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Abstracts of the 45Th Annual Scientific Congress of the Royal College of Surgeons of Thailand, 8-11 October 2020, RCST Virtual Annual Congress 2020 (Part I)

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Abstracts of the 45Th Annual Scientific Congress of the Royal College of Surgeons of Thailand, 8-11 October 2020, RCST Virtual Annual Congress 2020 (Part I) The THAI Journal of SURGERY 2020;41(3):96-114. Official Publication of The Royal College of Surgeons of Thailand Abstracts Abstracts of the 45th Annual Scientific Congress of The Royal College of Surgeons of Thailand, 8-11 October 2020, RCST Virtual Annual Congress 2020 (Part I) Free Paper General Surgery Altemeier procedure and two patients (n = 2, 13.4%) 12 YEARS RESULT OF SURGICAL TREATMENT underwent Delorme procedure. There were not postop- FOR RECTAL PROLAPSE IN NARESUAN UNI- erative complications in all patients. VERSITY HOSPITAL Two years after the surgery, we found the Alte- meier procedure did not find a relapse. The recurrence Natthanai Ngamnil, Sathon Thum-umnuaysuk of rectal prolapse had occurred in 4 patients (57.1%) Department of Surgery, Faculty of Medicine, Naresuan University, that underwent Abdominal (Ventral) rectopexy with Phitsanulok, Thailand Mesh procedure was on the average 8.50 months after the procedure. For the Delorme procedure, 50% of the Background: Rectal prolapse is a condition which patients had recurrent of rectal prolapse on average of the terminal end of large intestine protrudes out from 3 months after the procedure. the rectum. The main of the treatment is surgical man- Conclusion: All procedures are improvement in agement. Numerous surgical alternatives aim to restore quality of life and Wexner score were noted and no physiology by correcting the prolapse and improving complications after surgery and Altemeier procedure had continence and constipation with acceptable mortality better outcomes in Naresuan University. The decision and recurrence rates. between Perineal approach and Abdominal approach Objectives: To study the outcomes of surgical treat- will depend on the surgeon’s preference. ment in rectal prolapse patients in Naresuan University Keywords: Rectal prolapse, Altemeier, Rectopexy Hospital who underwent different surgical techniques for rectal prolapse and the rate of recurrence. Materials and Methods: Between 2007 and 2019, A COMPARISON OUTCOME OF ANALGESIC patients who had surgical treatment in rectal prolapse EFFECT BETWEEN GENERAL ANESTHESIA were collected data retrospectively. The data were ana- VERSUS GENERAL ANESTHESIA WITH PEC- lyzed about outcomes, complications, end-points were TORAL NERVE BLOCK IN MASTECTOMY changed in bowel function (Wexner Constipation Score and Fecal incontinence Severity Index) at pre-operative Siriporn Intarasangkanawin, Thitikon Krisorakun and post-operative and recurrent rate in 2 years. Department of Surgery, Rajavithi Hospital, Bangkok, Thailand Results: 15 patients who had surgical treatment in total rectal prolapse were women. 93.3% had no history Background: Breast cancer is most common can- of previous rectal surgery. For this study, seven patients cer in female patients comprising 31% of all estimated underwent Abdominal (Ventral) rectopexy with Mesh new cancer cases in the Thailand in 2018. Breast surgery (n = 7, 46.6%), six patients (n = 6, 40.0%) underwent can result acute postoperative pain and up to two thirds 96 Vol. 40 No. 3 Abstracts 97 of female patients develop persistent pain. Regional pre-operative diagnosis of the type of IH is useful for anesthesia techniques can improve patient outcomes in operative planning for the beginner. To our knowledge, terms of acute and persistent postsurgical pain. Preop- there is no study show the factor related with the ac- erative pectoral nerve block is an easy to perform and curacy of PE to diagnose the type of IH. superficial block technique and can reduces intraopera- Objective: This study aims to determine the accu- tive and postoperative opioid consumption. racy of PE and related factors for diagnosis of the type Objective: The author hypothesized that general of IH. anesthesia with intraoperative pectoral nerve block, Materials and Methods: The study design was compared to general anesthesia, provides comparable a retrospective analytical study. The medical record of reduce postoperative pain and reduce opioid consump- one hundred IH patients who underwent laparoscopic tion. repair in 2019 were reviewed. All patients were exam- Materials and Methods: From July 2019 - June ined by chief surgical resident. The cough and impulse 2020, 30 patients were randomized 1:1 ratio to either test, invagination test, and occlusion test were used to general anesthesia with pectoral nerve block or general differentiate the types of IH. Findings were compared anesthesia by single surgeon. Postoperative pain was with post-operative laparoscopic repair to determine evaluated by visual analogue scale (VAS) at 30 minutes, the accuracy. Factors including age, sex, BMI, and 2 hours, 6 hours, 12 hours and 24 hours. Post-operative recurrence-hernia, were analyzed and determined the opioid consumption was recorded during 24 hours. correlation to the accuracy by using the Chi-squared test. Result: Patients in general anesthesia with intra- Results: The study showed the accuracy of PE was operative pectoral nerve block group got significantly 79.4% (50 out of 68) for indirect inguinal hernia (IIH), less pain than patients in general anesthesia group in first 68.4 % (39 out of 57) for direct inguinal hernia (DIH), 30 minutes after surgery (2.4 ± 3.2 and 6.5 ± 2.1, P = and 100% (6 out of 6) for pantaloon hernia (p < 0.001). 