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

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

Prasit Mahawongkajit — 2026-06-19

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.

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

Sarinya Boonpoapichart — 2026-03-01

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

Chotirot Angkurawaranon — 2026-06-07

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.