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Sri Jayewardenepura Kotte, Sri Lanka

Samarakoon L.B.,General surgical unit | Guruge M.H.,University of Colombo | Jayasekara M.,University of Colombo | Malalasekera A.P.,University of Colombo | And 2 more authors.
Patient Safety in Surgery | Year: 2014

Background: Carpal tunnel syndrome is a common presentation to surgical outpatient clinics. Treatment of carpal tunnel syndrome involves surgical division of the flexor retinaculum. Palmar and recurrent branches of the median nerve as well as the superficial palmar arch are at risk of damage.Methodology: Thirteen cadavers of Sri Lankan nationality were selected. Cadavers with deformed or damaged hands were excluded. All selected cadavers were preserved with the conventional arterial method using formalin as the main preservative. Both hands of the cadavers were placed in the anatomical position and dissected carefully. We took pre- determined measurements using a vernier caliper. We hypothesized that the structures at risk during carpal tunnel decompression such as recurrent branch of the median nerve and superficial palmar arch can be protected if simple anatomical landmarks are identified. We also hypothesized that an avascular area exists in the flexor retinaculum, identification of which facilitates safe dissection with minimal intra operative bleeding. Therefore we attempted to characterize the anatomical extent of such an avascular area as well as anatomical landmarks for a safer carpal tunnel decompression.Ethical clearance was obtained for the study.Results: In a majority of specimens the recurrent branch was a single trunk (n =20, 76.9%). Similarly 84.6% (n = 22) were extra ligamentous in location. Mean distance from the distal border of the TCL to the recurrent branch was 7.75 mm. Mean distance from the distal border of TCL to the superficial palmar arch was 11.48 mm. Mean length of the flexor retinaculum, as measured along the incision, was 27.00 mm. Mean proximal and distal width of the avascular area on TCL was 11.10 mm and 7.09 mm respectively.Conclusion: We recommend incision along the radial border of the extended ring finger for carpal tunnel decompression. Extending the incision more than 8.16 mm proximally and 7.75 mm distally from the corresponding borders of the TCL should be avoided. Incision should be kept to a mean length of 27.0 mm, which corresponds to the length of TCL along the above axis. We also propose an avascular area along the TCL, identification of which minimizes blood loss. © 2014 Samarakoon et al.; licensee BioMed Central Ltd. Source

Charoenkajonchai S.,General surgical unit
Asian Pacific Journal of Cancer Prevention | Year: 2010

Background: It is generally known that long duration of untreated colonic cancer can lead to obstruction. Another contributing factor might be tumor growth rate. The present study was conducted to compare tumor growth rates related to lymph node metastasis of the obstructive and non-obstructive colonic cancers. Methods: 169 patients who underwent operations for colonic cancer were studied retrospectively. Patient and tumor characteristics as well as clinical outcomes were analyzed. Results: 94 patients (55.6%) presented with obstructed colonic cancers, and 75 (44.4%) with non-obstructed, 78.7% and 57.3%, respectively having a tumor size greater than 5 cm. On logistic regression analysis, both groups had similar lymph node metastasis rates (OR=1.6; 95% CI=0.8-3.2). Conclusion: No relations between obstruction and tumour size or lymph node metastasis were found. Thus, obstructions only occur because of other factors and do not contribute to tumor growth. Utilizing effective screening programs to determine obstructions is recommended. Source

Bracale U.,University of Naples Federico II | Bracale U.,General and Mini Invasive Surgical Unit | Rovani M.,University of Naples Federico II | Picardo A.,General surgical unit | And 10 more authors.
Hernia | Year: 2014

