S. Kumarage | University of Kelaniya (original) (raw)

Papers by S. Kumarage

Sri Lanka Journal of Surgery, 2015

Botulinum toxin injection to the puborectalis in the management of pelvic floor dyssynergia.

BMC Medical Education

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....

BMC research notes, Jan 30, 2017

Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-... more Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000-61, 2000 to 2004-178, 2005 to 2009-190, 2010 to 2014-250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided ...

IOSR Journal of Dental and Medical Sciences, 2016

Introduction: A comprehensive knowledge of the regional anatomy and abnormalities of the arterial... more Introduction: A comprehensive knowledge of the regional anatomy and abnormalities of the arterial supply to the extra-hepatic biliary system is a requisite for safe biliary tract surgery. Objective: To describe morphological characteristics of arterial supply to extra-hepatic biliary system using human cadavers. Method: Descriptive-prospective cross sectional study was performed in 60 cadavers, to observe variations in arterial supply to extra-hepatic biliary system. Results: The mean length of right and left hepatic arteries was 2.8cm and 2.3cm respectively. The mean length of proper hepatic artery was 3.1 cm. The mean length of cystic artery was 1.4cm before its division into anterior and posterior branches ranged from 0.9cm to 2.1 cm. 74.9% of the cystic arteries originated as a single artery from the right branch of the hepatic artery. In 43% of the specimens, right hepatic artery was lying in the triangle of Calot's. Conclusion: Variations in arterial supply inrelation to the extra-hepatic biliary system vasculature is common.

IOSR Journal of Dental and Medical Sciences, 2016

Introduction: The symptomatic outcome following laparoscopic cholecystectomy in patients with gal... more Introduction: The symptomatic outcome following laparoscopic cholecystectomy in patients with gallstone disease has notbeen evaluated extensively. Objective:To assess the symptom prevalence of pre and postlaparoscopic cholecystectomy for symptomatic gallstone disease. Methods: A descriptive study was carried out on 60 patients treated by laparoscopic cholecystectomyfrom 2013 to 2016.Patients with choledocholithiasis were excluded.The symptom profile of the patients was evaluated by a standardized interviewer administered questionnaire which included demographic details; pre and post-operative symptoms; returning to full activity; wound complications and their general acknowledgement of the surgical intervention. The questionnaire was administered to the patients at least three monthspostoperatively. To establish the relevance of abdominal symptoms to gallstone disease, the frequency of pre and post-operative symptoms were compared. Results: Symptoms relieved by cholecystectomy were nausea, vomiting, colicky abdominal pain and back-pain. Flatulence, fat intolerance, and nagging abdominal pain were unaffected. Relief of heartburn outweighed the de novo development of this symptom after cholecystectomy.Post cholecystectomydiarrhoea occurred in 11%. In the elderly age group (>60 years), significant number of patients regained full activity after laparoscopic cholecystectomy. Patient acknowledgementof a satisfactory cosmetic resultis 100% following the laparoscopic cholecystectomy. Conclusion: Despite the persistence or de novo occurrence of symptoms, majority of patientsconsidered that they obtained symptomatic improvement following surgical treatment and were pleased with the end result.

Sri Lanka Journal of Surgery, 2015

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. r

Sri Lanka Journal of Surgery, 2014

World Journal of Surgical Oncology, 2010

Objectives: This study compares clinico-pathological features in young (<40 years) and older pati... 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.

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.

Colorectal Disease, 2008

The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surge... more The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy. Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C). More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream--13%vs 38%, P = 0.001 and 21%vs 21%, P = NS; incontinence--4.2%vs 17%, P = 0.008 and 8%vs 8%, P = NS; hesitancy--13%vs 35%, P = 0.034 and 17%vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men--62.5%, women--25%vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision--50%vs segmental colectomy - 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial.

