (n ¼ 3; 2.6%), pouch-vaginal fistula (n ¼ 1; 0.9%) and pouch-anal fistula (n ¼ 1; 0.9%) that required extended enterostomal therapy, after loop ileostomy reversal. Conclusion: Nineteen percent of patients following creation of a loop ileostomy and 10.5% of patients after reversal of the ileostomy required extended enterostomal care by a specialized enterostomal therapist, which supported resumption of a normal life.
2014 IEEE REGION 10 SYMPOSIUM, 2014
Minimally Invasive Surgeries (MIS) such as laparoscopic procedures are increasingly preferred ove... more Minimally Invasive Surgeries (MIS) such as laparoscopic procedures are increasingly preferred over conventional surgeries due to many different advantages. Laparoscopic surgical procedures are very complex compared to open surgeries and require high level of experience and expertise. Hybrid surgery simulators available for training using physical phantoms are expensive and not readily available in majority of health care facilities around the world. Therefore, computer simulation or Virtual Reality (VR) is a better way to obtain skills for MIS. A VR simulator incorporated with haptic feedback provides a comprehensive training closer to real world experience. In this paper, we present a novel approach to incorporate force feedback to VR laparoscopic surgery training. The proposed interface incorporates force feedback in all three axes to provide three levels of force feedback. Computational models of abdomen organs were generated using the cryosection data of Visible Human Project of the National Library of Medicine, USA. The organ models were developed with three basic force categories: soft, mild and hard. A hardware interface is developed to provide the force feedback for the interaction of virtual tools with the said organ models while generating the tool navigation information for the VR simulator.
World Journal of Surgical Oncology, 2010
Objectives This study compares clinico-pathological features in young (<40 years) and older pa... more Objectives This study compares clinico-pathological features in young (<40 years) and older patients (>50 years) with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival. Materials and methods A twelve year prospective database of colorectal cancer was analysed. Fifty-three young patients were compared with forty seven consecutive older patients over fifty years old. An analysis of survival was undertaken in young patients using Kaplan Meier graphs, non parametric methods, Cox's Proportional Hazard Ratios and Weibull Hazard models. Results Young patients comprised 13.4 percent of 397 with colorectal cancer. Duration of symptoms and presentation in the young was similar to older patients (median, range; young patients; 6 months, 2 weeks to 2 years, older patients; 4 months, 4 weeks to 3 years, p > 0.05). In both groups, the majority presented without bowel obstruction (young - 81%, older - 94%). Cancer...
Surgical Endoscopy, 2010
Management of chronic right iliac fossa (CRIF) pain is poorly documented in literature. No guidel... more Management of chronic right iliac fossa (CRIF) pain is poorly documented in literature. No guidelines are available on the best therapeutic approach. Patients presenting from October 2007 to August 2009 with pain persisting or recurring in right lower abdomen over a period of 6 weeks or more were assessed. Severity of CRIF pain was documented using a ten-point visual analogue scale. Initial history and examination were followed by urine analysis, blood counts, X-ray and ultrasound scan of the abdomen. Full colonoscopy was performed in all negative cases. Diagnostic or therapeutic laparoscopy was offered to patients with normal initial investigations. The normal-looking appendix was removed in the absence of other positive laparoscopic findings. Patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s immediate complications, pain score at 8 weeks and histology of appendix were assessed. Nineteen patients with median age of 43 years (range 32-52 years) underwent laparoscopy. All were female. Median pain score was 5 (range 4-6). During surgery, 12 (64%) had positive findings. Of these, 6 (30%) had adhesions, which were separated. Three patients with congested appendices were removed. One caecal perforation, tubal mass and ovarian cyst were treated laparoscopically. Seven (36%) patients who had macroscopically normal appendices underwent appendicectomy. There were no immediate postoperative complications. Significant improvement was seen in overall pain score after surgery (median 5, range 4-6 versus median 0, range 0-6; p = 0.001). However, only 57% of patients with normal appendix had improved pain scores (median 5, range 4-6 versus median 1, range 0-6; p = 0.12). All patients with positive laparoscopic findings improved after surgery. Laparoscopy seems effective in evaluation and treatment of CRIF pain. The role of appendicectomy with normal-looking appendix needs further evaluation.
Journal of Medical Case Reports, 2008
Introduction: The variations in the morphological characteristics of the extra-hepatic biliary sy... more Introduction: The variations in the morphological characteristics of the extra-hepatic biliary system are interesting. Case presentation: During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis. Conclusion: Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.
