50th postgraduate course souvenir programme of the up-pgh department of surgery

8/10/2019 50th Postgraduate Course Souvenir Programme of the UP-PGH Department of Surgery

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Table of Contents

Foreword 3

Messages 6

50th Postgraduate Course Scientic Activities

Opening Ceremonies Program 10

14th Chancellor Alfredo T. Ramirez Memorial Lecture 12

Scientic Programme 18

Scientic Session Abstracts 23

Participants Prole 43

Event Pictures 44 Scientic Activities

Opening Ceremonies & ATR Memorial Lecture

Scientic Sessions

Meet the Professor Dinners

Fellowship Night

Workshops

Participants, Consultants, Residents & Alumni

Sponsors

Department of Surgery Ofcers 160

Consultant Staff 161

Resident Staff 162


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The rst UP-PGH Department of Surgery Postgraduate course

dates back in 1969 when Dr. Alfredo T. Ramirez, then the executive

ofcer of the depar tment initiated short intensive postgraduate

courses in surgery. Since then it became a regular educational

postgraduate activity of the department. In the last fteen years,

the UP-PGH postgraduate course was titled Mastery in Surgery to

highlight exceptional surgical issues as topic content with resourcespeakers who are experts in their own elds as key component

of this event.Yearly, the scientic program varies in its content

and strategy depending upon its theme.When the Foundation for

the Advancement of Surgical Education, Inc. (FASE) was formed

in 2003, through the initiative of Dr. Jose C. Gonzales, then the

Chair of the Department of Surgery, UP-PGH and Dr. Eduardo R.

Gatchalian, the rst FASE President, it regularly helped sponsor this

activity to realize the departments commitment in helping surgical

practitioners nationwide in advancing their knowledge and expertisein the comprehensive management of the different surgical disorders.

Mastery in Surgery 2014 theme isInnovations and Advances

in Surgery. Proceeds of this event will be donated to the Foundation

for the Advancement of Surgical Education (FASE), which will

then help fund the indigent surgical patients of the Department

of Surgery, UP-PGH; training of surgical residents to help them

achieve the highest quality of surgical training responsive to the

needs of the Filipino people; and assistance in the professionaldevelopment programs for the consultant staff of the department.

FOREWORD


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Message from the

Chancellor

I extend my warm greetings and congratulations to the

members of the Foundation for the Advancement of Surgical

Education (FASE), Inc, and the College of Medicine-Philippine

General Hospital Department of Surgery, UP Manila, on the

conduct of the 50th Postgraduate Course, Mastery in Surgery

2014, with the theme Innovations and Advances in Surgery.

Surgery is one of the broadest and most chal-

lenging health disciplines in patient care. With the ev-er-expanding range of diseases that are treated surgi-

cally and the development of new therapies, surgeons

are expected to learn more in a limited period of time.

Today, surgical education is characterized by rapid

and vibrant changes in knowledge, understanding of surgi-

cal diseases, and new procedures and technologies. In ad-

dition, demand for greater accountability and patient safety,

including institutions where training occurs and heightened

requirements for oversight in training programs, is increas-

ing. Novel educational and training paradigms are necessary

to meet the challenges of the 21st century and ensure the

production of professional, competent, and skillful surgeons.

Through the years, this course has proven to be a

good venue for the discussion and tackling of different themes

related to surgery by doctors from different institutions and

settings nationwide. It gathers the biggest number of sur-

geons from different specialties and in such an environment,

enrichment of learning that is essential to practice is assured.

On this note, I welcome the participating sur-

geons from the provinces in the Philippines and I com-

mend you for never missing the opportunity to share and

learn new insights and experiences through this course.

MANUEL B. AGULTO, MD

Professor and Chancellor

University of the Philippines Manila


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Message from the

Director

To my most beloved department in the Philippine

General Hospital, my sincere congratulations on its 50th

postgraduate course. The theme Innovations and Advances

in Surgery embodies the challenges the department will face

in the 21st century, shaping our commitment to being the

premiere surgical training institution in the country. As I look

back on the history of the Department of Surgery and reect

on its years of struggle and evolution, I cannot help but feel

a profound sense of pride at the distinction we have earned

as the maven and trendsetter for all surgical specialties.

This annual postgraduate course is a testament to

our enduring commitment to continuing surgical education,

training and research. We have set the pace and trend for

other institutions and remain to be the benchmark of excel-

lence. The department is blessed with a multitude of tal-

ent, skill and intellect. The departments capability to har-

ness this diversity and direct it all towards common shared

goals is its strength and the foundation on which it stands.

I am one with you in your aspirations and struggles,

as well as in your failures--however few they may be -- andtriumphs. The PGH remains steadfast in its support of your

goals and ambitions. Together we can accomplish much.

Mabuhay!

JOSE C. GONZALES, MD

Director

Philippine General Hospital


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Message from the

President

Greetings to all participants of the 50th Post-

graduate Course of the Department of Surgery in co-

operation with the Foundation for the Advancement

of Surgical Education (FASE), Inc. The postgraduate

course, being the 50th, we felt it very appropriate to pre-

sent to you Innovations and Advances in Surgery.

We have lined up an array of topics from:

our roles and liabilities as Trainers in Surgery, up-

date on the management of different surgical condi-

tions and advances in minimally invasive surgery.

We have also lined up didactics on the different

specialties. As in the past, we will have our Meet the Pro-

fessor dinners and we continue to offer our short courses.

I hope you nd our 50th Postgraduate Course: Mas-

tery in Surgery 2014 as interesting as our previous courses.

TELESFORO GANA JR., MD

President

Foundation for the Advancement of

Surgical Educaiton Inc.


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Message from the Chair

The Department of Surgery, UP-PGH is pre-

senting its 50th Postgraduate Course: Mastery in Sur-

gery 2014, Innovations and Advances in Surgery.

For 49 postgraduate courses, the UP-PGH Surgery

Department has been a partner with you, our partici-

pants, in your continuing professional development to-

wards lifelong learning in the art and science of Surgery.

For this 50th postgraduate course, the postgradu-

ate course committee has come up with another excel-lent course on whats new and innovative especially with

the tremendous developments in minimal access surgery.

Aside from the lectures, we are again offering

Meet the Professor dinners where you will have sessions

with selected consultants where you can share your prob-

lematic cases with them and discuss treatment options.

We are also offering 4 workshops where you will learn

skills and management options of particular surgical conditions.

We know that all of us will learn a lot from this

50th offering of our postgraduate course and we hope tosee all of you again for the next 50 postgraduate courses.

WILMA A. BALTAZAR, MDProfessor and Chair

Department of Surgery - UPCM

UP-Philippine General Hospital


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Message from the

Post-Graduate Chair

In behalf of the Foundation for the Advancement

of Surgical Education, Inc. and the UP-PGH Department

of Surgery through the Post-Graduate Courses Commit-

tee, may I welcome you to our 50th Postgraduate Course,

Mastery in Surgery 2014 with the theme Innovations and

Advances in Surgery on September 3-5, 2014 at the Dia-

mond Hotel Manila. We are privileged to present to you a

scientic program that involves the eleven divisions of the

Department of Surgery, UP-PGH. Expect extensive discus-

sions on theme-aligned issues in General Surgery as wellas Subspecialty Surgery. This will also include special ses-

sions by the Residency Training Committee (Session 1)

and the Research Committee (Session 13) of the Depart-

ment. You are also encouraged to participate in the four

simultaneous Meet the Professor Dinners for the chance

to have a close and informal small group discussion with

four General Surgery Professors. Four simultaneous short

courses on the third day will again be offered to participants

who are interested to have an additional course on any

of the topics designed to help them advance their knowl-

edge and skills needed in their day-to-day patient care. We

also enjoin you to attend the Fellowship Night for a night

of fun, food, drinks and games to commemorate the mem-ories of the fty postgraduate courses of the department.