Ceylon Medical Journal, 2011

To improve the prognosis of patients with familial adenomatous polyposis (FAP) by early diagnosis... more To improve the prognosis of patients with familial adenomatous polyposis (FAP) by early diagnosis and prophylactic treatment through a coordinated FAP register. The establishment and descriptive analysis of the prospective database of the FAP registry. University surgical unit, Colombo North Teaching Hospital Ragama, Sri Lanka. Probands were identified by tracing all diagnosed FAP patients from 1996 to 2010 and their family members at risk. The establishment of a polyposis register included the following stages: ascertainment of probands (first contact symptomatic FAP patients), construction of pedigrees, counselling relatives and prophylactic screening of family members at risk, treatment and follow up. Twenty seven enrolled probands (12 male and 15 female, age 11-52 years, median age 34 years) were investigated. Pedigree analyses showed 206 relatives at risk. Twenty four family members at risk were screened of a total of 51 registered individuals. The rate of spontaneous mutations was 41%. Thirty five were diagnosed with FAP. Eight were screen detected (median age - 32 years) and 27 symptomatic (median age - 34 years). Concomitant colorectal cancer was detected in 17 (63%) symptomatic individuals and in 1 (13%) screen detected individual. Colectomy was performed in 27 (77%) patients while 8 (23%) are on chemoprophylaxis. Congenital hypertrophic retinal pigment epithelium was detected in 15. Desmoids tumours (6%) and other extraintestinal manifestations including osteomas, sebacious cysts and dental abnormalities (34%) were also detected. A thyroid gland malignancy was screen detected while retinoblastoma, hepatoblastoma and cerebral tumours were seen in pedigrees. A polyposis register may improve prognosis of FAP by early detection. It will help coordinate, optimise and streamline clinical management of patients with FAP and their relatives at risk.

Ceylon Medical Journal, 2009

British Journal of Surgery, 2002

British Journal of Surgery, 2001

Background: The feasibility and safety of a minilaparotomy approach for curative resection of col... more Background: The feasibility and safety of a minilaparotomy approach for curative resection of colonic cancer have not been fully elucidated. The purpose of this study was to compare outcomes utilizing this alternative technique with those of conventional laparotomy.

Detail:

INTRODUCTION: Rheumatic and congenital heart diseases account for the majority of hospital admiss... more INTRODUCTION: Rheumatic and congenital heart diseases account for the majority of hospital admissions for cardiac patients in India. Tetralogy of Fallot is the most common congenital heart disease with survival to adulthood. Infective endocarditis accounts for 4% of admissions ...

Sri Lanka Journal of Surgery, 2015

Botulinum toxin injection to the puborectalis in the management of pelvic floor dyssynergia.

BMC Medical Education

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....

BMC research notes, Jan 30, 2017

Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-... more Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000-61, 2000 to 2004-178, 2005 to 2009-190, 2010 to 2014-250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided ...

IOSR Journal of Dental and Medical Sciences, 2016

Introduction: A comprehensive knowledge of the regional anatomy and abnormalities of the arterial... more Introduction: A comprehensive knowledge of the regional anatomy and abnormalities of the arterial supply to the extra-hepatic biliary system is a requisite for safe biliary tract surgery. Objective: To describe morphological characteristics of arterial supply to extra-hepatic biliary system using human cadavers. Method: Descriptive-prospective cross sectional study was performed in 60 cadavers, to observe variations in arterial supply to extra-hepatic biliary system. Results: The mean length of right and left hepatic arteries was 2.8cm and 2.3cm respectively. The mean length of proper hepatic artery was 3.1 cm. The mean length of cystic artery was 1.4cm before its division into anterior and posterior branches ranged from 0.9cm to 2.1 cm. 74.9% of the cystic arteries originated as a single artery from the right branch of the hepatic artery. In 43% of the specimens, right hepatic artery was lying in the triangle of Calot's. Conclusion: Variations in arterial supply inrelation to the extra-hepatic biliary system vasculature is common.

