The Thai Journal of Surgery

Comparison of 5-Year Oncological Outcomes of Locally Advanced Rectal Cancer Patients Treated with Radiotherapy versus Without Radiotherapy: A Real-World Single-Center Retrospective Study

Mookda Nivaarrarsuwonnakul — 2026-03-06

Background and Objective: Most oncologists treat rectal cancer following NCCN guidelines. Chemoradiotherapy (RT) is preferred for patients with suspected or proven T3-4 disease and/or regional node involvement. RT may result in tumor shrinking, reduce risk of local recurrence in the pelvis, and has been standard of care in North America for locally advanced rectal cancer. Because access to radiation is limited in Thailand, half of the patients deny being referred to radiation centers due to long waiting times and expenses. A transabdominal resection without radiotherapy (RT) was inevitable, but it observed favorable results. This study aimed to compare the long-term oncological outcomes of locally advanced rectal cancer patients who received RT with those who did not receive RT.

Materials and Methods: This retrospective study reviewed data of patients with clinical stage T3-4 rectal cancer who underwent curative resection, received RT, and those without RT from 1 January 2014 to 31 December 2019 in Trang Hospital. The survival and disease status of patients were updated as of 31 July 2024.

Results: Of 54 rectal cancer patients who underwent curative transabdominal resection (mean age 61.57 ± 10.8 years, male 51.9%), 26 patients (48.1%) received RT, and 28 patients (51.9%) did not receive RT. The median follow-up time was 68.5 months (range, 5-113 months). There was no statistical difference between the RT group and the no RT group in 5-year disease-free survival (72.1% vs.88.5%; P = 0.320) and 5-year overall survival rates (68.8% vs. 82.1%; P = 0.242). The 5-year local recurrence rate was higher in the RT group, but there was no statistically significant difference (21.7% vs. 4.0%; P = 0.147).

Conclusion: In rectal cancer patients who were eligible for curative transabdominal resection, receiving or not receiving RT offered comparable long-term oncological outcomes. Omitting RT is an option when radiotherapy is unavailable.

Foreign Body in the Rectum: A Case Series of 20 Patients (2021–2025)

Ashutosh Singh — 2026-03-06

Background: Rectal foreign bodies are uncommon presentations in surgical practice but have seen a steady rise due to changing social and sexual behaviors. Prompt diagnosis and proper management are essential to avoid serious complications.

Objective: To analyze clinical presentations, types of foreign bodies, management strategies, and outcomes in 20 patients treated for rectal foreign bodies between 2021 and 2025.

Materials and Methods: A retrospective analysis of 20 cases presenting to a tertiary care hospital was conducted. Clinical data, including demographics, type and cause of foreign body insertion, management approach, and outcomes, were recorded.

Results: The majority were males (90%) with a mean age of 36.5 years. Most insertions were self-induced for sexual gratification. Objects included bottles (30%), vegetables (25%), sex toys (20%), and metallic tools (10%). Manual removal under anesthesia was successful in 75% of cases, while 25% required surgical intervention. No mortality was recorded, but 10% had mucosal injuries.

Conclusion: Early recognition, non-judgmental patient handling, and an algorithmic approach help ensure safe extraction and avoid complications.

Retrospective Review on Open-Heart Surgery in Buriram Hospital Starting Now and Moving Forward to the Future

Warach Taksinachanekij — 2026-03-06

Background: According to the First National Adult Cardiac Surgical Database Report, open-heart surgery from 2006-2008 included 16,017 patient records, with an in-hospital mortality rate of 6.7% and a 30-day mortality rate of 7.4%, compared to a worldwide 30-day mortality rate of 4.6%. For Buriram Hospital, the first open-heart surgery was performed on 31 May 2022.

Objective: This study conducted a retrospective review of patients undergoing open-heart surgery at Buriram Hospital to evaluate outcomes, morbidities, mortalities, and major postoperative complications, with the goal of improving surgical techniques, enhancing quality of life, and reducing mortality, morbidity, and hospitalization rates.