Indian Journal of Gastroenterology, 2013
Lymph node status is important in staging colorectal cancer (CRC). Presence of metastatic nodes d... more Lymph node status is important in staging colorectal cancer (CRC). Presence of metastatic nodes differentiates stage III from stage II. The role of adjuvant therapy is still unclear in stage II CRC. Inadequate node sampling may result in inaccurate staging. Records of 131 patients with stages II and III CRC who underwent curative resection, having five or more lymph nodes harvested from the specimen, were prospectively followed up and analyzed. The Kaplan-Meier method was used to analyze survival, based on groups of serially ascending values of lymph nodes harvested. Regression analysis was performed by Cox proportional hazards ratio model with right-censored CRC survival data at a 10 % significance level. The effect of nodal harvest on survival was adjusted for age, sex, preoperative carcinoembryonic antigen (CEA) level, neoadjuvant chemoradiation, pathological tumor stage, histological type, differentiation, margin positivity, angioinvasion, perineural invasion, and lymphovascular infiltration. The total population showed improved survival with 14 or more nodes harvested (p= 0.005). For both rectal (n= 83; p= 0.03) and colon cancers (n= 46; p= 0.08), most significant survival benefits were seen with over 14 nodes harvested, irrespective of the stage. With multiple regression analysis, advanced age (p= 0.003), male sex (p= 0.017), lymphovascular infiltration (p= 0.015), and preoperative CEA levels (p= 0.096) were found to be other significant factors. The lymph node effect remained significant (HR = 0.19, p= 0.004) after adjusting for the above factors. A lymph node harvest of 14 or more resulted in better survival outcome from CRC in this population. Staging of the disease could be accurate with increased nodal harvesting.
BMC Medical Education, 2020
Background The Covid-19 pandemic necessitated the delivery of online higher education. Online lea... more Background The Covid-19 pandemic necessitated the delivery of online higher education. Online learning is a novel experience for medical education in Sri Lanka. A novel approach to undergraduate surgical learning was taken up in an attempt to improve the interest amongst the students in clinical practice while maximizing the limited contact time. Method Online learning activity was designed involving medical students from all stages and multi consultant panel discussions. The discussions were designed to cover each topic from basic sciences to high-level clinical management in an attempt to stimulate the student interest in clinical medicine. Online meeting platform with free to use basic plan and a social media platform were used in combination to communicate with the students. The student feedback was periodically assessed for individual topics as well as for general outcome. Lickert scales and numeric scales were used to acquire student agreement on the desired learning outcomes....
The Lancet, 2021
Background 80% of individuals with cancer will require a surgical procedure, yet little comparati... more Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494.
Sri Lanka Journal of Surgery, 2020
Sri Lanka Journal of Surgery, 2020
Introduction Novel surgical techniques fail to reach all parts of the world equally due to financ... more Introduction Novel surgical techniques fail to reach all parts of the world equally due to financial constraints. Non-availability of highcost 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 pneumoperitoneum. The patient had a rapid uneventful recovery. The patient was placed in Lloyd-Davies position and a GelPoint port [Applied Medical, Rancho Santo Margarita, California] was placed at the proposed ileostomy site in the RIF [Figure 1], and a GelPoint Path [Applied Medical, Rancho Santo Margarita, California] transanally. A flexible endoscope [Fuji EC-760ZP, Fujifilm, Japan] was used in place of a second laparoscopic stack and a 30-degree
BMC Research Notes, 2019
Objective: At present, cholecystectomy is carried out for thalassaemia patients with gall stone d... more 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.
Gastroenterology research and practice, 2017
There has been a continuous debate on whether elderly patients with colorectal cancer (CRC) fair ... more There has been a continuous debate on whether elderly patients with colorectal cancer (CRC) fair worse. The aim of this study is to assess the thirty-day mortality (TDM) and overall survival (OS) of elderly patients undergoing surgery for CRC. OS between two groups (≥70 versus <70 years) having surgery for CRC was analyzed. Demographics, tumour characteristics, and serological markers were considered as independent factors. Multivariable analysis was done using the Cox proportional hazard model. We also compared overall survival in the elderly versus those <60 and <50 years. 477 patients, 160 elderly (55% male; median age 75, range 70-89) and 317 younger patients (49% male; median age 55, range 16 to 69), were studied. Overall survival in CRC patients ≥70 is comparable to <70 (P = 0.45) and <60 years (P = 0.08). Poor OS was observed in the ≥70 versus <50 years (P = 0.03). TDM in the elderly was poor (P < 0.05). Postoperative cardiac complication was the only det...
