Laparoscopic Surgery

With the advancements in medical technology , the open surgery is becoming obsolete and the alternative and the future is Laparoscopic Surgery. Let’s understand how a laparoscopic surgery is performed and advantages of Laparoscopic surgery.

Rectal Bleeding

A lot of people ignore rectal bleeding or they simply don’t know about it. But Rectal bleeding is not something that you can ignore. Listen to Dr. Chandika Liyanage explaining what rectal bleeding is.

Gastritis

Gastritis is a common health problem among most Sri Lankans. Let’s listen to Dr. Chandika Liyanage, consultant Gastrointestinal Surgeon talking about identifying the gastritis based on symptoms.

Gallbladder Disease

Do you experience severe abdominal pain specially after eating fatty food ? The gallbladder isn’t an organ that gets a lot of attention — unless it’s causing you pain. Listen to Dr. Chandika Liyanage to learn more about Gallbladder disease.

Fatty liver: Is it a scourge of our times?

Dr Chandika Liyanage MBBS, MPhil, MS, MRCS
Consultant Surgeon and Senior Lecturer in Surgery
North Colombo Teaching hospital and North Colombo Liver transplantation Service.

Fatty liver in lay terms can be simply defined as infiltration of the liver tissue with fat. In scientific terms this means abnormal retention of triglyceride vacuoles in the hepatocytes or the cells of the liver. Worldwide the incidence of fatty liver disease is on the rise. The incidence of fatty liver can range from about 10 to 25 %. However in the United States the incidence of fatty liver disease is about 33%. Alarmingly the incidence of fatty liver disease in Sri Lanka is significantly high. At the Ragama health study, which was a population-based study looking at the prevalence of fatty liver disease, showed that 30% of the population had fatty liver disease. This is further confirmed by our experience at the North Colombo transplant service where majority of the transplanted patients were cryptogenic cirrhosis (non alcoholic) patients. Further, as hepatobiliary surgeons undertaking laparoscopic gallbladder surgery, we see many patients who have fat infiltrated livers. Majority of these patients are females. This leaves us with an enormous health problem threatening our population. Interestingly more than 60% of these patients can have this condition reversed if they opt for a life style change.

The causes for Fatty liver disease could be alcohol or non-alcoholic. This is the basis for identifying the two conditions alcoholic fatty liver disease and non-alcoholic fatty liver disease (NAFLD). The causes for NAFLD include mainly obesity, which may be associated with insulin resistance and other metabolic problems. It could be a part of the metabolic syndrome, which is coined by obesity, diabetes, hypertension and high lipids. In addition nutritional problems and drugs and toxins also can result in this disease process. Unfortunately we see many females and some males who present with cirrhosis of liver requiring transplant. When we dig into their history we hear unfortunate stories of taking drug concoctions and liver toxins as form of therapy for long periods of time ,slowly destroying their livers.

Fatty Liver

Healthy Liver and Fatty Liver

Accumulation of fat can progress in to inflammation. This is the danger of fatty liver disease. This state is called Steatohepatitis, and in non-alcoholics it is called non alcoholic steatohepatitis (NASH). An alcohol consumption of less than two drinks per day (<20g for women and < 30g for men) will be a criterion to include them in to the NASH group. When there is extensive inflammation and high degree of steaotosis, it will lead to hepatocyte ballooning and necrosis with progression to fibrosis. This will eventually progress to the condition called cirrhosis. Though the transformation of alcoholic steaotohepatitis to cirrhosis is clear, the trigger for NASH to progress to cirrhosis is not very clear.

Most of these patients are diagnosed by elevated liver enzymes or due to liver enlargement and incidentally on ultra sound scan findings.

Generally liver function tests, vial hepatitis serology and imaging studies, mainly an abdominal ultra sound will help to diagnose this condition. Though not widely practiced, the confirmation is by a liver biopsy.

Though much research has been done on this subject there are no clear answers on treating this condition. Majority of fatty liver disease patients can reverse the condition by life style modification. The cardinal step is to avoid the causative factor. If it is alcohol it should be stopped. All hepato toxins should be avoided. High energy yielding refined carbohydrate and fat consumption should be minimized to cut down on the surplus of calories. Exercise helps in improving insulin resistance and to reduce excess body weight. Up-to-date the only un-debated form of remedy for fatty liver disease is to loose 10% of existing body weight.

It is important to have good glycaemic control and to achieve ideal body weight for your corresponding height. Patients should seek treatment for diabetes and hyperlipidaemias as early as possible and should screen themselves for this condition, as the prevalence is quite high in our population.

Alarmingly we now see this condition in the young adult population as well. When fatty liver sets in early in life there is a high probability that they will develop liver dysfunction later in life. This will mean people will require liver transplants unless this condition is taken seriously. The fact that it is reversible for most is encouraging. However the effort from the affected is still very discouraging.