IOSR Journal of Dental and Medical Sciences, 2016

Introduction: The symptomatic outcome following laparoscopic cholecystectomy in patients with gal... more Introduction: The symptomatic outcome following laparoscopic cholecystectomy in patients with gallstone disease has notbeen evaluated extensively. Objective:To assess the symptom prevalence of pre and postlaparoscopic cholecystectomy for symptomatic gallstone disease. Methods: A descriptive study was carried out on 60 patients treated by laparoscopic cholecystectomyfrom 2013 to 2016.Patients with choledocholithiasis were excluded.The symptom profile of the patients was evaluated by a standardized interviewer administered questionnaire which included demographic details; pre and post-operative symptoms; returning to full activity; wound complications and their general acknowledgement of the surgical intervention. The questionnaire was administered to the patients at least three monthspostoperatively. To establish the relevance of abdominal symptoms to gallstone disease, the frequency of pre and post-operative symptoms were compared. Results: Symptoms relieved by cholecystectomy were nausea, vomiting, colicky abdominal pain and back-pain. Flatulence, fat intolerance, and nagging abdominal pain were unaffected. Relief of heartburn outweighed the de novo development of this symptom after cholecystectomy.Post cholecystectomydiarrhoea occurred in 11%. In the elderly age group (>60 years), significant number of patients regained full activity after laparoscopic cholecystectomy. Patient acknowledgementof a satisfactory cosmetic resultis 100% following the laparoscopic cholecystectomy. Conclusion: Despite the persistence or de novo occurrence of symptoms, majority of patientsconsidered that they obtained symptomatic improvement following surgical treatment and were pleased with the end result.

Sri Lanka Journal of Surgery, 2015

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. r

Sri Lanka Journal of Surgery, 2014

World Journal of Surgical Oncology, 2010

Objectives: This study compares clinico-pathological features in young (<40 years) and older pati... 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.

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.

Colorectal Disease, 2008

The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surge... more The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy. Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C). More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream--13%vs 38%, P = 0.001 and 21%vs 21%, P = NS; incontinence--4.2%vs 17%, P = 0.008 and 8%vs 8%, P = NS; hesitancy--13%vs 35%, P = 0.034 and 17%vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men--62.5%, women--25%vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision--50%vs segmental colectomy - 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial.

Ceylon Medical Journal, 2011

To improve the prognosis of patients with familial adenomatous polyposis (FAP) by early diagnosis... more To improve the prognosis of patients with familial adenomatous polyposis (FAP) by early diagnosis and prophylactic treatment through a coordinated FAP register. The establishment and descriptive analysis of the prospective database of the FAP registry. University surgical unit, Colombo North Teaching Hospital Ragama, Sri Lanka. Probands were identified by tracing all diagnosed FAP patients from 1996 to 2010 and their family members at risk. The establishment of a polyposis register included the following stages: ascertainment of probands (first contact symptomatic FAP patients), construction of pedigrees, counselling relatives and prophylactic screening of family members at risk, treatment and follow up. Twenty seven enrolled probands (12 male and 15 female, age 11-52 years, median age 34 years) were investigated. Pedigree analyses showed 206 relatives at risk. Twenty four family members at risk were screened of a total of 51 registered individuals. The rate of spontaneous mutations was 41%. Thirty five were diagnosed with FAP. Eight were screen detected (median age - 32 years) and 27 symptomatic (median age - 34 years). Concomitant colorectal cancer was detected in 17 (63%) symptomatic individuals and in 1 (13%) screen detected individual. Colectomy was performed in 27 (77%) patients while 8 (23%) are on chemoprophylaxis. Congenital hypertrophic retinal pigment epithelium was detected in 15. Desmoids tumours (6%) and other extraintestinal manifestations including osteomas, sebacious cysts and dental abnormalities (34%) were also detected. A thyroid gland malignancy was screen detected while retinoblastoma, hepatoblastoma and cerebral tumours were seen in pedigrees. A polyposis register may improve prognosis of FAP by early detection. It will help coordinate, optimise and streamline clinical management of patients with FAP and their relatives at risk.

Ceylon Medical Journal, 2009

British Journal of Surgery, 2002

British Journal of Surgery, 2001

Background: The feasibility and safety of a minilaparotomy approach for curative resection of col... more Background: The feasibility and safety of a minilaparotomy approach for curative resection of colonic cancer have not been fully elucidated. The purpose of this study was to compare outcomes utilizing this alternative technique with those of conventional laparotomy.

Detail:

INTRODUCTION: Rheumatic and congenital heart diseases account for the majority of hospital admiss... more INTRODUCTION: Rheumatic and congenital heart diseases account for the majority of hospital admissions for cardiac patients in India. Tetralogy of Fallot is the most common congenital heart disease with survival to adulthood. Infective endocarditis accounts for 4% of admissions ...