Introduction: In inguinal hernia repair, many complications are due to mesh fixation technique. Therefore, new types of atraumatic methods of fixation have been proposed. In this article, we present the results of a prospective multicentric parallel randomized controlled trial aiming to compare two mesh fixation techniques: fibrin sealant (QUIXIL®, Omrix Biopharmaceuticals S.A., Belgium) and Lichtenstein technique. Method: Adult patients with primary uncomplicated inguinal hernia were randomized in two groups: fibrin sealant group (FSG) and Lichtenstein group (LTG). The two groups underwent a follow-up of 15 months. Operative time is the primary outcome. Intraoperative and postoperative outcomes were analyzed. Moreover, a differential cost analysis was performed. Patients and evaluators (with exception of the surgeon who treated the patient) were blinded. Results: A total of 102 patients, 50 in FSG and 52 in LTG, were enrolled from January 2009 to June 2010, and two patients were lost to follow-up at the twelfth month. No significant differences in baseline and clinical characteristics were observed in the two groups. Operative time was longer in LTG (median/ interquartile range: 35 min/30-42.5 min vs. 31 min/28-35 min; effect size: 0.65/95 % CI 0.50-0.91; p < 0.05). No differences in intraoperative complications were observed. No significant differences were observed in early complication rate (RR = 0.62; p > 0.05). Numbness rate was lower in the FSG at 1 week (RR = 0.43; p < 0.01) and at 1 month (RR = 0.17; p < 0.05). No significant differences were observed after 6 months. Postoperative pain was lower in the FSG at 1 week (0/0-1 vs. 1/0-2; p < 0.05) and at 1 month (0/0-0 vs. 0/0-1; p < 0.05). Pain disappeared in all patients after 6 months. Analgesic assumption rate was lower in the FSG (RR = 0.42; p < 0.05). Twenty per cent of FSG and 9.62 % of LTG patients were discharged within 12 h; 78 % of FSG and 90.38 % of LTG patients were discharged within 24 h. The only one recurrence we observed was in FSG group. About costs, although fibrin sealant needed for one mesh fixation is about 10 times more costly than the needed sutures, the total costs of the two procedures did not change significantly. This was mainly due to reduction in operative time. Conclusions: The use of fibrin sealant determined a significant reduction in short-term numbness rate and postoperative pain. There was no relevant difference in total costs per patient between the two procedures. © 2012 Springer-Verlag France. Source

Leung A.,James Cook University | Heal C.,James Cook University | Perera M.,Urological Society of Australia and New Zealand | Perera M.,General surgical unit | And 2 more authors.
Journal of Thrombosis and Thrombolysis | Year: 2015

To identify patient-related risk factors for venous thrombosis in patients with central venous catheters (CVC) or peripherally inserted central catheters (PICC). We performed a systematic review of the literature assessing patient-related risk factors for thrombosis related to CVC or PICC. The databases PubMed, Ovid and the Cochrane library were searched for observational studies pertaining to patient-related risk factors for CVC and PICC-related thrombosis. The initial search through PubMed, Ovid and the Cochrane library yielded 516 results. After 71 duplicates were removed, 445 articles were assessed for eligibility based on title and abstract. Four hundred and eleven articles were then excluded and 33 full text articles were manually assessed for eligibility. Eight articles were eliminated as they did not contain content relevant to the review. Twenty-five studies were then selected to assess 20 risk factors. There were no consistent significant associations for catheter-related thrombosis across the twenty-five studies. Multiple studies identified age, malignancy, diabetes, obesity, chemotherapy, thrombophilia and a history of thrombosis as significant risk factors for catheter-related thrombosis. Inconsistent findings among studies make it difficult to establish which patient-related risk factors are associated with catheter-related thrombosis. Future studies could include larger sample sizes and more cases of catheter-related thrombosis to produce more significant results. Identification of patient-related risk factors could lead to early recognition of upper limb deep vein thrombosis in patients with catheters, thereby preventing complications. © 2015, Springer Science+Business Media New York. Source

Samarakoon L.,General surgical unit | Weerasekera A.,General surgical unit | Sanjeewa R.,General surgical unit | Kollure S.,General surgical unit
Journal of Medical Case Reports | Year: 2012

Introduction: Schwannoma, otherwise known as a neurilemmoma, is a tumor arising from peripheral nerve sheaths. Although commonly noted in association with the eighth cranial nerve as intracranial acoustic neuroma, cases of schwannoma arising in other locations have been reported in the literature. These tumors usually cause symptoms as a result of their mass effect and, since they are benign, encapsulated and non-invasive tumors, complete surgical excision is considered curative. Case presentation: We report the case of a 46-year-old Sri Lankan man who presented to our facility with recent onset of difficulty evacuating his bowels. He was noted to have a giant presacral schwannoma on magnetic resonance imaging scan. The mass was surgically excised with improvement of our patients symptoms. A subsequent histopathological examination confirmed the presence of a benign schwannoma. Conclusions: Although schwannomas commonly occur in the extremities, a rare case of occurrence in the pelvis is reported here. Due to the limited space in the pelvis, the local mass effect may be the presenting feature of such a lesion and surgical excision is curative. © 2012 Samarakoon et al.; licensee BioMed Central Ltd. Source

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