Hemas Hospital – Wattala conducts an Endoscopic Ultrasound Workshop with University of Kelaniya Surgery Department

Hemas Hospital-Wattala, the flagship hospital of the first internationally accredited hospital chain in Sri Lanka, conducted a workshop on endoscopic ultrasound procedure for the specialist surgeons and gastroenterologists together with the kelaniya University Surgery department recently. Dr. Malay Sharma, Consultant Gastroenterologist / Hepatologist and Head of Endoscopic Services Jaswant Rai Speciality Hospital, Meerut, India, conducted the workshop.

The day-long workshop, collaborated by Biomed International and Pentax Medical, was initiated with an intention of developing local expertise in the area of gastrointestinal diagnosis and surgery and covered all important aspects related to Endoscopic Ultrasound Diagnosis using live demonstrations on patients. Surgeons and gastroenterologists from various teaching hospitals participated for this workshop conducted for the first time in Sri Lanka.

Dr. Sharma, sharing his thoughts, said, “Endoscopic Ultrasound (EUS), a minimally invasive procedure, is a harmony of endoscopy and ultrasound for accurate diagnosis of digestive tract. It often can be coupled with other diagnostic procedures to be used as an alternate method for exploratory surgery. Imaging tests used in EUS, such as in CT scan and MRI, help determine the magnitude of the disease through accurate evaluation of root causes of symptoms in the digestive tract. It is important for consultants who perform in this area to be up-to-date with the latest and I, therefore, hope this workshop will be of use to those who aspire to be specialists in this area.”

Former president of the College of Surgeons and renowned specialist surgeon from the University Surgical Unit, Professor Ranil Fernando, also, addressed the participants at the workshop highlighting the importance of doctors being competent with new skills.

Dr. Samanthi de Silva, General Manager & Head of Medical Services, Hemas Hospitals-Wattala, commenting about the workshop said, “We are pleased to facilitate the first-ever workshop conducted in Sri Lanka on EUS for surgeons and gastroenterology specialists, which is also the first workshop to be conducted by a private hospital on the same subject. It is our aspiration to become the centre of excellence for gastrointestinal surgery, diagnostic and therapeutic procedures and, so, we are happy to build the skills of our doctors, which in turn would contribute to improve the standards of health care services in the country for the community. The knowledge and experience shared through the workshop will, no doubt, help enhance skills of our consultants who are keen to excel in GI as a specialty.”

Hemas Hospitals-Wattala expanded into gastrointestinal healthcare services early this year with the launch of its fully-fledged, state-of-the-art gastrointestinal centre (GI centre). Free walk-in clinic, the first of its kind by a Sri Lankan hospital, was introduced subsequently as an extension to GI services provided by the hospital and as a result patients can, now, undergo free health examination to diagnose gastrointestinal problems. Further, as a part of its regular staff training abroad to improve endoscopic skills, the hospital, also provided two of its nurses an extensive GI related training in India recently.

Hemas Hospitals is a subsidiary of Hemas Holdings, one of Sri Lanka’s leading conglomerates with a focus on 5 key sectors of FMCG, healthcare, transportation, leisure and power generation.

Expansions of Gastrointestinal services offered by Hemas Hospitals-Wattala

17th June‘14:
Hemas Hospitals, the only internationally accredited hospital chain in Sri Lanka, expands its gastrointestinal services by introducing a walk-in clinic for diagnosis and treatment of gastrointestinal problems. This facility, the first of its kind by a Sri Lankan hospital, is available at its Wattala branch.

The walk-in-clinic provides patients of Hemas Hospitals-Wattala free health examination throughout weekdays with a well-trained panel of medical officers attending to diagnosing patients. The clinic will be open for patients from 9a.m. to 3p.m. during weekdays and on Saturdays.

Hemas Hospitals launched its fully-fledged, state-of-the-art gastrointestinal centre (GI centre) at its Wattala branch in January this year. This unit has the capability of diagnosing and treating patients for a wide range of gastrointestinal issues and has shown growth over 40%, ever since its launch, in terms of referrals made by patients.

The GI centre attached to Hemas Hospitals – Wattala is the only hospital in Sri Lanka that is capable of carrying out advanced PH capsule study, a precise diagnosis method used to check acid levels in the oesophagus.

Expressing satisfaction over treatment received from Hemas Hospitals GI centre, Niroshani Gamage, 41years, from Negombo said, “I got to know about the PH capsule study test when I visited Hemas Hospitals for severe gastritis and heartburn issue. The doctor, who checked, directed me to the GI unit and there, I had to undergo a PH capsule study. The outcome of the test was extremely helpful for the doctor to precisely diagnose the case and prescribe medication. I am, now, on a different treatment schedule, revised based on the test results. I feel much better now and my situation is fast improving.”