Materials and Methods: Retrospective reviews from 31 May 2022 to 31 December 2024 at the Division of Cardiothoracic Surgery, Department of Surgery, Buriram Hospital, focusing on patients who underwent open-heart surgeries, consisted of 164 patients.

Results: Of these, 131 were elective surgeries, 20 were urgent surgeries, and 13 were emergency surgeries. In total, 158 patients underwent heart-lung machine surgery with an average duration of 154.49 ± 63.24 minutes. The average aortic cross-clamp time was 104.64 ± 47.33 minutes. The average hospitalization duration was 15.85 ± 9.08 days. The survival rate of postoperative patients was 96.11%. (156 survivors) with a mortality rate of 4.89% (8 deaths). In the patient group, the mean risk of death after heart surgery (EUROSCOREII) was 4.27 ± 7.66%.

Conclusions: The results of open-heart surgery at Buriram Hospital were satisfactory compared to global and national results. Factors affecting hospitalization duration of patients were health status and the urgency of patients’ conditions before surgery. The findings were empirical data to improve the efficiency of care for patients undergoing open-heart surgery at Buriram Hospital.

Single-Surgeon Experience with 2,790 Consecutive Elective Groin Hernia Repairs Under Local Anesthesia: Outcomes and Technical Considerations

Phichai Phongmanjit — 2026-03-06

Objective: This study presents the author’s 34-year experience with groin hernia repair under local anesthesia, a technique adopted in 1989. It discusses the rationale, evolution, technical considerations, clinical benefits, and alignment with the 2023 International HerniaSurge Guidelines, which support local anesthesia in selected patients. This method is especially valuable for high-risk patients unsuitable for general or regional anesthesia.

Materials and Methods: This retrospective analysis draws from records from Chiangrai Prachanukroh Hospital. All procedures were performed or supervised by a single surgeon. Included were adult patients (≥ 18 years) undergoing elective groin hernia repair; cases with acute complications were excluded. Data collected included demographics, hernia type, repair technique, operative time, hospital stay, and complications. Ethical approvals were obtained.

Results: From September 1989 to September 2023, 2,790 groin hernia repairs were performed under local anesthesia. Most patients were male (97%), with indirect inguinal hernia being the most common (77.8%). A tension-free repair with a modified Lichtenstein technique was used in 76% of cases. Intraoperative assessment included voluntary patient straining to confirm the integrity of the repair. A one-day surgery (ODS) approach was applied in 91.4% of cases. The overall complication rate was 5.28%, and the recurrence rate was notably low at 0.71%.

Conclusion: Groin hernia repair under local anesthesia is a safe, effective, and cost-efficient option, well-suited for one-day surgery. With excellent outcomes and reduced inpatient resource use, this approach supports broader adoption in Thailand’s healthcare system. The author encourages wider use of local anesthesia in routine open groin hernia repairs.

The Critical Window for Appendicitis Diagnosis: A Time-Based Analysis of Rupture Risk

Tin Artavatkun — 2026-03-06

Background: Risk of appendix rupture varies over time. It aims to identify factors contributing to treatment delays, potentially heightening rupture risk. Findings could help surgeons intervene more quickly, lowering rupture chances and improving outcomes. Insights could contribute to effective treatment guidelines, particularly benefiting regions with limited healthcare access.

Objectives: To understand how appendix rupture risk changes over time and to identify factors associated with rupture and treatment delays, facilitating prompt intervention and better outcomes.

Materials and Methods: A retrospective analysis of 800 acute appendicitis cases at Rajavithi Hospital (October 2019 - September 2022) assessed symptom onset time and initial clinical signs. Patients diagnosed and treated for acute appendicitis were included; prior cases or incomplete records were excluded. Symptom onset was patient-reported, and diagnoses were based on initial assessments. Rupture was confirmed intraoperatively. Statistical analysis used a significance level of p < 0.05.

