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

Outcome of Open Inguinal Hernia Repair: Modified Lichtenstein 2-Point Fixed Technique

2025-08-21T16:08:13+07:00

Inguinal hernia is a common surgical condition. The Lichtenstein technique has been shown to have a very low recurrence rate; however, postoperative complications, particularly chronic inguinal pain, are still observed. This study modified the Lichtenstein technique to reduce such adverse effects while maintaining the low recurrence rate. Patient data were retrospectively reviewed from those who underwent open hernioplasty using the Modified Lichtenstein 2-Point Fix Technique between January 2014 and December 2022 at Maharaj Nakhon Si Thammarat Hospital. Data were obtained from the hospital’s hos XP database, and follow-up was conducted via telephone. A total of 668 patients underwent the procedure, comprising 649 males and 19 females, with a mean age of 57.4 ± 16.84 years (range, 12–91 years). The mean operative time was 30.65 ± 13.38 minutes (range, 10–120 minutes). Follow-up information was successfully obtained from 245 patients at least two years after surgery. No recurrence of inguinal hernia was observed in the follow-up group, and 37 patients (15.10%) reported chronic pain. The results suggest that the Modified Lichtenstein 2-Point Fix Technique is a time-efficient procedure with no recurrence and an acceptable rate of postoperative discomfort. This modified approach may serve as a suitable and effective option for general surgeons, particularly in resource-limited settings.

The Association Between Distance from Major Highways to Hospitals and Road Traffic Injury Mortality in Thailand

2025-08-21T16:10:00+07:00

Background: Road traffic injuries (RTIs) remain a leading cause of morbidity and mortality globally, especially in low- and middle-income countries like Thailand. Timely access to trauma care is critical to improve survival, yet the influence of hospital proximity to main roads on RTI outcomes in Thailand is not well understood.

Methods: We conducted a retrospective observational study analyzing data from 35 hospitals across Thailand during 2024. Hospital distances from main highways were calculated using geographic information systems. Outcome measures included the number of RTI-related injuries, deaths, and the fatality-to-injury ratio (FIR). Statistical analyses comprised Pearson’s correlation, multiple linear regression, and logistic regression to examine associations between distance, injury burden, and mortality. Spatial heatmaps identified geographic clusters of high fatality.

Results: The mean hospital distance to the nearest main road was 14.7 km (SD 8.3). A total of 12,450 RTI cases and 312 deaths (fatality rate 2.5%) were recorded. Distance from main roads showed no significant correlation with injury counts (r=0.09, p=0.71), but a moderate positive correlation with mortality counts (r=0.38, p=0.19). Multiple regression indicated injury and disability counts were strong predictors of death (p<0.001), while distance exhibited a borderline negative association with mortality. Logistic regression classified hospitals by FIR strata with 85.7% accuracy; disability burden strongly predicted higher FIR. Heatmaps revealed clusters of elevated FIR in remote provinces.

Conclusion: Proximity to main roads alone does not predict RTI incidence or mortality in a straightforward manner; instead, injury severity and disability burden predominantly influence fatality outcomes. Geographic remoteness may contribute to delayed access to care, impacting survival. These findings emphasize the need for integrated trauma care strategies addressing timely access and functional recovery, and for targeted EMS resource allocation to high-risk regions in Thailand.

Randomized Controlled Trial of Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Versus Open Thyroidectomy: A Comparative Study of Efficacy and Complications.

2025-09-20T17:15:18+07:00

Background: Minimally invasive thyroid surgery has evolved significantly, offering improved cosmetic and clinical outcomes¹. Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a scar-free alternative to conventional open thyroidectomy (OT)². This study aims to compare the safety and clinical outcomes of TOETVA and OT in patients with benign thyroid nodules, incorporating data from a randomized controlled trial (RCT).

Methods: A single-blind randomized controlled trial was conducted on patients with thyroid nodules ≤8 cm. Patients were randomized to undergo either TOETVA or conventional thyroidectomy. Postoperative pain had been evaluated using VAS on days 1 and 2. A 3-month follow-up was performed to evaluate complications, including recurrent laryngeal nerve (RLN) palsy, bleeding, and infection.