Again, we hope that this years theme will be of great

help in your quest for mastery in the eld of surgery that is essen-

tial in the improvement of the overall management outcome.

May I thank all the members of the Postgraduate Courses

Committee for their sincere dedication and help in coming

up with this endeavor and most especially to our Depart-

ment Chair, Dr. Wilma A. Baltazar, Dr. Jose Macario V. Fay-

lona, Dr. Mark Richard C. Kho and the rest of the consultant

staff for facilitating the attainment of major logistical support.

ORLINO C. BISQUERA, JR., MD, FPSGS, FPCSChairman Postgraduate Courses Committee

Department of Surgery

Philippine General Hospital

Clinical Associate Professor

UP College of Medicine


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Scientic Session

Abstracts


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HEMANGIOMAS AND

LYMPHANGIOMAS

IN CHILDRENMA. CELINE ISOBEL A. VILLEGAS, MD


Division of Pediatric Surgery

Department of Surgery, UP-PGH

Early diagnosis of a childs lesion is critical be-cause it will lead to proper management. These le-

sions were collectively known as hemangiomas, birth-

marks, portwine stains, etc. In the 1980s and 1990s,

these lesions were classied into two general sub-

types: hemangiomas and vascular malformations.

The main difference between the two sub-

types was the natural history of the condition. He-

mangiomas have a natural regression history while

vascular malformations are permanent structures.

Hemangiomas are further subdivided into infantile

hemangiomas, congenital hemangiomas and deeper he-mangiomas. Newer classications have been added since

the 1990s. Because of the natural regression history, it is

important for parents to understand that time will decrease

the size of the lesions. Presently, drugs like steroids and

propanolol are used to hasten the hemangiomas regression.

Vascular malformations are slow-ow mal-

formations or fast-ow lesions. Slow-ow lesions in-

clude capillary, lymphatic and venous malforma-

tions. However, these types of malformations can

be a combination of lymphatic and venous tissues.

Fast-ow vascular malformations in children in-

clude aneurysms, arteriovenous stulas and arteriorvenous

malformations. Obviously, these fast-ow lesions have an

element of arterial supply. These lesions are more for the

realm of vascular surgeons and interventional radiologists.

The most helpful diagnostic stud-

ies for hemangiomas and lymphangiomas in-clude ultrasound in its different guises and MRI

Like a lot of difcult congenital conditions in the

pediatric age group, the multidisciplinary approach to treat-

ment must not be ignored. Together with other specialists

pediatric surgeons are usually involved in the diagnosis and

treatment of slow-ow vascular malformations. Depend

ing on what type of lesion is present in the child, surgery

and/or sclerosants, embolization and lasers can be used


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UPDATES AND

CURRENT

PRINCIPLES IN THE

MANAGEMENT OF

COLORECTAL

CANCERMANUEL FRANCISCO T. ROXAS, MD


Division of Colorectal Surgery

Department of Surgery UP-PGH

The management of cancer in the colon and ano-

rectum has evolved with the advent of improved technology

resulting in better diagnostic imaging and use of advances in

equipment and knowledge to treat cancer. These include but

are not limited to: the multidisciplinary team (MDT) confer-

ence, neoadjuvant treatment, utilization of endoscopic treat-

ment, aggressive treatment of curative Stage IV disease andenhanced recovery after surgery (ERAS).

The progress of the Multidisciplinary Team confer-

ence arose from the need to have all members of the medi-

cal team involved in the management of the patient to sit

down together to discuss and develop a treatment plan tai-

lored to a particular patient in accordance to his/her clinical

condition and stage of disease.

The use of Neoadjuvant Treatment, particularly the

combination of radiotherapy and chemotherapy for middle

and lower rectal cancer has resulted in improved survival

and lower recurrence rates. This is secondary to the up-graded quality of diagnostic imaging modalities such as the

magnetic resonance imaging, computed tomography, endo-

rectal ultrasound and colonoscopy to better stage the dis-

ease.

The use of Endoscopy and Minimally Invasive Tech

niques have revolutionized surgical procedures in the colon

and rectum. The advantage of using small incisions with the

capability of performing oncologic resections has resulted in

better patient tolerance for surgical procedures.

Curative Stage IV colon and rectal cancer patients have

more options available to them. The combination of multivisceral resections, chemotherapy and/or radiotherapy has

improved disease free survival for these set of patients.

Enhanced Recovery After Surgery is set to revo-

lutionize how a patient is managed peri-operatively. The

changes include Pre-operatively: uid and carbohydrate

loading, no prolonged fasting, no or selective bowel prepa-

ration, and use of antibiotic and thrombo-prophylaxis. Intra

operatively: use of short acting anesthetic agents and mid-

thoracic epidural anesthesia, no routine placement of drains

and maintenance of normothermia. Post-operatively: no na

sogastric tubes, early removal of foley catheter, early insti-

tution of oral nutrition, early mobilization, use of non-opioidoral analgesia or NSAIDs and stimulation of gut motility are

encouraged.


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INNOVATIONS IN THE

MANAGEMENT OFHEMORRHOIDS AND

ANAL FISTULAARMAND C. CRISOSTOMO, MD




HEMORRHOIDS

The following are the modalities to manage hemorrhoids

Type of

Procedure

Indication Success Recurrence Complica-

tions

Rubber

Band Liga-

tion

Grade I, II,

III internal

hemorrhoids

65-85% 68% at 4 to

5 years

Pain,

bleeding

thrombosis,

perineal

sepsis

Dopplerguided

hemorrhoi-

dal artery

ligation

Grade II andIII internal

hemorrhoids

90% 10%

Stapled

hemorrhoi-

dopexy

Grade II,

III and IV

internal

hemorrhoids

same as

convention-

al excisional

hemorrhoid-

ectomy

Long term

recurrence

and pro-

lapse

Rectal

perforation,

retroperito-

neal sepsis,

anovaginal

stula and

bleeding

ANAL FISTULA

The main goals of treatment are cure of the disease, preven

tion of recurrence and maintain anal function.

Below are the options in the management of complex ana

stula, except for stulotomy for simple anal stulas.

Type of Proce-

dure

Success/Heal-

ing

Recurrence Incontinence

Seton Insertion 16% 17%Advancement

Flap

70% none

Fibrin Glue 60-70% 11%

Fibrin Plug 15-80% 13%

Ligation of

Intersphincteric

Fistula Tract

56-90% Usually inter-

sphincteric

stula


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ROLE OF MINIMALLY

INVASIVE SURGERY

IN COLORECTAL

SURGERYHEMOGENES J. MONROY, III, MD




The benets of minimally invasive surgery includes

reduced pain after surgery, accelerates post-operative re-

turn of bowel function and mobility, shorten hospital stay,

reduced formation of adhesions and decreased incidence of

incisional hernias.

The use of laparoscopic and robotic surgery has

extended its utility not only to benign conditions but also to

oncologic resections with equivalent results as with con-

ventional open surgery. The challenge in laparoscopic and

robotic surgery in colorectal surgery is working in several

quadrants of the abdomen. The indications for the use of

minimally invasive surgery in colorectal surgery includes di-agnostic laparoscopy to stage and create stomas, for diver-

ticular disease, for colon and rectal cancer.