Introduction: Lymph node status is important in staging colorectal cancer. Presence of metastatic... more Introduction: Lymph node status is important in staging colorectal cancer. Presence of metastatic nodes differentiates stage III from stage II. The role of adjuvant therapy is still unclear in stage II cancer. Inadequate node sampling may result in inaccurate staging. Methods: Records of 131 patients with stage II and III disease who underwent curative resection between 1997 and 2007 were analysed. Only those with 5 or more lymph nodes harvested from the specimen were included. All patients were prospectively followed up for a minimum of three years. A univariate analysis was used to compare actuarial overall survival by the Kaplan-Meier method based on different lymph node groups. Based on similar studies published statistical significance was assigned to a P value of 0.1. Results: Sixty one cancers were stage II [mean age – 56, male – 55%] and 70 were stage III [mean age -59, male – 52%]. The total population showed improved survival with 14 or more nodes harvested (P= 0.005). Nod...
Sri Lanka Journal of Surgery, 2015
Botulinum toxin injection to the puborectalis in the management of pelvic floor dyssynergia.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Fecal incontinence (FI) impairs quality of life. We performed an audit of biofeedback (BFB) in ma... more Fecal incontinence (FI) impairs quality of life. We performed an audit of biofeedback (BFB) in management of patients with FI. Fifty patients (median [range] age 30 [4-77] years; 28 men) who received BFB for median (range) of 15 weeks (4-28), either postoperatively (n=39), or as the sole treatment (n=11) were evaluated. Cleveland continence score (0-good, 20-poor), anorectal manometry parameters, and patient satisfaction (assessed by Fecal Incontinence Quality of Life Scale [FIQLS]) were evaluated at baseline and after the BFB therapy in all patients. Continence scores improved after intervention. In the surgery + BFB group, mean (SD) continence scores baseline vs. postsurgery + BFB (post-treatment) were 18.2 (3.9) vs. 6 (5.9; p< 0.01). In the BFB alone group, scores were similar at baseline 11.7 (5.9) and 6.1 (5.2) post BFB (p=0.08). Maximum resting anal pressure (MRP) improved from preoperative 12.6 (9.8) mmHg to: vs. 21.1 (11.9) mmHg post-treatment (p< 0.01). In patients wh...
Hepatobiliary & pancreatic diseases international : HBPD INT, 2008
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.
International Journal of Nursing Studies, 2008
Introduction: Patients who have a temporary loop ileostomy have impaired quality of life. Complic... more Introduction: Patients who have a temporary loop ileostomy have impaired quality of life. Complications associated with a loop ileostomy or ileostomy closure will impair patients' quality of life further and require extended enterostomal therapy. We performed a prospective audit of loop ileostomy to ascertain the nature of the workload that may be created with ileostomy-related complications. Patients and methods: One hundred and forty patients (67 males, 73 females, median age 50 years, range 5-90 years) who received a temporary loop ileostomy were analysed after completion of proformas on a prospective basis between 1999 and 2006. Results: Operation was performed for rectal cancer 100 (71%), familial adenomatous polyposis 14 (10%), ulcerative colitis 21 (15%) and for trauma or Hirchsprung's disease 5 (3%). Complications of loop ileostomy were: retraction 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), parastomal hernia 1 (0.7%), paraileostomy abscess 4 (3%) and severe skin excoriation 9 (6%). The loop ileostomy was reversed in 117 (83%) at a median (range) of 13 weeks (1-60). Ileostomy closure-related complications were: small bowel fistula 1 (0.9%), small bowel obstruction 5 (4.3%) and a stitch sinus in 1 (0.9%). Five women developed recto-vaginal fistula (n ¼ 3; 2.6%), pouch-vaginal fistula (n ¼ 1; 0.9%) and pouch-anal fistula (n ¼ 1; 0.9%) that required extended enterostomal therapy, after loop ileostomy reversal. Conclusion: Nineteen percent of patients following creation of a loop ileostomy and 10.5% of patients after reversal of the ileostomy required extended enterostomal care by a specialized enterostomal therapist, which supported resumption of a normal life.
2014 IEEE REGION 10 SYMPOSIUM, 2014
Minimally Invasive Surgeries (MIS) such as laparoscopic procedures are increasingly preferred ove... more Minimally Invasive Surgeries (MIS) such as laparoscopic procedures are increasingly preferred over conventional surgeries due to many different advantages. Laparoscopic surgical procedures are very complex compared to open surgeries and require high level of experience and expertise. Hybrid surgery simulators available for training using physical phantoms are expensive and not readily available in majority of health care facilities around the world. Therefore, computer simulation or Virtual Reality (VR) is a better way to obtain skills for MIS. A VR simulator incorporated with haptic feedback provides a comprehensive training closer to real world experience. In this paper, we present a novel approach to incorporate force feedback to VR laparoscopic surgery training. The proposed interface incorporates force feedback in all three axes to provide three levels of force feedback. Computational models of abdomen organs were generated using the cryosection data of Visible Human Project of the National Library of Medicine, USA. The organ models were developed with three basic force categories: soft, mild and hard. A hardware interface is developed to provide the force feedback for the interaction of virtual tools with the said organ models while generating the tool navigation information for the VR simulator.
World Journal of Surgical Oncology, 2010
Objectives This study compares clinico-pathological features in young (<40 years) and older pa... more Objectives This study compares clinico-pathological features in young (<40 years) and older patients (>50 years) with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival. Materials and methods A twelve year prospective database of colorectal cancer was analysed. Fifty-three young patients were compared with forty seven consecutive older patients over fifty years old. An analysis of survival was undertaken in young patients using Kaplan Meier graphs, non parametric methods, Cox's Proportional Hazard Ratios and Weibull Hazard models. Results Young patients comprised 13.4 percent of 397 with colorectal cancer. Duration of symptoms and presentation in the young was similar to older patients (median, range; young patients; 6 months, 2 weeks to 2 years, older patients; 4 months, 4 weeks to 3 years, p > 0.05). In both groups, the majority presented without bowel obstruction (young - 81%, older - 94%). Cancer...
Surgical Endoscopy, 2010
Management of chronic right iliac fossa (CRIF) pain is poorly documented in literature. No guidel... more Management of chronic right iliac fossa (CRIF) pain is poorly documented in literature. No guidelines are available on the best therapeutic approach. Patients presenting from October 2007 to August 2009 with pain persisting or recurring in right lower abdomen over a period of 6 weeks or more were assessed. Severity of CRIF pain was documented using a ten-point visual analogue scale. Initial history and examination were followed by urine analysis, blood counts, X-ray and ultrasound scan of the abdomen. Full colonoscopy was performed in all negative cases. Diagnostic or therapeutic laparoscopy was offered to patients with normal initial investigations. The normal-looking appendix was removed in the absence of other positive laparoscopic findings. Patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s immediate complications, pain score at 8 weeks and histology of appendix were assessed. Nineteen patients with median age of 43 years (range 32-52 years) underwent laparoscopy. All were female. Median pain score was 5 (range 4-6). During surgery, 12 (64%) had positive findings. Of these, 6 (30%) had adhesions, which were separated. Three patients with congested appendices were removed. One caecal perforation, tubal mass and ovarian cyst were treated laparoscopically. Seven (36%) patients who had macroscopically normal appendices underwent appendicectomy. There were no immediate postoperative complications. Significant improvement was seen in overall pain score after surgery (median 5, range 4-6 versus median 0, range 0-6; p = 0.001). However, only 57% of patients with normal appendix had improved pain scores (median 5, range 4-6 versus median 1, range 0-6; p = 0.12). All patients with positive laparoscopic findings improved after surgery. Laparoscopy seems effective in evaluation and treatment of CRIF pain. The role of appendicectomy with normal-looking appendix needs further evaluation.
Journal of Medical Case Reports, 2008
Introduction: The variations in the morphological characteristics of the extra-hepatic biliary sy... more Introduction: The variations in the morphological characteristics of the extra-hepatic biliary system are interesting. Case presentation: During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis. Conclusion: Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.
Indian Journal of Gastroenterology, 2013
Lymph node status is important in staging colorectal cancer (CRC). Presence of metastatic nodes d... more Lymph node status is important in staging colorectal cancer (CRC). Presence of metastatic nodes differentiates stage III from stage II. The role of adjuvant therapy is still unclear in stage II CRC. Inadequate node sampling may result in inaccurate staging. Records of 131 patients with stages II and III CRC who underwent curative resection, having five or more lymph nodes harvested from the specimen, were prospectively followed up and analyzed. The Kaplan-Meier method was used to analyze survival, based on groups of serially ascending values of lymph nodes harvested. Regression analysis was performed by Cox proportional hazards ratio model with right-censored CRC survival data at a 10 % significance level. The effect of nodal harvest on survival was adjusted for age, sex, preoperative carcinoembryonic antigen (CEA) level, neoadjuvant chemoradiation, pathological tumor stage, histological type, differentiation, margin positivity, angioinvasion, perineural invasion, and lymphovascular infiltration. The total population showed improved survival with 14 or more nodes harvested (p= 0.005). For both rectal (n= 83; p= 0.03) and colon cancers (n= 46; p= 0.08), most significant survival benefits were seen with over 14 nodes harvested, irrespective of the stage. With multiple regression analysis, advanced age (p= 0.003), male sex (p= 0.017), lymphovascular infiltration (p= 0.015), and preoperative CEA levels (p= 0.096) were found to be other significant factors. The lymph node effect remained significant (HR = 0.19, p= 0.004) after adjusting for the above factors. A lymph node harvest of 14 or more resulted in better survival outcome from CRC in this population. Staging of the disease could be accurate with increased nodal harvesting.