Results: Seventy patients were randomized to undergo either TOETVA or conventional thyroidectomy. The baseline characteristics, including age and thyroid nodule size, were comparable between groups. The mean operative time was longer in the TOETVA group (99 vs. 75 minutes, P < .001) and the pain score on the second postoperative day (0.74 vs. 1.86, P < .001). At the 3-month follow-up, complications in the TOETVA group included one case of transient RLN palsy, one case of mental nerve injury, and one case of subcutaneous emphysema. No complications were reported in the OT group.

Conclusion: TOETVA is associated with reduced postoperative pain and improved cosmetic outcomes compared to conventional thyroidectomy in the management of benign thyroid nodules.

Prevalence and Risk Factors of Complicated Appendicitis at Debaratana Nakornratchasima Hospital

2025-09-06T14:46:16+07:00

Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain. Without prompt treatment, it can lead to complications such as perforation, intra-abdominal abscess, or generalized peritonitis. This study aimed to determine the prevalence and factors associated with the occurrence of complications in patients with acute appendicitis.

Methods: This was a retrospective study utilizing data collection forms to extract information from medical records. A total of 458 patients diagnosed with appendicitis at Debaratana Nakhonratchasima Hospital were included. Data were analyzed using descriptive statistics and inferential statistics, including the independent t-test, chi-square test, and Mann–Whitney U test. Multivariable logistic regression was performed to identify factors associated with complicated appendicitis, with results presented as adjusted odds ratios (Adj. OR) and a significance level set at p < 0.05.

Results: Among 458 patients with acute appendicitis, 65 (14.19%) had complicated appendicitis. Multivariate logistic regression identified five significant preoperative risk factors (p < 0.05): age ≥ 50 years (adjusted odds ratio [aOR] = 2.23; 95% confidence interval [CI]: 1.11–4.45; p = 0.023), rebound tenderness (aOR = 2.67; 95% CI: 1.37–5.20; p = 0.004), neutrophil percentage (per 1% increase) (aOR = 1.09; 95% CI: 1.01–1.19; p = 0.043), symptom duration before admission (per hour) (aOR = 1.10; 95% CI: 1.07–1.13; p < 0.001), and preoperative waiting time (per hour) (aOR = 1.13; 95% CI: 1.05–1.21; p < 0.001). In addition, patients with complicated appendicitis had significantly longer operative time, greater intraoperative blood loss, a of drain insertion, and longer hospital stays (p < 0.001).

Conclusion: Older age (≥50 years), rebound tenderness, elevated neutrophil levels, prolonged symptom duration before hospital admission, and delayed surgical intervention were significantly associated with complicated appendicitis. Early diagnosis and timely surgery are essential to reduce the risk of complications.

Seasonal and Regional Patterns of Road Traffic Injuries and Fatalities in Thailand: A Three-Year Provincial Study (2022–2024)

2025-08-02T16:03:53+07:00

Background: Thailand consistently ranks among the countries with the highest rates of road traffic fatalities worldwide, with peaks commonly observed during national festivals such as Songkran. However, limited research has examined provincial differences or compared injury and fatality patterns across months and years.

Methods: This retrospective study analyzed road traffic injury and fatality data from nine Thai provinces—including Bangkok and eight non-tourism-focused regions—during March to May for the years 2022 to 2024. The fatality-to-injury ratio (FIR) was used as a measure of crash severity, and temporal trends were analyzed with a focus on changes surrounding the Songkran festival.

Results: April consistently exhibited the highest injury counts, with FIRs also peaking in several provinces during the same month. While Bangkok recorded the largest number of injuries, provinces like Sa Kaeo, Phayao, and Sukhothai displayed markedly higher FIRs, suggesting disproportionately severe outcomes in rural areas. Nong Bua Lamphu demonstrated a consistent decline in injuries and stable low FIRs, indicating potential effectiveness of localized safety strategies.

Discussion: Thailand’s road safety crisis is not homogenous. Risk patterns vary significantly across time and space, underscoring the need for localized, data-driven interventions. Metrics such as FIR should complement total case counts in guiding policy. Expanding road safety campaigns beyond festival periods, strengthening emergency medical services, and investing in rural infrastructure could collectively reduce preventable deaths.