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Purpose@#Minimally invasive surgery (MIS) offers patients several benefits, such as smaller incisions, and fast recovery times. General surgery residents should be trained in both open and MIS. We aimed to examine the trends of minimally invasive and open procedures performed by general surgery residents in Thailand. @*Methods@#A retrospective review of the Royal College of Surgeons of Thailand and Accreditation Council for Graduate Medical Education general surgery case logs from 2007 to 2018 was performed for common open and laparoscopic general surgery operations. The data were grouped by three time periods, which were 2007–2010, 2011–2014, and 2015–2018, and analyzed to explore changes in the operative trends. @*Results@#For Thai residents, the mean number of laparoscopic operations per person per year increased from 5.97 to 9.36 (56.78% increase) and open increased from 20.02 to 27.16 (35.67% increase). There was a significant increase in the average number of minimally invasive procedures performed among cholecystectomy (5.83, 6.57, 8.10; p < 0.001) and inguinal hernia repair (0.33, 0.35, 0.66; p < 0.001). Compared to general surgery residents in the United States, Thai residents had more experience with open appendectomy, but significantly less experience with all other operations/procedures. @*Conclusion@#The number of open and minimally invasive procedures performed or assisted by Thai general surgery residents has slowly increased, but generally lags behind residents inthe United States. The Thai education program must be updated to improve residents’technical skills in open and laparoscopic surgery to remain competitive with their global partners.
ABSTRACT
Background and Objective: Primary hyperparathyroidism is now being diagnosed with increasing frequency. Simultaneously there has been an apparent change in the presentation of the disease and indication for surgery. The aim of this study was to examine the clinical presentation and pathology of parathyroid glands for primary hyperparathyroidism.Methods : This retrospective descriptive study was carried out over 14 years, from 1994 to 2008, at Srinagarind Hospital, Faculty of Medicine, KhonKaen University. Information on the clinical presentation, parathyroid hormone level, serum calcium level and pathological report of parathyroid glands was obtained from retrospective parathyroid surgical database.Results: Out of 40 patients diagnosed with primary hyperparathyroidism at Srinagarind Hospital, there were 27 female, mean age 47.22(13 – 73) years and 13 male patients. Bone fracture was the most common clinical presentation found in 19 patients, the second was renal calculi found in 11 patients, one patient was presented with bone fracture and renal calculi and 8 patients were presenteded with non-specific symptoms. Pathological reports were adenoma in 39 glands of 39 patients and hyperplasia 4 glands in one patient. Mean serum parathyroid hormone level 481.69 pg/ml (79 - 1361.7 pg/ml)and mean serum calcium level was 12.66 md/dl (9.5-16.5 mg/dl)calcium was 12.66 mg/dl (9.5 – 16.5 mg/dl) and levelConclusion: This study shows that severe bone disease with fractures are the most common presentation of primary hyperparathyroidism. The second is renal calculi. The most common pathological report was adenoma.Keywords: Primary hyperparathyroidism; clinical spectrum, pathology
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Objective : To study the outcome of inpatient trauma cases of Accident and Emergency Unit, Department of Surgery, Faculty of Medicine, Khonkaen university compared with the result of Khon Kaen Hospital and standard outcome. Method : We retrospectively studied trauma patients who was admitted in Accident and Emergency Unit, Department of Surgery, Faculty of Medicine, Khon Kaen university between 1 January 1997 to 31 December 1997. TRISS score has been calculated to define the survival probability (Ps) of all 291 patients and stratified into 3 groups. We compared the actual death of each group to the outcome study of Khon Kaen Hospital (n=2492). We also used Z-statistic to compared the actual survivors and expected survivors from TRISS norms.Result : The actual death of Non-preventable death group, Potentially preventable death group and Preventable death group were 41.67%, 45.45% and 6.39% respectively. The outcome study of Khon Kaen Hospital in each group were 87.6%, 67.7% and 2.8% respectively. The Z-score was – 0.02306 (P = 0.008 – 0.01)Conclusion : In Non-preventable death group (Ps 0.00-0.25), the outcome of treatment was better than the outcome study of Khon Kaen Hospital In Potentially preventable death group (Ps 0.25-0.50), no statistically difference between the 2 studies In preventable death group (Ps 0.50-1.00), the outcome study of Khon Kaen Hospital was better than outcome of Accident and Emergency Unit The Z-score -0.02306 indicated no statistically difference between number of actual survivors and expected survivors from TRISS norms.
ABSTRACT
Background: Many previous studies have shown the advantages of laparoscopic appendectomy such as smaller surgical wound, less complication, faster recovery and shorter discharge period. However, the laparoscopic appendectomy method is required the longer operative time and higher operation cost.Objective: This is a preliminary study for modification technical of appendiceal stump by using Hem-o-lock clipTM in laparoscopic appendectomy.Materials and Methods: By review of operative notes and analyzing from medical records.Study design: Retrospective study and descriptive analysisSetting: Srinagarind Hospital, Faculty of Medicine, KhonKaen UniversityPopulation and Samples: There are nine patients whose were diagnosed as appendicitis and had been treated by laparoscopic appendectomy.Intervention: All patients were treated as laparoscopic appendectomy. The appendiceal stump was management by Hem-o-lock clipTM as a new technique in order to manage by Endo-GIATM or by EnoloopTM techniqueResults: The appendiceal stump operation managed by Hem-o-lock clip TM in laparoscopic appendectomy has shown that the mean of operative time is 32.22 + 13.48 minute, 95% CI 21.85, 42.59, and without complication in all cases. Moreover, the average of discharge period is only 3 days Conclusions: This study shows that the advantages of appendiceal stump managed by Hem-o-lock clips TM in laparoscopic appendectomy are no complication, decrease operative time and operative costs is in acceptable range as previous studies.