Results: Participants' mean age was 35.78 ± 14.33 years. Average time from symptom onset to hospital presentation was 23.90 ± 23.87 hours, and door-to-surgery time was 12.79 ± 6.99 hours. Univariate analysis showed significant associations between rupture and older age (p = 0.002), higher temperature (p = 0.002), increased heart rate (p < 0.001), higher ASA class (p < 0.001), and elevated WBC count (p < 0.001). No significant association was found with gender, symptom onset-to-hospital time, or intra-hospital timeframes. Multivariate analysis confirmed older age (p = 0.011), higher temperature (p = 0.019), elevated pulse rate (p < 0.001), higher ASA class (p = 0.038), WBC ≥ 10,000 (p = 0.002), increased door-to-ATB time (p = 0.018), and longer surgical consultation time (p = 0.039) as rupture predictors.

Conclusion: Older age, elevated temperature, heart rate, WBC count, higher ASA classification, and delays (door-to-ATB time, surgical consultation time) are significant factors influencing appendicitis rupture. Addressing these could improve outcomes.

Colonic Hypoganglionosis in an Adult Female: A Case Report

Senthil VK — 2026-03-06

Hypoganglionosis is a rare cause of intestinal obstruction characterized by a reduced number of ganglionic cells in the colon. Patients with this condition may present with constipation and acute intestinal obstruction. Based on the segment of the intestine affected, it can be classified into type one, in which the pathology is confined to a segment of the colon, and type two, in which the hypoganglionosis is widespread but less severe. In children, the condition can be isolated or associated with Hirschsprung’s disease. Hypoganglionosis is extremely rare in adults and is not easy to diagnose. We present this 39-year-old female patient who presented with symptoms of acute intestinal obstruction and was initially managed medically. Still, she ultimately underwent a total colectomy, and the diagnosis of colonic hypoganglionosis was made on histopathological evaluation. Her recovery was uneventful, and she has been symptom-free.

Progression of Vascular Pythiosis and Management of Intra-Abdominal Arterial Involvement

Titi Saichuea — 2026-03-06

Intra-abdominal vascular pythiosis is a rare, life- and limb-threatening infection caused by Pythium insidiosum. A 36-year-old Thai male with thalassemia presented with a chronic left leg ulcer that progressed despite debridement, leading to a below-knee amputation (BKA). Post-BKA, chronic osteomyelitis necessitated an above-knee amputation (AKA). The stump failed to heal, and intra-abdominal vascular pythiosis was diagnosed using PCR and computed tomography angiography (CTA), which revealed extensive arterial occlusion. Management included antifungal and antibacterial therapy, high AKA, and arterial resection. Over 36 months, the patient showed clinical improvement with stable inflammatory markers. Timely diagnosis of vascular pythiosis is essential for optimizing treatment outcomes, and radical surgical resection continues to serve as the cornerstone of effective therapy.

The Current Surgical Management of Complicated Left-Sided Colonic Diverticulitis: Narrative Review Article

Kumar Hari Rajah — 2026-03-06

Acute left-sided diverticulitis represents the most prevalent form of acute diverticulitis and is categorized into two types: complicated and uncomplicated. The surgical intervention for complicated diverticulitis is classified into the Hartmann’s procedure or sigmoid resection with anastomosis, accompanied by a protective ileostomy. Damage control surgery is indicated for patients with complicated left-sided diverticulitis who are hemodynamically unstable. Laparoscopic lavage serves as a bridging procedure in cases of complicated diverticulitis with purulent discharge or classified as Hinchy 3, aiming to stabilize the patient for subsequent definitive surgery. This review will examine the surgical management of complicated left-sided diverticulitis, with a focus on Hartmann’s procedure and colonic resection with anastomosis. Additionally, we will explore the role of laparoscopic lavage in the context of complicated diverticulitis.