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Background: Post-operative pulmonary complications (PPCs) are common problems after abdominal operations. The incidence varies from 10 to 69% for atelectasis and 9 to 40% for post-operation pneumonia. Many studies have investigated risk factors and risk indices for predicting PPCs. However, no definite predictors for PPCs have yet been described. Objective: To develop a simple, reliable, and safe diagnostic tool for early detection of post-operation pulmonary complications. Methods: A series of 151 consecutive patients scheduled for elective abdominal operations were studied between 1 September 2003 and 31 August 2004 at The Department of Surgery, Faculty of Medicine at Siriraj Hospital. The patients were measured for peak expiratory flow rate (PEFR) a night before operation, followed by every 24 hr post-operation. The data was analyzed using univariate and multivariate regression analyses with respect to post-operation pulmonary complications. Results: A total of 15 patients (9.9%) developed post-operation pulmonary complications. Univariate analysis demonstrated that preoperative PEFR (PrePEFR) and 24 hr post-operation PEFR (PostPEFR) could predict PPCs. Using multivariate regression analyses, the PEFR Score was developed and calculated as (17.24 х Malignant)-(0.16 х PostPEFR). A cut point value was -4.68. The diagnostic sensitivity was 80% and specificity was 73.5%. Conclusion: 24 hours post-operation PEFR is a simple and valuable bedside method for predicting PPCs. Keywords: Peak expiratory flow rate, post-operative pulmonary complications

Objective: To evaluate the influence of preoperative chemoradiation in locally advanced rectal cancer on ability to perform sphincter preserving surgery. Methods: Between 1998 and 2005, a prospective clinical trial of preoperative chemoradiation therapy (CTX/XRT) that delivered 45 Gy in 25 fractions over 5 weeks with bolus infusion of 5-fluorouracil (200 mg/m2/day) or capecitabine (2000 mg/m2/day) was given to 42 rectal cancer patients admitted to the Department of Surgery, Siriraj Hospital, Bangkok, Thailand. The pretreatment stage distribution, as determined by endorectal ultrasonography and computed tomography of the pelvis, included uT3N0 in 90.48% and uT3N1 in 9.52% of cases. Approximately 6 weeks after completion of CTX/XRT, surgery was performed in every patient. The choice of the surgical procedure was based on the surgeonus discretion. Results: The patient population consisted of 25 males (59.52%) and 17 females (40.48%) who had a median age of 57 years (range 32-79 years). Distal border of the tumors were located at a median of 5 cm (range 2-10 cm) above the anal verge. Thirty cases (71.43%) had distal border of the tumors within 6 cm from the anal verge. The pathological tumor stages were T1N0 in 2 cases (4.76%), T2N0 in 9 cases (21.43%), T2N1 in 4 cases (9.52%), T3N0 in 12 cases (28.57%), T3N1 in 8 cases (19.05%), T3N2 in 2 cases (4.76%) and T4N0 in 1 case (2.38%). The results included 9.52% pathological complete response, 42.86% downstaging and 50% sphincter preservation rate. Of the tumors located < 6 cm from the anal verge, sphincter preservation was accomplished in 30% of the patients. The pretreatment location of distal border of the tumors (< 6 cm vs. > 6 cm from anal verge) was the only factor predictive of sphincter preservation (p < 0.001). No local recurrence was detected during the period of follow up (median 23 months). Conclusion: The administration of preoperative chemoradiation for locally advanced rectal cancer is associated with tolerable toxicity and high rates of tumor downstaging. The preoperative chemoradiation and tumor downstaging do not increase rate of sphincter preservation in locally advanced rectal cancer.

Objective: Hilar cholangiocarcinoma is one of the most common causes of biliary tract obstruction in Thailand. However, in most patients, the tumors are unresectable. Endoscopic retrograde cholangiopancreatography (ERCP) with endoprosthesis insertion can provide effective internal biliary drainage in these patients; however, there are still some controversy regarding the complications, success rate and technical aspect of this approach. The aim of this study was to report results of palliative endoscopic endoprosthesis insertion using plastic stents in unresectable hilar cholangiocarcinoma. Methods: We analyzed 72 sessions of ERCP with plastic stent insertion in 61 patients with unresectable hilar cholangiocarcinoma, treated at the Endoscopic Unit, Department of Surgery, Siriraj Hospital from 1999-2001. Statistical analysis were done using chi-square test. Results: In 72 sessions of ERCP with plastic stent insertion, overall successful drainage was 48%. Early complication was found in 13 sessions (18%) with cholangitis 13.9%, pancreatitis 2.8%, bleeding 2.8% and intra-abdominal collection 2.8%. Unilateral stent insertion was done in 94% (right side 43.4%, left side 49.1%) and bilateral stent insertion was performed in 7.5%. The success rate of right duct stent insertion was 63.1% while that of left duct stent insertion was 36.4% (p