The use of minimally invasive surgery for colorec-

tal surgery should follow the traditional surgery principles

and standards. For colon and rectal cancer surgeries, there

should be complete exploration of the abdomen, adequate

proximal and distal margins, ligation of the major vessels at

its respective origin.

HYPERTHERMIC

INTRAPERITONEAL

CHEMOTHERAPYMARC PAUL J. LOPEZ, MD




Hyperthermic Intraperitoneal Chemotherapy includes cytoreductive surgery to remove visible tumors intra-

peritoneally, followed by infusion of a highly concentrated

heated chemotherapy delivered directly in the abdomen dur

ing surgery. Heating the solution improves the absorption o

the chemotherapy drugs and destroys microscopic cancer

cells remaining in the abdomen after tumor debulking.

HIPEC is a treatment option for people who have

advanced surface spread of cancer within the abdomen

without disease involvement outside of the abdomen.

Advantages of this procedure includes:

1. Allows for high doses of chemotherapy

2. Enhances and concentrates chemotherapy

within the abdomen

3. Minimizes the rest of the bodys exposure to

the chemotherapy

4. Improves chemotherapy absorption and

susceptibility of cancer cells

5. Reduces some chemotherapy side effects


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EPIDEMIOLOGY,

ANATOMY, ANDPATHOPHYSIOLOGY

OF CAUSTIC INJURY

ORLINO C. BISQUERA, JR., MD, FPCS

SHIELA S. MACALINDONG, MD, DPBS

Caustic injuries are tissue injuries caused by chemi-

cal reactions resulting from ingestion of caustic agents. It is

a public concern since caustic agents are widely available

as household and industrial cleaning products and that its

ingestion may result in signicant morbidity and mortality. In

the US, 5-15,000 caustic ingestions occur per year with bi-

modal age distribution. Ingestions occurring in the 1-5 years

age group are frequently accidental while those occurring in

the 21 years age group are commonly intentional in nature.

The true prevalence in the developing countries is difcult

to estimate due to under-reporting. In the Philippine Gen-eral Hospital from 2008-2012, there were 195 adult cases of

caustic ingestion with mean age of 37. It is more common

in males (60%) than females (40%) and were intentional in-

gestions in 87% of the time with major depressive disorder

as the most common psychiatric disorder. Half of the cases

were due to acid (muriatic) and only about 35 % from al-

kali (liquid sosa) ingestion. Majority (75%) of the cases were

treated conservatively and surgical intervention were done

in the remaining cases with esophago-gastrectomy as the

most common procedure done. Operative mortality rate was

23% and an overall mortality rate of 7.2%.

The ingestion of caustic substances may result to awide spectrum of injuries from mild with no acute or chronic

sequela to severe and potentially fatal. In the acute setting,

caustic injuries are true surgical emergencies in the setting

of bleeding, necrosis, and/or perforation. The systemic con-

sequences in the acute setting are formidable, with patients

prone to uid and metabolic disturbances, acidosis, sepsis,

coagulopathy, hemolysis, respiratory distress, and hepatic

and renal failure. In the long-term, patients face the chal

lenge of gastrointestinal reconstruction, stricture, and the

attendant nutritional, metabolic, functional, psychologica

and overall quality of life issues.

The best management of caustic injuries is preven

tion. Strategies to avoid these injuries altogether include

preventative packaging and labeling, restrictions on potency

and availability, and injury prevention programs.

Caustic substances are generally classied as acids

(pH 7). Bleaches are also considered

caustic substances although pH is typically neutral in com

mercial preparations. The extent of caustic injuries are de

termined by several factors including the identity or nature

of the agent which is largely dened by its pH, volume in-

gested, concentration, physical state, duration of exposure

and to some extent, the gastric status.

The substances that pose the greatest concern are

acids with pH 12. Sulfuric and hydro-

chloric acids are acids commonly found in toilet and swim-

ming pool cleaners, rust removers, and battery uids. Lye isa general term that refers to bases, usually sodium or potas-

sium hydroxide, used as household cleaning products.

Acids cause coagulation necrosis which leads to

formation of coagulum or eschar in the supercial layers

Alkalis, on the other hand, lead to liquefactive necrosis with


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saponication of facts, dissolution of proteins, and emulsi-

cation of cell membranes. Due to these differences in patho-

physiology, it is generally held that acids produce injuries

with limited depth whereas alkalis produce deeper injuries.However, while this may be true for mild acids and bases,

strong bases and acids may also lead to deep tissue injuries.

With acids, the formation of eschar leads to hypoperfusion

of surrounding tissues thereby predisposing to ischemia.

Alkalis cause thrombosis of adjacent vessels leading to

necrosis. Extent of injury with acids is usually determined

within 48 hours. Acids generally cause more injuries in the

stomach than the esophagus while the reverse is true for

bases. With acids, the formation of supercial coagulum in

the esophagus and the partial neutralization by the alkaline

pH of the esophagus limit the injury to the esophagus. Acids

induce pylorospasm causing pooling in the stomach leading

to greater injury. The increased viscosity of bases increasescontact time with the esophagus causing more injury. Acids

are noxious, have poor taste, and tend to evoke protective

responses hence limiting the volume ingested. However,

they predispose to aspiration leading to more respiratory

complications. Alkalis are tasteless and odorless and do not

tend to evoke protective responses causing greater volume

to be ingested. Acids, having more systemic absorption,

have greater systemic complications including metabolic ac-

idosis, hemolysis, disseminated intravascular coagulation,

liver failure and renal failure. Hydrouoric acid in particular

causes profound hypocalcemia and hypomagnesemia.

The physical form of the caustic substance, whethersolid or liquid, determines the pattern and distribution of in-

jury to GI tract. Solids are more difcult to swallow and tend

to adhere to mucosa. Hence, injuries are found more proxi-

mally (mouth, pharynx, and upper esophagus) and tend to

be focal and deep. Liquids tend to travel more distally hence

causing more injuries to the esophagus and stomach. Inju-

ries from liquids are usually circumferential and diffuse.

Concentration of acids and bases are directly pro-

portional to extent of injury. In rat esophagus model, ex-

posure to sodium hydroxide at 1.83% concentration causes

epithelial necrosis alone whereas concentration of 14.33%

leads to full thickness injury.

Similarly, the greater the quantity ingested, the

greater the injury. Several factors inuence the quantity in-

gested. Intentional ingestions, acids, and liquid substances

correlate with greater volume ingested.

Longer duration of exposure to the caustic sub

stance likewise increases injury risk. Rapid transit of acid

through esophagus due coagulum contribute to limited es

ophageal injury. The esophagus has increased exposure toalkali due to repeated episodes of regurgitation. Acids in-

duce pylorospasm causing delayed emptying of acids from

the stomach, thereby increasing gastric injury and limiting

damage to the duodenum.

To some extent, the status of the stomach during

ingestion inuences extent of injury because of the buffering

effect of food. With an empty stomach, the gastric mucosa

along the lesser curvature and antrum are most at risk. With

a full stomach, gastric injury tends to be diffuse.

Burns of the GI tract due to caustic ingestion are

dened by degrees according to depth of injury. 1st degreeburns involve the mucosa only whereas 2nd degree burns

extend to the muscularis layer. 1st degree burns heal com-

pletely without stricture whereas 2nd degree burns have risk

for stricture formation. 3rd degree burns are full thickness

injuries with or without perforation. They are at highest risk

for perforation and stricture formation. Extent of injury is as

sessed endoscopically using Zargars endoscopic grading.

Degree of esophageal injury at endoscopy is an accurate

predictor of systemic complications and death with each

increased injury grade correlated with a 9-fold increase in

morbidity and mortality. 30% of grade 2 and 80% of grade 3

injuries will develop strictures.

Oropharyngeal injury is not a reliable indicator of es

ophageal involvement as 70% of those with oropharyngea

burns have no esophageal burns and 10-30% of those with

esophageal burns have no oropharyngeal burns. Extensive

esophageal damage is usually coupled with laryngeal injury

and upper airway edema. Supraglottic or epiglottic burns are

harbingers of airway obstruction.

Caustic substances induce acid-base reactions tha

cause injury by disruption of organic macromolecules, heat

generation, and further production of toxic chemicals such

as oxygen radicals, suldes, nitric/nitrous oxide, chlorine

and others. There are 3 phases of caustic injury. In the ini-

tial phase, lasting 1-4 days, acute necrosis occurs with eo-

sinophilic necrosis, hemorrhagic congestion, lipid peroxida

tion, and vascular thrombosis. At 4-7 days, granulation and

ulceration occurs. This phase is characterized by mucosa

sloughing, bacterial invasion, formation of granulation tis-


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sues, and appearance of broblasts with brin formation. If

ulceration exceeds the muscle plane, perforation is likely to

occur. The last phase is characterized by cicatrization and

scarring. At 2 weeks, collagen deposition begins and at 1

month, ulcers start to epithelialize. Scar retraction begins as

early as 3 weeks and may last up to 6 months. 6-12 weeks

is the average time for full brosis to be achieved. Tissue

tensile strength is low during the rst 3 weeks and perfora-

tion can occur at any time during the rst 2 weeks. Hence,

endoscopy is avoided 5-15 days after injury. Strictures may

occur as early as 3 weeks or as late as 1 year. Majority

(80%) occur within 8 weeks. The resultant lower esophageal

sphincter pressure impairment and shortening of involved

esophagus increase gastroesophageal reux that further

contributes to stricture formation.

The anatomic areas of GI tract narrowing are mostat risk for acute and chronic injuries from caustic ingestion

due to delayed transit in the area thereby increasing contact

time. In the esophagus, these areas are the cricopharyn-

geus, level of aortic arch and left mainstem bronchus and

the lower esophageal sphincter. In children, injury in the

upper esophagus is more likely due to compression by the

thymus. In the stomach, injury commonly occurs in the py-

loroantral area.

The esophagus is unique from the rest of the GI

tract in that it lacks a serosal layer. It is located in the pos-

terior mediastinum with close anatomic relations to the tra-

chea, the L mainstem bronchus and aorta. Perforation of thethoracic esophagus can cause life-threatening mediastinitis.

The adventitia of the anterior wall of the cervical and up-

per thoracic esophagus is attached to the connective tissue

of the posterior wall of the trachea which is membranous

due to the incomplete tracheal rings at its posterior aspect.

Extensive necrosis of the upper esophagus can involve the

trachea to cause necrosis and tracheoesophageal stula.

The descending aorta is closely related to the posterolateral

aspect of the middle to lower thoracic esophagus. Extensive

necrosis of the esophagus in these areas can cause aortoe-

sophageal stulas. Extreme care must be exercised when

mobilizing the thoracic esophagus during resective proce-

dures for strictures to avoid injuries to the tracheobronchialtree and aorta.

Close proximity of the stomach to other intraab-

dominal organs such as the colon, pancreas, spleen , left

lobe of the liver, left kidney and left adrenal may necessitate

multivisceral resection in the setting of extensive necrosis

with extensions to these organs. With acid ingestions, the

duodenum is protected by pylorospasm and the alkaline pH

However, in 34.6% of acid ingestions, grade I/II duodena

injuries may occur. For injuries that extend beyond the py

lorus, the ampulla of Vater may be involved hence concern

for drainage of the common bile duct and pancreatic duct.

The systemic complications of caustic injury are brought

about by complex interplay of interrelated pathways asso-

ciated with inammation. Central to the pathophysiology

of systemic complications in caustic injury is the systemic

inammatory response (SIRS) which can lead to multiple

organ dysfunction syndrome (MODS), and ultimately multi-

organ failure (MOF) in severe cases even in the absence

of infection. With inammation comes the activation of in-

ammatory cells, cytokine release, generation of free radi-

cals, and changes in vascular permeability and tone. Fluid

sequestration with third-spacing in addition to GI losses (e.gvomiting), bleeding, and inability to take uids orally predis-

pose patient to hypovolemia and shock. Tissue ischemia

and necrosis lead to decrease in serum bicarbonate and in-

crease in lactate causing metabolic acidosis. Presence of

shock also contributes to acidosis. Ischemic and necrotic

tissues can promote bacterial translocation and overgrowth

which can lead to sepsis. Respiratory complications can

arise in the setting of direct injury, aspiration, or pulmonary

edema from third spacing. Systemic absorption particularly

with acids can lead to coagulopathy, hemolysis, acidosis

and renal and liver failure.

Long-term complications are formidable and in-clude strictures, gastroesophageal reux, stulas (tracheoe-

sophageal, gastrocolic), and cancer. Recurrent pulmonary

infections should raise suspicion of tracheoesophageal s-

tula. Risk of cancer, commonly esophageal squamous cel

carcinoma, is increased by 1000-3000 times relative to the

general population. The long latency period (10-25 years)

requires surveillance long after the caustic ingestion even

(15-20 years later).


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ACUTE CARE:

ASSESSMENT,DIAGNOSTIC TESTS

AND RESUSCITATIONGEMMA LEONORA B. UY, MD, FPCS

CLINICAL PRESENTATION

Patient who ingest caustic substances have a di-

verse range of clinical presentations. The initial symptoms

upon presentation are not directly correlated to the degree of

injury. Patients may present with pain in the oropharyngeal,

retrosternal and epigastric areas. They may also complain

of dysphagia, odynophagia, drooling, excessive salivation,

vomiting and hematemesis. Severe retrosternal or back pain

may signal mediastinitis or esophageal perforation. There

may also be direct and rebound tenderness on abdominal

examination. Hoarseness, wheezing and shortness of breath

may occur with injury to the larynx and epiglottis. Fever and

hemodynamic instability indicate extensive injury. Morbidityand mortality are proportional to the degree of injury.

INITIAL MANAGEMENT

Upon consult at the ER for caustic ingestion, a thor-

ough evaluation is done. PGH has a unique set-up for the

multidisciplinary management of caustic ingestion and the

team is activated at the ER comprising of the Department

of Surgery, Section of Gastroenterology for endoscopy, De-

partment of Psychiatry for non-accidental cases and the Na-

tional Poison Management and Control Center. The patient

is kept on NPO, and an intravenous line is inserted for uid

resuscitation. Acute care for caustic ingestion is similar to

management of other injuries. Patients with oropharyngeal

injury must be carefully assessed for airway obstruction; la-

ryngoscopy must be done to check for swelling of the larynx

and epiglottis. If these are present, it is recommended to

maintain the airway with a tracheostomy rather than by en-

dotracheal intubation. It is noteworthy, however, that the absence of pain does not preclude signicant gastrointestina

damage.

For stable patients not in surgical abdomen, a ches

X-Ray upright is done to evaluate for pneumomediastinum

and pneumoperitoneum, indicating esophageal or gastric

perforation. To conrm equivocal ndings, an esophago-

gastric or upper GI series with water soluble contrast may

be carefully attempted. Arterial blood gas analysis is done

and if metabolic acidosis is present and surgery is indicated

patient is given aggressive resuscitation, however, it is not

necessary to wait for the acidosis to be fully corrected since

this can be corrected only by removal of all necrotic tissues

In general, there is no need for oral dilution of the

ingested acid or base. Neutralization of pH with acid or al-

kaline lavage must not be attempted as this may cause exo-

thermic reaction, and may cause further thermal injury. Blind

NGT insertion is also contraindicated.

ENDOSCOPY

Endoscopy is the gold standard for assessing depth

and extent of injury, and determining appropriate therapeu-

tic action. There are reports suggesting that asymptomatic

patients who have ingested low potency substances do no

require endoscopy. However, most adult patients who inges

caustic material with suicidal intentions usually take very

potent substances, and therefore, emergent endoscopy is

recommended for all patients. Upper GI endoscopy must be

performed within 24 hours of ingestion of caustic substance


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EGD must be avoided during days 5-15 post ingestion due

to wound softening due to absence of collagen. Endoscopy

is contraindicated in the following conditions: hemodynami-

cally unstable patients, patients with suspicion of perfora-

tion, patients in severe respiratory distress, and patients withsevere pharyngolaryngeal edema or necrosis.

Zargars grading classication of mucosal injury

caused by ingestion of caustic substances

GRADE FEATURES

0 Normal

1 Supercial mucosal edema and ery-

thema

2 Mucosal and submucosal ulcerations

2A Supercial ulcerations, erosions andexudates

2B Deep discreet or circumferential ulcera-

tions

3 Transmural ulcerations with necrosis

3A Focal necrosis

3B Extensive necrosis

4 Perforation

Minimal mucosal damage is associated with minimal

morbidity and mortality with low risk for developing strictures.

Injuries exceeding grade 2A are at higher risk of developing

serious complications. Grades 2B and 3 may warrant care-

ful observation, ideally in an ICU, and nutritional support. If

they remain stable with resolution of abdominal pain, feed-

ing may be gradually progressed starting with water intake

if they are able to swallow saliva after 48 hrs of ingestion.

Patients with clinical or radiologic evidence of perforation re-

quire immediate laparotomy.

SURGICAL

APPROACHES IN THE

MANAGEMENT OF

CAUSTIC INJURIESNELSON D. CABALUNA, MD, FPCS

Surgical management of caustic injury is affectedprimarily by the severity and extent of injuries. However

the corrosive properties of the ingested substance and its

amount and concentration as well as the duration of contac

in the gastrointestinal tract are all predictors of surgical out

come.

The main principle in the surgical management aims

to do an adequate resection or debridement thereby remov-

ing ALL necrotic tissue and preserving all viable tissues. A

comprehensive abdominal exploration is mandatory if signs

and symptoms of perforation and ongoing tissue necrosis

are evident. In patient with severe post corrosive injury o

with grade IIIB on endoscopy, prompt surgical interventionin patients have shown to decrease morbidity and mortality

Extent of surgical resection is based on the extent of injury

Extensive debridement of necrotic tissue is required in pa-

tients with multiple and complex perforations.

A study conducted in UP-PGH from 2009-2013

which included 195 cases of caustic injury showed a major

ity of non-surgical cases and only 28.7% were managed sur-

gically. Common surgical options in the acute setting include

the following 1) Exploration, Esophagogastrectomy with cer

vical esophagostomy, 2) Exploration, Esophagogastroduo

denojejunectomy with tube pancreatostomy, 3) Exploration

gastrectomy with abdominal esophagostomy. Placement oa tube jejunostomy after extensive surgery to initiate early

enteral feeding is recommended. Drain placement such as

bilateral tube thoracostomy in the chest and Jackson pratt

drain in the abdomen are routine and recommended.

The potential catastrophic presentation and lifelong


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complications following caustic ingestion remains to be asocioeconomic burden and a challenging encounter in the

surgical practice. Moreover, prevention plays a role in ad-

dressing this problem by means of preventive strategies and

early recognition of psychosocial distress since most of the

cases we have encountered are non-accidental

SURGICAL

MANAGEMENT OF

CHRONIC SEQUELAE

OF CAUSTIC

INJURIESRODNEY B. DOFITAS, MD, FPCS

Chronic sequelae of caustic injuries include es-

ophageal stricture, gastric stricture, esophageal cancer, and

trachea-esophageal stula.

Esophageal strictures are primarily seen in those

with grade 2B or 3 injury, with peak incidence of two months,

and occurs as early as two weeks or as late as years af-

ter ingestion. The management include balloon or bougie

dilatation, or in cases of refractory strictures, stents which

are kept in place for a period of time. Intraluminal steroids

also show some benet in the management of esophageal

strictures. Surgical management includes esophagectomywith reconstruction by colonic interposition graft, and gastric

transposition.

Gastric stricture or gastric outlet obstruction usually

presents with early satiety and weight loss, observed from

5-6 week up to several years after ingestion. Feeding je-

junostomy can be used to improve the patients nutritiona

status and ensure the success of surgery. Distal gastrecto-

my and gastrojejunostomy are usually done for antropyloric

strictures, subtotal gastrectomy or total gastrectomy usually

are done for those with extensive disease.

Caustic injuries usually present with 1000 to 3000-

fold increase in incidence of esophageal cancer with mean

latency of 41 years (13-71 years).

Tracheo-esophageal stula are rare complications

of caustic ingestion. They present around 2 weeks post in-


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jury. Diagnosis through chest CT and contrast studies can

conrm the stula. Timing of surgery ranges from 6 months

to 1 year. Surgical management includes direct repair, clo-

sure of stricture, tracheal resection, and reconstruction, with

a mortality rate of 8.3% for single stage repair. Nonsurgicalmanagement usually carries a poor prognosis.

FOLLOW UP FOR

PATIENT WITH

CAUSTIC INJURYNERESITO T. ESPIRITU, MD, FPCS

Majority of the complications of caustic injury are de

tected late. Diligent and timely follow up is required to ensure

such late appearing sequelae are caught early. The mos

complications include esophageal stricture, gastric outle

obstruction, esophageal neoplasm and tracheoesophageastula.

Timely evaluation and dilatation of strictures play a

central role in achieving good outcome. Late managemen

is usually associated with marked brosis rendering the pro

cedure difcult. Delayed intervention has been proven to be

strong predictor of future esophageal replacement.

The risk of developing carcinoma in a strictured es

ophagus is 100-1000x higher than the general population

and is usually seem at the location of the stricture. Hence,

long term annual follow up is recommended. For patients

who have developed long term sequelae of caustic injuryswallowing and speech rehabilitation are paramount strate-

gies to alleviate debilitating effects of caustic injury.

Each patient must be evaluated individually. And

although the late sequelae of caustic injury follow a predict

able pattern, clinical picture varies widely. Both acute and

chronic phases of caustic injury require different approach-

es. Finally, great attention should be given even to low grade

injuries because of the potential devastating complications.


