PURPOSE This study sought to examine whether there was an association between language barriers and patient satisfaction with breast cancer care in Sri Lanka. METHODS A telephone-based survey was conducted in the three official languages (Sinhala, Tamil, or English) among adult women (older than 18 years) who had been treated for breast cancer within 6-12 months of diagnosis at the National Cancer Institute of Sri Lanka. The European Organisation for Research and Treatment of Cancer Satisfaction with Cancer Care core questionnaire was adapted to assess three main domains (physicians, allied health care professionals, and the organization). All scores were linearly transformed to a 0-100 scale, and subscores for domains were summarized using means and standard deviations. These were also calculated for the Sinhalese and Tamil groups and compared. RESULTS The study included 72 participants (32 ethnically Tamil and 40 Sinhalese, with 100% concordance with preferred language). The most commonly reported best aspect of care (n = 25) involved affective behaviors of the physicians and nurses. Ease of access to the hospital performed poorest overall, with a mean satisfaction score of 54 (30.5). Clinic-related concerns were highlighted as the worst aspect of the care (n = 10), including long waiting times during clinic visits. Sixty-three percent of Tamil patients reported receiving none of their care in Tamil and 18% reported experiencing language barriers during their care. Tamil patients were less satisfied overall and reported lower satisfaction with care coordination ( P = .005) and higher financial burden ( P = 0.014). CONCLUSION Ethnically Tamil patients were significantly less satisfied than their Sinhalese counterparts and experienced more language barriers, suggesting there is a need to improve access to language-concordant care in Sri Lanka.

Background: Leaks from the pancreatojejunostomy (PJ) after a pancreaticoduodenectomy (PD) occur in 20%-40% patients. Clinically significant grade B & C leaks occurring in 12.3%-16.5% result in morbidity and mortality. This study looks at the outcomes of patients who had a PJ in a low volume HPB surgical unit. Methods: Retrospective analysis of a HPB patient database and records from 2011-2021 was done. Patient demography, clinico-pathological details, pancreatic leak rates (ISGPF classification) and survival was recorded. PJs were done using a duct to mucosa technique with 3-0 and 5-0 polypropylene with a stent in-situ. Results: Of the 59 patients, mean age was 55.1 years with a M:F ratio of 1.1:1. 93.2% (n = 55) of the PJs were done as part of a PD, 3.4% (n = 2) after central pancreatectomy and 3.4% (n = 2) after longitudinal PJs. Histologically, 78% (n = 46) were malignant and 81.4% had a R0 resection margin (n = 35/43) while 18.6% (n = 8) were R1 resections. Grade B and C leaks occurred in 6.8% (n = 4). One grade B and both grade C fistulae were after PD. The other grade B fistula followed a central pancreatectomy. One grade C leak led to death on postoperative day 18 despite reopening. Among those that developed Grade B or C fistulae, the pancreas was soft in 50% (2/4) and firm in 25% (1/4), whereas 75% (3/4) had a PD diameter ≤ 3 mm. The median postoperative ICU and hospital stay were 2 (IQR = 3, n = 24) and 11 days (IQR = 8, n = 31), respectively. Conclusions: Clinically significant PJ leaks were comparatively low in this group. However, grade B & C fistulae resulted in significant morbidity and in one case mortality. Even in low volume centres, adhering to standard practice can result in good outcomes.

Background: Hepaticojejunostomies (HJ) establish bilio-enteric continuity after resections for malignant and benign HPB disorders. The leak rates of HJs range from 2.2%-12.4% and contribute to morbidity and mortality. This study looks at the outcomes of patients who had a HJ in a low volume HPB surgical unit. Methods: Retrospective analysis of a patient database and records of HJs done at a single HPB surgical unit from 2011-21 was done. HJs were performed with a retro-colic Roux loop or single jejunal loop using single layer interrupted 4-0 or 5-0 polydiaxanone. Right subhepatic drains were placed. Results: Of the 97 patients, mean age was 51.86 years with a M:F ratio of 1:1.4. 64.9% (n = 63) of HJs were for malignancies while 35.1% (n = 34) were benign conditions. 56.7% (n = 55) had a HJ during a pancreaticoduodenectomy, 12.4% (n = 12) after extrahepatic bile duct resection and hepatectomy, 11.3% (n = 11) after choledochal cyst excision, 4.1% (n = 4) as palliative bypass procedures and 4.1% (n = 4) for repair of iatrogenic bile duct injuries. Bile leaks occurred in 3.1% (n = 3). Two occurred in HJs after hilar cholangiocarcinoma resections, where one persisted for 3 months -and the other led to mortality on the 15th postoperative day. The 3rd leak following choledochal cyst excision resolved in a day. Conclusions: Our results demonstrate excellent outcomes in terms of leak rates for HJs despite being a low volume HPB surgical centre. This is probably the result of meticulous surgical technique and peri-procedural care.