A case report of a 2-cm glucagonoma at head of pancreas in 48-year old woman presented with obstructive jaundice. She had no manifestation of the glucahonoma syndrome. She underwent bylorus preserving pancreaticoduodenectomy (PPPP). Immunohistochemical studies revealed that this tumor was a malignant glucagonoma. She made an uneventful recovery after the operation and was discharged from the hospital without complication. Six months later, she was found to have multiple liver metastases which did not response to chemotherapy and died 11 months after the operation with liver failure.

Rectal cancer is a common malignancy in Thailand. A case of 39-year-old female with rectal bleeding caused by adenocarcinoma of rectum is reported here. Successful treatment was achieved by preoperative chemoradiation therapy and low anterior resection. She is now symptom free and has good sphincter control. The history, physical examination, investigations, diagnosis and treatment are discussed.

Solid pseudo-papillary tumor (SSPT) of the pancreas is a rare pancreatic tumor. It is distinct from other pancreatic tumors in its age and sex distribution. Following aggressive resection there is a favorable prognosis, with most patients going on to cure. This entity is widely reported in the surgical and pathological literature. We present a case of huge SSPT of the pancreas in a young woman who underwent successful Whipple's operation. She has been followed for two years without any evidence of recurrence. We also present a review of the literature on SSPT. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic esophagomyotomy (LEM) has become the standard treatment for achalasia. Recently, robot-assisted laparoscopic esophagomyotomy (RA-LEM) is emerging as a safe alternative to conventional LEM. We hypothesized that RA-LEM may reduce intraoperative complications compared with LEM. Objective: To compare RA-LEM with LEM in terms of intraoperative complications for the treatment of achalasia. Patients and Methods: A total of 42 patients underwent surgical treatment of achalasia at Siriraj Hospital between 1 December 2001 and 30 November 2013. A retrospective review of demographic data, perioperative course, complications, and hospital stay was performed. Patients were divided into 2 groups: group A (RA-LEM) consisted of 29 patients and group B (LEM) consisted of 13 patients. Operative time, estimated blood loss, duration of stay, intraoperative and postoperative complication were analyzed. Results: We could not demonstrate significant differences in esophageal perforation (13.8 vs. 15.4%; P= 0.999), aspiration (6.9 vs. 0%; P= 0.999) and operative time (195 ± 42 vs 197 ± 45 minutes; P- 0.999) between RA-LEM and LEM groups. There were significant reductions in blood loss (26.90 + 45.13 vs 74.62 ± 45.21 ml; P< 0.001) and postoperative length of stay (4.10 ± 1.18 vs 7.92 ± 6.43 days; P< 0.001). Conclusions: There was no significant reduction in intraoperative and postoperative complication between RA-LEM and LEM. We concluded that robotic surgery is equivalent in feasibility" and safety to conventional LEM. RA-LEM may be associated with less blood loss and shorter hospital stay. [ABSTRACT FROM AUTHOR]

AbstractPurpose??The purpose of our study was to evaluate the short-term and long-term outcomes of emergency Lichtenstein tension-free hernioplasty for acutely incarcerated inguinal hernia.Methods??We conducted a retrospective study of patients who underwent emergency Lichtenstein hernioplasty for acutely incarcerated inguinal hernia between September 2002 and January 2006 in a major city hospital in Thailand. We analyzed the early postoperative complications and surgical outcomes.Results??All 24 patients were men, with a mean age of 53.8 ? 19.2 years (range 19?77). There was no perioperative mortality and only two postoperative complications (8.3%): a subcutaneous fluid collection, which resolved spontaneously within 2 weeks; and a superficial surgical site infection, which was treated successfully by intravenous antibiotics. The hospital stay was 3.8 ? 2.1 days (range 2?12). All patients attended regular follow-up visits (mean 20.2 ? 10.7 months, range 3?43). Clinical recurrence was found in one patient (4.2%), 7 months postoperatively.Conclusion??Lichtenstein hernioplasty can be used effectively as an emergency operation for incarcerated inguinal hernia with a good outcome and an acceptably low rate of postoperative complications. [ABSTRACT FROM AUTHOR]

A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma (HCC) presented with progressive dysphagia. He had undergone liver transplantation for HCC three and a half years prevously. At presentation, his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus, causing a luminal stricture. We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system. Recovery was uneventful and he was been doing well 2 mo after surgery. α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively. During the follow-up period, he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation.