Journal of the Association of General Surgeons of Thailand under the Royal of Patronage of HM the King

Message from the President of the Association of General Surgeons of Thailand under the Royal Patronage of HM King

2026-07-03T17:44:04+07:00

Dear Members of the Association of General Surgeons of Thailand under the Royal Patronage of His Majesty the King, and esteemed surgical colleagues,

On the occasion of assuming the position of President of the Association of General Surgeons of Thailand under the Royal Patronage of His Majesty the King for the 2026–2027 term, I would like to warmly welcome all members to a new chapter of strong and collaborative advancement of our profession.

General surgery is a vital foundation of Thailand’s healthcare system. It requires refined surgical skills, sound judgment, and decisive decision-making based on up-to-date knowledge, in order to provide the highest standard of care for patients at all levels of healthcare throughout the country.

I would also like to take this opportunity to sincerely thank all of you for your continued support of the Association’s activities and its journal. The collaboration and encouragement from our members have enabled the Journal of the Association of General Surgeons of Thailand to receive quality recognition and to be indexed in Thai Citation Index (TCI) Tier 2 for the assessment period from 1 January 2026 to December 2029. This achievement represents an important milestone that reflects the academic strength and increasingly international standards of our Association.

To ensure that the journal’s success as a Tier 2 publication remains strong and sustainable, we need the continued academic contributions of all our members. I would therefore like to cordially invite you to submit your academic articles or research works for publication in our journal. Together, we can share knowledge, strengthen academic excellence, and further advance the standards of Thai surgery.

Message from the Editor-in-Chief

2026-07-03T17:48:30+07:00

Dear Members of the Association of General Surgeons of Thailand under the Royal Patronage of His Majesty the King,

On behalf of the Editorial Board, I would like to sincerely thank all members for your continued support of the journal and the Association.

It is my great pleasure to share the good news that our journal has been evaluated by the Thai-Journal Citation Index Centre (TCI) and has been classified as a TCI Tier 2 journal for the assessment period from 1 January 2026 to December 2029. This represents an important milestone in further elevating our academic standards and strengthening the recognition of our journal at a broader, international level.

In this issue, we continue to present four valuable articles that reflect the ongoing development of surgical care quality across all levels of hospitals:

The first article presents lessons learned from Free Tissue Transfer (FTT) in a low-volume provincial hospital, highlighting the importance of team training, preparedness, and intraoperative problem-solving.

The second article reports the success and safety of Peroral Endoscopic Myotomy (POEM) at Nakornping Hospital for the treatment of achalasia, demonstrating that this advanced endoscopic technique can be performed effectively in a regional center.

The third article introduces the 5TAMeD innovation, a novel technique for push-type percutaneous endoscopic gastrostomy (Push-PEG), which is safe and can reduce device-related costs by more than 90%, making it particularly suitable for patients with advanced esophageal cancer.

The fourth article examines transient femoral nerve dysfunction (TFND) after open inguinal hernia repair under local anesthesia. This study provides important information for improving both safety and efficiency in one-day surgery systems.

On this occasion, I would like to cordially invite all surgeons and academic colleagues to submit your academic articles and research works for publication in our journal. Through your contributions, we can continue to share knowledge and collectively strengthen the future of Thai surgery.

Lessons from a Low-Volume and Non-academic hospital: Optimizing Outcomes in Free Tissue Transfer—A Case Series by a novice plastic surgeon

2025-12-01T14:11:41+07:00

Background: Free tissue transfer (FTT) has become the preferred method in modern reconstructive surgery, offering excellent functional and aesthetic outcomes, particularly for complex oncologic, traumatic, and post-infectious defects. This study describes the early experience and key lessons learned from a series of FTT procedures performed by a novice plastic surgeon at Nakhon Phanom Hospital, a standard-level (S-level) hospitals in Thailand.

Methods: Medical records of all patients who underwent FTT performed by a single surgeon were reviewed. Data collected included demographics, operative details, pathology results, and postoperative complications.

Results: Nineteen FTT procedures were identified, performed for reconstruction of the head and neck (n = 15) and lower extremities (n = 4). Five cases experienced postoperative complications resulting in flap compromise. Three of eight threatened flaps were successfully salvaged. The primary causes of flap loss were vascular complications, including venous congestion (26.3%) and arterial thrombosis (15.7%). The overall flap success rate was 73.7%.

Conclusions: Performing free tissue transfer as a novice plastic surgeon in a non-academic hospital with no prior experience in this procedure posed significant challenges. Limited early postoperative monitoring capacity, insufficiently trained nursing staff, and the surgeon’s learning curve contributed to delays in critical decision-making. Ultimately, improving outcomes in such settings requires recognizing systemic limitations, implementing continuous team training, and maintaining perseverance throughout the demanding early learning phase.

Per-oral Endoscopic Myotomy for Treatment of Achalasia, A Single Center Case Series

2026-02-28T16:43:55+07:00

Introduction: Achalasia is a rare esophageal motility disorder with multiple modality of treatment, however, a novel treatment with per-oral endoscopic myotomy (POEM) have recently gained recognition as a standard of care.

Objective: To evaluate the early outcomes and complications of per-oral endoscopic myotomy (POEM) in Nakornping Hospital.

Materials and Methods: A retrospective observational study of medical record reviewed all patients diagnosed with achalasia and was treated with POEM between August 2018 and March 2025. Patient demographic data, early outcomes and complications were evaluated. A follow up of at least 1 year data was collected.

Results: A total of 14 patients were included. Technical success was achieved in 92.8% (13/14) of cases, with one conversion to endoscopic dilatation due to bleeding. The median operative time was 162.5 minutes. Overall morbidity was 28.5% (n=4), including one perforation controlled with endoscopic clips, one bleeding event, and two cases of aspiration pneumonia. The median length of stay was 4 days. At 1-year follow-up, clinical success was evident as the median Eckardt score significantly improved from 7 preoperative to 1 (range: 0–3). Additionally, timed-barium esophagography measurements improved, and median BMI increased from 19.6 to 21.4 kg/m².

Conclusion: Per-oral endoscopic myotomy (POEM) is a safe and effective treatment of achalasia with proficient 1 year outcome. However a long-term follow is warrent for evaluation.

Innovative push percutaneous endoscopic gastrostomy by means of gastropexy and Foley catheter in a patient with advanced head and neck and esophageal cancer

2025-07-23T20:02:06+07:00

Enteral tube feeding plays a vital role in maintaining the quality of life of patients with cancer. Percutaneous endoscopic gastrostomy (PEG) with the push technique is a minimally invasive method that uses endoscopy to assist in the insertion of a feeding tube into the stomach. This method is preferred over pull method as it minimizes the risk of cancer spreading to the surrounding tissue of stroma, especially in patients with head and neck or esophageal cancer. However, it has some drawbacks, such as the possibility of complications related to the feeding tube and economic concerns. A surgical technique called push-PEG using thread the thread through trap and Alken metal dilator (5TAMeD) has been developed to provide a safe and simple method for oncologic patients in need of nutritional support. In a case study, a 59-year-old man diagnosed with malignant esophageal cancer underwent the push-PEG with 5TAMeD procedure and experienced a successful outcome. The patient's condition remained stable after the surgery, he was discharged from the hospital on the second day, and had no complications during the 4-week follow-up period. This case demonstrates the effectiveness, safety, and cost-effectiveness of the push-PEG with 5TAMeD technique for providing enteral nutrition support to advanced esophageal cancer patients.

Transient Femoral Nerve Dysfunction During Open Lichtenstein Repair Under Local Anesthesia: A Retrospective Cohort Study

2026-05-27T16:24:48+07:00

Objective
Transient femoral nerve dysfunction (TFND) following inguinal hernia repair under local anesthesia is likely underrecognized because symptoms are typically self-limited. This study evaluated the incidence, clinical presentation, and factors associated with TFND after open inguinal hernia repair under local anesthesia.

Methods
A retrospective cohort study was conducted in 636 consecutive patients undergoing open Lichtenstein inguinal hernia repair under local anesthesia between March 2018 and March 2026. TFND was defined as transient postoperative sensory disturbance over the femoral dermatome and/or motor weakness impairing knee extension or weight-bearing ambulation. Patients were assessed postoperatively until symptom resolution and discharge. Univariable and multivariable logistic regression analyses were performed to identify factors associated with TFND.

Results

TFND occurred in 74 patients (11.6%), including 26 (4.1%) with isolated sensory dysfunction and 48 (7.6%) with motor weakness. All neurological deficits resolved spontaneously within 1.5 – 6 hours without permanent sequelae or unplanned admission. Multivariable analysis identified complex hernia (adjusted odds ratio [aOR] 5.93, p < 0.001), advanced operative phase (phase 2: aOR 6.78, p = 0.001; phase 3: aOR 13.65, p < 0.001), female sex (male sex: aOR 0.30, 95% CI 0.13–0.66; p = 0.017), and left-sided hernia (right-sided hernia: aOR 0.45, 95% CI 0.29–0.83; p = 0.004) as independent factors associated with TFND. Outpatient day surgery was independently associated with lower TFND risk (aOR 0.41, p = 0.006). The composite case-mix index increased progressively across phases (p < 0.001).

Conclusions
TFND after open inguinal hernia repair under local anesthesia occurred in 11.6% of patients but was uniformly transient and self-limited, resolving spontaneously within 1.5 to 6 hours without permanent neurological sequelae or unplanned hospital admission. Multivariable analysis identified complex hernia (aOR 5.93), advanced operative phase (phase 2: aOR 6.78; phase 3: aOR 13.65), female sex, and left-sided hernia as independent risk factors for TFND, while outpatient day surgery was independently protective (aOR 0.41). These findings indicate that TFND is predominantly associated with operative complexity and evolving anesthetic infiltration behavior across the surgeon experience trajectory, rather than a simple dose-dependent effect of local anesthetics. The composite case-mix index further demonstrated that overall operative burden increased progressively across experience phases driven by concurrent changes in hernia complexity and bupivacaine utilization supporting the multidimensional nature of TFND risk in this setting. Greater awareness of this phenomenon and refinement of local-anesthesia infiltration techniques, including potential adoption of ultrasound guidance in complex cases, may improve perioperative safety and reduce TFND occurrence during groin hernia repair.