Dr. Samanthi de Silva, General Manager & Head of Medical Services, Hemas Hospitals-Wattala, commenting about the expansion of its GI centre at Wattala said, “Our main intention is to provide a comprehensive treatment package for all those who suffer from obesity and gastrointestinal diseases. There is a close relationship identified between obesity and gastrointestinal diseases which is also proven clinically. Therefore, our GI unit commenced its new addition – a weight reduction clinic conducted by a well-trained team including medical officers, gastrointestinal and Hepatobiliay surgeons and physicians.”

In addition, GI centre at Hemas Hospitals-Wattala provides endoscopy facilities; including hassle free capsular endoscopy, ERCP and surgical treatment facilities for all related gastrointestinal issues. Many patients who undergo surgery at Wattala benefit from minimally invasive laparoscopic surgery that leaves a small scar and helps them to return to normal work in a shorter time. Further, walk-in-patients for the clinic can consult specialists, gastrointestinal surgeons and physicians for advanced diagnosis as well.

Hemas Hospitals is a subsidiary of Hemas Holdings, one of Sri Lanka’s leading conglomerates with a focus on 5 key sectors of FMCG, healthcare, transportation, leisure and power generation.

Hemas Hospital launches a fully-fledged Center for Gastrointestinal Studies and Surgery for the first time in Sri Lanka

Hemas hospitals, the only internationally accredited hospital chain in Sri Lanka recently launched a fully-fledged gastrointestinal diagnostic and surgical facility and acquired Pentax EPK i 7000 endoscopy system with a High definition ERCP (Endoscopic Retrograde Cholangio Pancreatography) scope for the first time in Sri Lanka.

The diagnostic and surgical facility includes advanced diagnostic facilities for all gastrointestinal related issues via High definition Endoscopy and Colonoscopy facility, Capsule Endoscopy facility, PH capsule study facility and small bowel enterescopy facility.
Currently, Hemas Hospital is the only hospital in Sri Lanka which possesses the advanced PH capsule studies to measure the acid levels in the esophagus. Accurate diagnosis of acid levels helps the medical practitioners diagnose the acid reflux disease.

Further, the introduction of the capsule endoscopy facilitates the patients to avoid the painful traditional endoscopy procedure and to undergo an endoscopy just by swallowing a capsule with a mini video camera which can transmit the images of the esophagus and the bowels.

Other facilities offered by The Specialized Center for Gastrointestinal Studies are the routine endoscopy, colonoscopy and sigmoidoscopy facilities.

Hemas Hospitals also possesses the state of the art Laparoscopy Surgical Unit with facilities to carry out a wide range of advanced gastrointestinal surgeries including the removal of cancers in the bowel and stomach, esophagus related surgeries and gallbladder, Pancreas and Liver related surgeries.

With the setting up of the new facility, Hemas Hospitals has the capability of treating numerous Gastrointestinal related health issues such as Heartburn, Acid reflux, altered bowel habits, abdominal discomfort, frequent burping, bleeding per rectum and lumps in abdomen and groin and other related symptoms under the special attention of well-known Gastroenterologists and Gastrointestinal Surgeons.

Hemas Hospitals is a subsidiary of Hemas Holdings, one of Sri Lanka’s leading conglomerates with a focus on five key sectors – FMCG, Healthcare, Transportation, Leisure and Power generation.

Hemas Hospitals Wattala hosts workshop on Endoscopy

Hemas Hospitals, the only internationally accredited hospital chain in Sri Lanka recently facilitated a Pre congress workshop on ERCP (Endoscopic Retrograde Cholangiopancreatography) for the members of the College of Surgeons of Sri Lanka to coincide with its annual academic sessions just concluded.

The workshop was held at Hemas Hospital’s advanced theater complex using the recently acquired state –of-the-art Pentax EPK i 7000 High Definition Endoscopy System. With the EPK i 7000 system, Hemas Hospital also acquired a high definition ERCP scope, the first of its kind in Sri Lanka. During the workshop, a wide array of common ERCP procedures was clinically demonstrated by an eminent faculty of surgeons including Dr. K.L Fernando, Dr. N.M.M Nawarathne, Dr. Chandika Liyanage, and Professor Kim Heng Boon from Mount Elizabeth Hospital Singapore.

The workshop on ERCP was followed by a training session for nurses on handling and cleaning of endoscopy instruments. This session was conducted by a technical team representing Pentax Singapore.

Dr. Samanthi de Silva, General Manager, Hemas Hospital – Wattala said that organizing the workshop demonstrates Hemas Hospitals’ keen interest in providing its facilities for continuous training needs of the medical fraternity. “This is also in line with our long term plan of developing Hemas Hospital as a center of excellence in Gastrointestinal surgery”, she said.

“With the acquisition of the new High definition Endoscopy system, Hemas Hospital possesses the capacity to carry out advanced diagnosis in Gastro Intestinal studies” she added.

Hemas Hospitals is a subsidiary of Hemas Holdings, one of Sri Lanka’s leading conglomerates with a focus on five key sectors – FMCG, Healthcare, Transportation, Leisure and Power generation.