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TRAUMA SESSION:

LOOKING BACK,

MOVING FORWARDERIC TALENS, MD


Division of TraumaDepartment of Surgery UP-PGH

The Division of Trauma of the UP-PGH, since its

establishment in September 1989, as the rst Trauma Unit

dedicated to the care of the injured patients in the country

has had a rich track record of leadership in innovations and

local adaptations of various approaches in Trauma Care

From specic management of injuries to the neck, chest

and abdomen, to innovative perspectives and exploratory

approaches in resuscitation, to endeavours in promotingvarious advocacies in injury prevention and trauma care

the session discussants will describe and look back on the

signicant innovations of the Division, as well as move for-

ward to expound on current novel issues.

SHORT BOWEL

SYNDROME:HOPELESS NO MORESIEGFREDO R. PALOYO, MD


Division of Transplant Surgery


In recent years, we have witnessed increasing clini-

cal experience with intestinal transplantation with concomi-tant improved results. Several important advances have led

to improved outcomes which include newer immunosuppres-

sive drugs, improved technical skills and perioperative care.

As a result, the rate of patient survival at 1 year now exceeds

90% at experienced centers. Although long-term follow-up

data are still lacking, the role of intestinal transplantation in

the treatment of patients with gut failure is becoming clearer.

This presentation will touch on the essential principles and

concepts, indications as well as common complications of

intestinal transplantation and will be highlighted by discuss-

ing the rst case of isolated intestinal transplantation in the

Philippines.


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thrives in Western countries in which religious beliefs may

play secondary roles.

LEGISLATION AND ORGAN TRANSPLANTATION

Taiwan is an example among Asian countries in

which legislation has played a signicant part in the matura-

tion of transplantation. The rst successful deceased donor

liver transplant in Asia, performed by Chao-Long Chen in

1984, stirred discussions about what consti- tutes a deni-

tion of death.5 The debate eventually ended with the rst

organ transplant law in Asia with a denition of brain death

in 1987.6 Legislation and education play important roles

in promoting and safe- guarding organ donation. There are

only a few countries in Asia in which laws pertaining to or-

gan donation are in effect (Table 1).

However, legislation may not be the obligatory an-

swer. In a survey of ethical issues of organ transplan- ta-

tion in Taiwan and mainland China, Shih and col- leagues7

identied 7 major ethical dilemmas, including difculties in

touching the heart of the public, challenges in helping do-

nors and their families, the compe- tence and availability of

health professionals, question- able social farewell or death

for deceased donors, recipients, and their families, the ques-

tionable legiti- macy of prisoners motivations with death

penalties, worry about public discrimination, and challenges

to families taking care of the recipients. Understanding these

dilemmas and working through the networks of legal and so-

cial procedures will make the public appre- ciate the value oforgan donation. In Korea, sociocul- tural barriers attributed

to Confucianism, clarity con- cerning the denition of brain

death, and myths about selling spare organs contribute to

low deceased donor organ donation rates. These barriers

are compounded by bureaucratic problems due to policy

changes con- cerning organ procurement and insurance

coverage.8 The same problem is also true in most regions

of East Asia. In China, Malaysia, and Vietnam, sociolegal

factors have a greater impact on organ donation. The Vice

Minister of Health of China reiterated this concern when

he admitted that shortcomings in legislation, dis- parities in

technical competency, a lack of a well-orga- nized adminis-

trative system, and cost had resulted in rampant disenfran-chisement of would-be recipients and donors.9 Malaysias

development of organ transplantation is hampered by its

conservative outlook, cul- ture and value system, historical

background and religious convictions, and lack of legisla-

tion.10,11 The Health Ministry of Vietnam has acknowledged

the need for a separate organ transplant law, and its parlia

ment is debating the core issues.

Poverty is number 1 among the reasons for selling

organs in the Philippines and Pakistan. The concept of altru

ism is challenged in the Philippines, as a recent study showed

that 25% of the surveyed population accepted the idea of

compensated donation, and giving compensation does not

ultimately equate with commer- cialization.12,13 As early as

1988, Iran adopted a compensated living unrelated donor

transplantation program, mainly for kidney transplants. In

this program, many ethical problems that were associated

with paid kidney donation were prevented. Currently, Iran is

the only country with no renal transplant waiting lists, and

more than 50% of patients with end-stage renal disease

have functioning grafts.4 However, even developed coun-

tries have their problems. In Japan, there is still a culturaconict due to a lack of understanding and acceptance o

organ donation for transplantation on account of health pro-

fessionals lack of specic education and low condence in

donation-related tasks and disbelief in the concept of brain

death.14,15 In the 10 years since legislation on brain death

and organ donation was passed in Japan, fewer than 60

deceased do- nor organs have been used.

We take, for example, the growing need for live

transplantation. Rates of living donor liver transplantation

have increased exponentially, whereas rates of deceased

donor liver transplantation have remained low1,16 except in

China in the last 2 years with the promulgation of new Chinese organ transplantation laws in 2007. Recent reports of

donor deaths have drawn heavy criticism about sacricing

healthy donors in an attempt to save acutely ill patients. This

is the reason that donor safety should remain the highes

priority in any living donor liver transplantation procedure

The Vancouver Forum was specically held to present de-

nitive and timely statements regarding the responsibility o

the transplant community to the live organ donor.

ETHICS OF LIVE DONOR ORGAN DONATION

The ethical principles governing live donor organ

donation rest on 2 major issues: the autonomy of the deci-sion to donate based on informed consent and the safety

of the operation. There should be no coercion of the dono

in any form. The ethical dimension of equi- poise mandates

that with risk-benet analysis, the risk to the donor must

balance the benet to the recipient, the urgency of the re-


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CRITICAL CARE OF

LIVER TRANSPLANTPATIENTS

ALLAN M. CONCEJERO, MD


Division Thoracic and Cardiovascular Surgery


Liver transplantation (LT) is not just a medical is-sue but a social interest as well. The number of manpower

hours lost due to frequent hospitalizations, infections, and

disease progression by a working class patient who needs

liver transplant translates to millions of dollars. It is also not

just a private matter between physician and patient but be-

comes a social responsibility because of the involvement

of a third party-the donor. Whether the liver allograft comes

from a deceased or living donor, the state or society has the

responsibility of promoting as well as protecting the source

because it is for the common good.

The rst successful LT with extended survival in

Asia was performed in an adolescent with Wilsons diseasecomplicated by end-stage liver cirrhosis in 1984. The longest

Asian survivor, also with Wilsonian cirrhosis, has now been

living for 25 years. Initially, living donor liver transplantation

(LDLT) was performed only in pediatric recipients using a

left lateral segment graft. With experience, the indications

for LDLT have been extended to adults where a right lobe

graft is mainly used due to volume requirement.

Hepatitis virus-related liver cirrhosis with or without

hepatocellular carcinoma (HCC) is now the most common

indication for adult LT. Protocols in preventing posttransplant

hepatitis B virus (HBV) recurrence by using pretransplant

lamivudine and/ or adefovir or entecavir, preventing de novoHBV posttransplant when using HBV core antibody positive

donors by lamivudine and immunization, and preventing

hepatitis C virus recurrence by using pegalyted interferon

and ribavirin are widely used. The Australasian Liver Trans-

plant Study has shown the efcacy of low-dose hepatitis B

immumnoglobulin in preventing HBV re-infection posttrans-

plant thus decreasing total cost in the management of these

patients.

LT now offers the best chance for cure for selected

patients with unresectable HCC. But not all patients with un-

resectable HCC are suitable to be transplanted. Improved

outcome of LT for HCC greatly depends on recipient selec-

tion and accurate tumor staging. Both rely heavily on diag-

nostic imaging. The role of adjuvant and neoadjuvant treat

ments needs further evaluation in the overall objective of

disease removal and liver replacement.

