Browsing by Author "P. Pongchairerks"
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Publication Metadata only The impact of laparoscopic cholecystectomy on the practice and training of gallbladder surgery in Thailand(1996-09-01) P. Pongchairerks; Mahidol University; Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityThe objective of this study was to find out the impact laparoscopic cholecystectomy had on the practice and training of cholecystectomy in Thailand. This study involved prospective interviewing by questionnaires, of patients who had had cholecystectomies by laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) techniques starting from their immediate postoperative days, comparison of the length of hospital stay and the costs of LC and OC, and the surveillance of Thai laparoscopic surgeons' experience and surgical residents' attitude towards this procedure. The results revealed that laparoscopic surgeons offered LC to most of their patients with gallstones but in each institution the proportion of cholecystectomies performed was below 70%. Patients' satisfaction was higher and postoperative pain was less after LC. Complications occurred in 2.12% (37 in 1744 patients). The length of hospital stay was slightly shorter (2.68 ± 0.62 versus 3.30 ± 0.95 days) and the expenses were only slightly higher for LC. Most residents were interested to learn this procedure only after they have finished their formal surgical training; they still felt that LC was suitable only for patients with a higher economic status and that it was associated with a higher complication rate. This study suggest that LC did have an impact on the practice of cholecystectomy and future planning of trainings should take into account the necessity to change residents' misunderstanding about the suitability of this procedure in appropriate patients.Publication Metadata only Ultrasound-guided liver biopsy: accuracy, safety and sonographic findings.(1993-11-01) P. Pongchairerks; Mahidol UniversityAn experience of 97 liver biopsies performed under the guidance of a portable ultrasonographic procedure was reviewed. Of the 88 cases in which the results of biopsy were available, 73 malignant and 7 benign liver diseases were correctly diagnosed by the procedure, an accuracy of 90.9 per cent. There was no mortality. Significant complication was observed in 5 cases and consisted of 3 cases of intraperitoneal bleeding that required only blood transfusion, one case of upper gastrointestinal bleeding presumed to be hemobilia and one case of persistent fever of 38 degrees C that subsided after antibiotic administration. Ultrasound-guided liver biopsy can be an effective and safe outpatient procedure for pathological diagnosis of liver diseases. Analysis of sonographic and histologic correlation revealed that the types of sonographic appearance could not be significantly correlated to the histologic nature of the masses. Therefore, accurate prediction of pathology of liver masses from their sonograms is not possible.Publication Metadata only Use of laser in general surgery(1992-01-01) P. Pongchairerks; Mahidol University