0.00). Furthermore, patients in general anesthesia with Occult hernia was found in 12.2%. Fifty-two percent intraoperative Pecs block II group required significant were given the corrected diagnosis in both groin hernia. fewer postsurgical opioid consumption than patients in There were no factors correlated with the accuracy of PE. general anesthesia group [median (min-max); 0 (0-6) Conclusion: The physical examination for dif- mg and 3 (0-6) mg, P = 0.01]. ferentiation of inguinal hernia type was only 52%. The Conclusion: The pectoral nerve block reduces accuracy in diagnosis of IIH is higher than DIH. Age, postsurgical opioid consumption for patients undergoing sex, BMI, and recurrence-hernia status were not cor- breast surgery. related with the accuracy of PE. Keywords: Accuracy, Diagnosis, Inguinal hernia, ACCURACY OF PHYSICAL EXAMINATION Laparoscopy, Factors OF INGUINAL HERNIA DETECTED BY LAPA- ROSCOPIC INGUINAL HERNIA REPAIR AND RELATED FACTORS ACCURACY OF PROGRAM FOR CALORIE AND PROTEIN INTAKE ESTIMATION IN SURGICAL Sarit Suwanakijboriharn1, Pawan Chansaenroj1,2 PATIENTS IN THE RAJAVITHI HOSPITAL 1 Department of Surgery, Somdech Phra Pinklao Hospital, Bangkok 10600, Thailand Pohnpatchara Debsane, Somboon Subwongcharoen 2 Department of Surgery, Queen Sirikit Naval Hospital, Chonburi Department of Surgery, Rajavithi Hospital, College of Medicine, 20180, Thailand Rangsit University, Bangkok, 10400, Thailand Background: Inguinal hernia (IH) is one of the Background: Malnutrition has many negative ef- most common surgical problem. Studies has been shown fects on surgical patients. The lack of tools can be used that the accuracy of physical examination for diagnosis to estimate calorie and protein intake in practice. the types of IH is about 35-70%. Laparoscopic approach Objective: The aim of this study was to create the is better to demonstrate the type, size and occult hernia, tool to estimate calorie and protein intake that correlate compare to open approach. Previous studies showed with the gold standard method. 98 Abstracts Thai J Surg Jul. - Sept. 2020 Materials and Methods: The study was experi- feasibility, safety and benefit from several multi random- mental development and observational cross-sectional ized trials. study. Total food trays in this study were 140 trays, divide Objective: This study aims to show outcomes into regular diet 70 trays and soft diet 70 trays. After of laparoscopic surgery for colorectal cancer in Vajira eating food trays were estimated calories and protein Hospital. intake by using the program that the researchers created. Materials and Methods: Retrospective study Its name is RJH CAL-PRO version 1. In the same food colorectal cancer patients who underwent laparoscopic tray, nutritionists measure calories and protein intake by resection between 2014 and 2019. Outcome including weighing as the reference method. The researchers and demographic data, tumor characteristics, complication nutritionists did not know the results of each other. In in 30 days postoperative, five-year survival, disease free the final step Analysis was done to study the difference survival and factor associated with five-year survival and and correlation between 2 methods. recurrence. Results: Comparisons between using the program Results: Total 211 case performed laparoscopic and using the gold standard to measure calorie intake colorectal surgery. Overall complication rate was were no statistical differences in soft diet and regular diet 23.61%. Most were minor complication such as elec- food trays (p = 0.825, p = 0.419). A high correlation was trolyte imbalance, phlebitis in 52.9%, followed by found between two methods to measure calorie intake in anastomosis leakage in 19.6% Incidence of conversion the soft diet (r = 0.989, p < 0.001) and regular diet food shows in 13 patients (6.02%). The five-year overall trays (r = 0.991, p < 0.001). No statistical difference was survival rate was 75.24% and five-year disease-free found between two methods to measure protein intake survival was 73.99%. In subgroup of disease-free sur- in the soft diet and regular diet food trays (p = 0.875, p vival colon resection was 94.2% and rectum resection = 0.135). Between using the program and using
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