Because the Milan criteria have been considered

restrictive criteria whereby transplantation may be deniedto an HCC transplant candidate whose outcome may oth-

erwise be acceptable, the University of California San Fran

cisco (UCSF) and Pittsburg criteria were developed. The

Japanese experience in LDLT for HCC has shown that

some patients transplanted for HCC beyond Milan criteria

have survival rates similar to those within Milan; and spe

cialists argue that tumor biologic behavior is more importan

rather than size and number which are often over-estimated

by imaging methods. Specialists advocate to an expanded

criteria. Novel approaches to down-staging tumors initially

beyond the Milan criteria are now being evaluated using

loco-regional therapies like transarterial embolization, per

cutaneous ethanol injection, and radiofrequency ablation oa combination of strategies.

LDLT is now an acceptable treatment modality fo

HCC. There are no concensus accepted criteria for the use

of LDLT for HCC. Centers offering LDLT use currently ac-

cepted criteria in deceased donor LT or adopted their own


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criteria. The Milan criteria have been expanded to UCSF,

Pittsburgh, Tokyo, Kyoto, Asan, and Hangzhou criteria.

Cumulative data in the past 20 years have shown anincreasing survival after pediatric solid organ transplantation.

In LT, the most common indication for transplant is biliary

atresia followed by metabolic diseases of the liver. Survival

rate in excess of 80% at 2 years is a common achievement

with current transplantation practices. In LT, judicious re-

cipient and donor selection, careful preoperative planning,

excellent anesthesia management, prompt detection and

treatment of complications and improved use of immuno-

suppresion have resulted to long-term survival among trans-

planted children. As a result, we are becoming more aware

of the late complications of LT in children. As compared to

adults, children have much less morbidity and mortality from

recurrent disease, but, because they require immunosup-pression throughout the critical phases of growth and devel-

opment, the spectrum of late complications is dominated by

consequences of long-term immunosuppression.

However, data from the U.S. Organ Procurement

and Transplant Network showed that better early patient

and graft survivals do not equally translate to late patient

and graft survivals. This is due to a. immunosuppression

choice that affects the graft, b. late graft failure mechanism

unrelated to immune injury, and c. inadequate immunosup-

pression due to minimization strategies and non-adherence.

Renal dysfunction remains to be the foremost concern in

liver transplantation that affects survival pre- and posttrans-plant because a. pretransplant renal dysfunction correlates

with post LT outcome, b. pre renal dysfunction may dictate

post LT immunosuppression, and c. early introduction of cal-

cineurin inhibitors may worsen long-term renal dysfunction.

The other critical care unit concerns that inuence

recipient survival in the ICU include: 1. induction therapy with

basiliximab, 2. choice of calcineurin inhibitor, including dose

reduction, 3. management of gastrointestinal disorders, 4.

mechanical ventilator use, 5. replacement of inadequate cir-

culating volume, 6. treatment of infections, and 7. early iden-

tication of surgically correctable problems (hepatic artery

thrombosis, portal vein thrombosis, bile duct stenosis and

leakage, hepatic vein stenosis).

Late posttransplant period should focus on adverse

effects of calcineurin inhibitors (dyslipidemia, proteinuria,

pulmonary toxicity, oral ulcers), development of new-onset

diabetes mellitus, cardiovascular events and hypertension.

CRITICAL CARE OF

INTESTINALTRANSPLANT

RECIPIENTSSIEGFREDO R. PALOYO, MD


Division of Transplant Surgery


Intestinal and multivisceral transplantation has

evolved from an experimental procedure to the treatment o

choice for patients with irreversible intestinal failure and seri-

ous complications related to long-term parenteral nutrition

Increased numbers of transplant recipients and improved

survival rates have led to an increased prevalence of this

patient population in intensive care units. Management of

intestinal and multivisceral transplant recipients is uniquely

challenging because of complications arising from the high

incidence of transplant rejection and its treatment. Long-

term comorbidities, such as diabetes, hypertension, chronic

kidney failure, and neurological sequelae, also develop inthis patient population as survival improves. Herein we pre-

sent the essential principles in the intensive care manage-

ment of intestinal transplant recipients.


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MINIMALLY INVASIVE

THORACIC SURGERYRACEL IRENEO LUIS C. QUEROL, MD


Division of Thoracic and Cardiovascular Surgery

Department of Surgery

For over a century since the rst thoracotomy was

performed in 1891 by Theodore Tufer, open thoracotomy

has been the norm in the diagnosis and management of tho-racic surgical diseases. Over the past two decades since

its description, minimally invasive thoracic surgery and in

particular VATS lobectomy has undergone a revolution. This

session aims to give the participants an overview of the his-

tory, rationale, current practice and future directions of mini-

mally invasive thoracic surgery. Video presentations of the

more common procedures are also presented in an interac-

tive manner.


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Total Number of Participants 244

Pre-Registered 76

On-site 168

Prole of Participants

Consultants 118

Alumni 26 Residents 100

Participants by Region

NCR 49

Luzon 96

Visayas 42

Mindanao 57

Participants by Hospital Afliation

Government Hospital 108

Private Hospital 125

Both Govt and Private 6

Not Specied 5

Participants Prole


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Event Pictures


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4The Registration Team


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Dr. Tablan, Dr. Tiongco, Dra. Baltazar, Mrs. Tablan and Mrs. Ditas Panopio


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Dr. Tiongco poses with collegues Dr. and Mrs. Tablan and Dra. Almonte


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Dr. Porong Gana and Dr. Ed Bautista


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5Dra. Almonte and Sister Eva

Dr. Monroy,, Dr. Espiritu, Dr. Cabaluna, Dr. Bisquera and Dra. Moreno


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hief Resident Dr. Poy Ng with ACRs Dr. Dave Resoco, Dr. Mab Moreno,

Dr. Krista delos Santos and Dr. Bjay Pasco


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Dr. Arjel Ramirez leads the singing of the Philippine National Anthem

. Dante Ang (right) leads the ceremony and introduces Dr. Porong Gana (left), President of

ASE Inc., who gives a masterful Welcome Remarks

Opening Ceremony


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UPCM Associate Dean for Planning and Research Dr. Crisostomo delivers a message in

behalf of UPCM Dean Dr. Agnes Mejia

Dr. Tony Perez and Dr. Noneng Monroy


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GH Director and former Department of Surgery Chair Dr. Jose Gonzales delivers his message

P Manila Chancellor Dr. Manuel Agulto delivers his message to all particpants


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Dr. Gana and Dra. Baltazar sign a memorandum of agreement between the Department of

urgery and MDPie, making the PGH Surgery Postgraduate Course contents available online


62/176. Eric Berbarabe as the Master of Ceremony Dr. Mon de Vera introduces the

14th ATR Memorial Lecturer

14th ATR Memorial Lecture

r. Porong Gana, Mrs. Bella Yan-Ramirez and Dra. Wilma Baltazar honors Dr. Tiongco with a plaque


63/176Dr. Jose M. Tiongco delivering his 14th ATR Memorial LectureSurgery and Mountain Climbing


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Scientic

Sessions


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ession 1: Panel Discussion - Trainers in Surgery: Role and Legal Liabilities

art II with Panelists Dr. Armand Crisostomo, Dr. Regina Berba, Dr. Tony

erez and Dr. Jojo Arcilla, moderated by Dr. Bok Ocampo


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Session 2: Pediatric Surgery Lecture - Pediatric Lymphangiomas and Hemangiomas

by Dra. Celine Villegas (L), moderated by Dra. Esther Saguil (R)

RBGM Lunch Symposium delivered by Dr. Noneng Monroy


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ssion 4: GS2 Panel Discussion - Dr. Manuel Roxas (moderator), (L-R) Dr. Noneng Monroy, Dr

rmand Crisostomo, Dr. Ancoy Lopez and Dr. Dione Sacdalan


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ession 5: GS1 Mini Symposium on Caustic Injury - Dr. Jun Bisquera, Dr. Gemma Uy,

Dr. Nelson Cabaluna, Dr. Rodney Dotas and Dr. Tito Espiritu, moderated by Dr. Mark Kho


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GS1 Consultants: Dr. Rodney Dotas, Dr. Mark Kho, Dr. Nelson Cabaluna, Dra. Gemma Uy,

Dr. Tito Espiritu and Dr. Jun Bisquera

GS1 Residents, Fellows, Alumni and Consultants


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ession 6: Plastic Surgery Lecture - Microtia: Tenga Ko, Tenga Mo Rin by Dr. Jay Lizardo,

moderated by Dr. Bernie Tansipek

ession 7: Urologic Surgery Lecture - Robotics in Urologic Surgery by Dr. Dennis Serrano,

moderated by Dr. Linnie Cabungcal


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Session 8: Transplant Surgery Lecture - Short Bowel Syndrome: Hopeless No More by

Dr. Don Paloyo, moderated by Dr. Junico Visaya

Johnson and Johnson Lunch Symposium delivered by Dr. Tony Perez


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ession 10: Mini Symposium on Critical Care Management of Transplant Patients

y Dr. Allan Concejero and Dr. Don Paloyo, moderated by Dr. Ed Bautista

ession 9: Trauma Surgery Lectures and Panel Discussion by Dr. Ed Ayuste, Dr. Eric Talens, and

Dr. Bok Ocampo


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Session 11: TCVS Lecture on Minimally Invasive Thoracic Surgery

by Dr. Rus Querol, moderated by Dr. Gisel Catalan

Session 12: GS3 Panel Discussion - Multidisciplinary Approach in the Management of Malignan

Liver Disease, with panelists: Dr. J. Catibog, Dr. Mon De Vera, Dr. Janus Ong and Dra. Sandova

Tan, moderated by Dr. Jojo Arcilla


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Session 13: Research for Surgeons by Dr. Mela Lapitan, moderated by Dr. Eric Berberabe

ession 14: Endosurgery Lecture - Innovations and Advances in Hernia Surgery by Dr. Macky

aylona and Dr. Tony Perez, moderated by Dr. Dante Ang


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Meet the

Professors

Dinner


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Fellowship

Night


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The FellowshipNight


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Dra. Wilma Baltazar and Dr. Allan Concejero registering for the Fellowship Night


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he Surgery Band: Dr. Raphy Arada, Dr. Armand Crisostomo, Dr. Aneza Maglangit, Dr. Marc

ueser and Dr. Poy Ng


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10Dr. Serrano giving a toastfor the night


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GS3 Workshop: Choledochoscopy


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TCVS Workshop: Thoracic,

Cardiac and Vascular Trauma


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Burn Workshop: Wound Care:

Updates in Wound Management


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GS1 Workshop: Principles of

Breast Cancer Management


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Participants

ConsultantsResidents &

Alumni


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eptember 4, 2014: Day 2 Scientic Sessions


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13Dr. Rus Querol, Dr. Dominic Bichara & Dr. Don Paloyo

Women surgeons: Dr. Krista delos Santos, Dr. Tine Paguirigan, Dr. Donna Dy-Abalajon,Dr. Apple Valparaiso, Dr. Gemma Uy, Dr. Janneth Tan, Dr. Cheche Tayag


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Dr. Jay Lizardo giving his lecture on Microtia


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13Surgery residents trying outthe 3D laparoscopic machin


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Sponsors


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158The Postgraduate Courses Committee 2014


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Ofcers of the Foundation for the Advancement of Surgical Education, Inc. President

Vice-President

Secretary

Treasurer

Executive Director

Department of Surgery Ofcers Chair

Executive Vice-Chair

Executive Assistant

Finance Ofcer

Assistant Chair for Academic Affairs

Assistant Chair for Training

Assistant Chair for Services

Assistant Chair for Special Projects Assistant Chair for Research

Division Chiefs of the Department of Surgery Surgical Oncology, Head & Neck, Breast,

Skin & Soft Tissue, & Esophagogastric Surgery

Colorectal Surgery

Hepatobiliary and Pancreatic Surgery

Endosurgery

Trauma

Surgical Critical Care

Thoracic and Cardiovascular Surgery

Urology

Pediatric Surgery

Plastic Surgery

Burns

Organ Transplant

Postgraduate Courses Committee Chair Orlino C. Bisquera, Jr., MD

Co-Chair Jose Macario V. Faylona, MD

Members:

Mark Richard C. Kho, MD, Catherine S. Co, MD, Dante G. Ang, MD,Edgardo G. Gonzales, MD, Ana Melissa H. Cabungcal, MD, Leoncio L. Kaw, MD,

Ma. Celine Isobel A.Villegas, MD, Bernard U.Tansipek, MD,

Allan Dante M. Concejero, MD, Junico T.Visaya, MD, Anthony R. Perez, MD,

John Paulo B. Ng, MD, Dave R. Resoco, MD, Gerald Marion M. Abesamis, MD,

Florencio Angelo C. Lucero, MD, Ms. Eleanor R. Mercado and Ms. Juvy M. Concepcion

Telesforo E. Gana, Jr., MD

Jaime F. Esquivel, MD

Gerardo G. Germar, MD

Dennis P. Serrano, MD

Ms. Teresita T. Venturina

Wilma A. Baltazar, MD

Nelson D. Cabaluna, MD

AEricson B. Berberabe, MD


Eduardo R. Bautista, MD

Anthony R. Perez, MD

Jose Macario V. Faylona, MD

Nikko J. Magsanoc, MDMarie Carmela M. Lapitan, MD

Rodney B. Dotas, MD

Hermogenes DJ Monroy, MD

Ramon L. de Vera, MD

Anthony R. Perez, MD

Eric SM Talens, MD

Eduardo R. Bautista, MD

Adrian E. Manapat, MD


Antonio DR. Catangui , MD

Gerardo G. Germar, MD

Glenn Angelo S. Genuino, MD



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Joel Patrick A. Aldana, M.D.

Josena R. Almonte, M.D.Dante G. Ang, M.D.

Crisostomo E. Arcilla, Jr., M.D.

Eric Perpetuo E. Arcilla, M.D.

Eduardo C. Ayuste, Jr., M.D.

Jeane J. Azarcon, M.D.

Wilma A. Baltazar, M.D.

Eduardo R. Bautista, M.D.

AEricson B. Berberabe, M.D.

Orlino C. Bisquera, Jr., M.D.

Brian Samuel S. Buckley, M.D.Alvin B. Caballes, M.D.

Nelson D. Cabaluna, M.D.

Gisel T. Catalan, M.D.

Antonio D.R. Catangui, M.D.

Catherine S. Co, M.D.

Allan Dante M. Concejero, M.D.

Rafael Isidro DJ. Consunji, M.D.

Armando C. Crisostomo, M.D.

Jose Joven V. Cru

50th postgraduate course souvenir programme of the up-pgh department of surgery

Documents