up-pgh department of surgery's 49th postgraduate course souvenir programme

Table of ContentsForeword

Messages

49th Postgraduate Course Scientific Activities

Opening Ceremonies Programme•

13th Chancellor Alfredo T. Ramirez Memorial Lecture Programme•

ScientificProgramme•

Residents’ Course Coordinators

Scientific Session Abstracts

Participants’ Profile

Event PicturesScientificActivities•

Opening Ceremonies & ATR Memorial Lecture ScientificSessions Meet the Professor Dinners Workshops

Sponsors•Consultants, Residents & Staff•Participants•

Department of Surgery Officers

Consultant Staff

Resident Staff

List of Sponsors

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f o r e w o r d

ThefirstUP-PGHDepartmentofSurgeryPostgraduatecoursedatesbackin1969whenDr.AlfredoT.Ramirez,thentheexecutiveofficerofthedepartmentinitiated short intensivepostgraduate courses in surgery. Since then it becamearegulareducationalpostgraduateactivityofthedepartment.Inthelastfifteenyears,theUP-PGHpostgraduatecoursewastitledMasteryinSurgerytohighlightexceptional surgical issues as topic content with resource speakers who are experts intheirownfieldsaskeycomponentofthisevent.Yearly,thescientificprogramvariesinitscontentandstrategydependinguponitstheme.WhentheFoundationfor theAdvancement of Surgical Education, Inc. (FASE) was formed in 2003,throughtheinitiativeofDr.JoseC.Gonzales,thentheChairoftheDepartmentofSurgery,UP-PGHandDr.EduardoR.Gatchalian, thefirst FASEPresident, itregularly helped sponsor this activity to realize the department’s commitmentin helping surgical practitioners nationwide in advancing their knowledge andexpertiseinthecomprehensivemanagementofthedifferentsurgicaldisorders. MasteryinSurgery2013themeis“BacktoBasics:PreventingComplications,ImprovingOutcomes”.ProceedsofthiseventwillbedonatedtotheFoundationfor theAdvancement of Surgical Education (FASE), whichwill then help fundthe indigent surgical patients of theDepartment of Surgery,UP-PGH; trainingofsurgicalresidentstohelpthemachievethehighestqualityofsurgicaltrainingresponsivetotheneedsoftheFilipinopeople;andassistanceintheprofessionaldevelopmentprogramsfortheconsultantstaffofthedepartment.

messages

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Message from the Chancellor

My warmest felicitations to the members of the Foundationfor theAdvancementofSurgicalEducation (FASE)and theUP-PGHDepartmentofSurgeryontheholdingofthe49thPostgraduateCourse“Mastery inSurgery2013:Back toBasics—PreventingComplications,ImprovingOutcomes.”

On behalf of UPManila, I welcome the surgeons from different provincesnationwideforyourcontinueddesireandenthusiasmtoupdateyourknowledgeandshareexperiencesandbestpracticeswithcolleagues.

There is so much to learn in health and medicine and we are fortunate that groupssuchasFASEandourownsurgeonshavebeenexertingthe‘extramile’thisyear tobringusanothereditionof thiscourse.Youcandono less thanseize thisopportunitybyactivelyparticipatingandsharingwhatyouwilllearnwiththosewhowereunabletoattendthecourse.

Finally,Ihopethat,asinpreviousyears,thecoursewillcontributegreatlyinyoureffortstodeliverthebesthealthcaretopatients.

MANUEL B. AGULTO, MDProfessor and ChancellorUniversityofthePhilippinesManila

6Message from the Dean

Onceagain,onbehalfoftheUPCollegeofMedicineIwouldliketocongratulatetheFoundationfortheAdvancementofSurgicalEducation (FASE) and the UP-PGH Department of Surgery onyour49thPostgraduateCourse,Mastery inSurgery2013withthisyear’s theme“Back to Basics: Preventing Complications, ImprovingOutcomes.”

IamgladthatyourFoundationandDepartmentcontinuetostrivetoberelevanttothechangingtimes.Withourthemelastyearbeing“FromSimpletotheSpectacular,”youattemptedtopresentthelatestandpioneeringdevelopmentsinyourfield.Thisyear’stheme,however,“BacktoBasics”hastheclearintentionofemphasizingwhathasalwaysbeensignificantinyoursaswellasinotherspecialties,thatofpreventingcomplicationsandimprovingoutcomes.Thisisparticularlyimportantinthelightoftheverylimitedresourcesallottedtohealthcarebutwiththeexpectationofamorecost-effectivetreatmentoption.Improvedoutcomes,therefore,becomesagoalforallmanagementmodalitiestostrivefor.

Again,congratulationstoFASEandmorepowerinyourfutureactivities.

AGNES D. MEJIA, MDProfessor & Dean

UPCollegeofMedicine

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Message from the Director

MyheartfeltcongratulationstotheFoundationfortheAdvancementofSurgicalEducation(FASE)onits10thanniversary,andtheDepartmentofSurgeryonits49thAnnualPostgraduateCourse-Mastery in Surgery 2013: Back to Basics: Preventing Complications, Improving Outcomes.

The foundersof FASE initially envisionedFASE tobe the funding arm

ofthenumerousprojectsandactivitiesoftheDepartmentofSurgery,allaimedat continuing surgical education.Along theway,we discovered that advancingeducationalsomeantadvancingthequalityofpatientcarethatwedeliver.IamwitnesstohowtirelesslyandselflesslyitsofficersandmembershaveworkedtomaketheFoundationthestableandreliableorganizationthatitnowis.

FASEhasbecomethemanyfacesofcharitytomanypeople.ForthePGHsurgicalpatient,itisthesourceoffundsfortheexpensiveMRIorCT•Scan,orthelinenanddrapesintheOperatingRoom;For the surgery resident, it is a reliable donor for CME activities, support•for conventions, provider of books, journals and other training materials andactivities;For the surgery consultant, it is a partner for consultant development and•postgraduatetraining;Forthealumnus,itistheseedbywhichtheannualpostgraduatecoursegrowsand•reachesouttomanyofyoupracticingawayfromyouralma mater.

Ipraythatwiththemanyadversitiesthatbesetyourdepartmentandyourhospital,FASEwillremaintobebeaconofhopebywhicheachofuswillstrivetocontinuetodeliverthehighestqualityofsurgicalcare,trainingandeducationinthecountry.

Mabuhay!

JOSE C. GONZALES, MDDirectorPhilippineGeneralHospital

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Message from the President

Mabuhay!

Welcometothe49thMasteryinSurgeryPostgraduateCourseembracingthetheme,“BacktoBasics”

Thiscoursecoversdidacticsonvariousdiseaseswithtipsonhow to improve outcomes and prevent complications. This year’scoursewillcommenceaveryinterestingChancellorAlfredoT.RamirezMemorialLecture,andtocaptheday,interactivesessionsareinplaceforthe“MeettheProfessor”sessions.

ItakegreatpridethattheFoundationfortheAdvancementofSurgicalEducation,Inc.,isagaininpartnershipwiththeDepartmentofSurgery,UPCollegeofMedicine,PhilippineGeneralHospital.WehavebeenpartnersinthisPostgraduateCourseforthepastdecadeandwewillcontinuethisendeavorformanymoreyears.

As long as you continue to participate in our continuing medical/surgicaleducationactivities,wewillcontinuetosharetheknowledgeandresourcesofthePhilippineGeneralHospitalwithyou.

I wish to thank the altruistic efforts shared by the consultants and staff oftheDepartmentofSurgery. Further, Iexpressmyappreciationtoall thesponsorsanddonorswhohavehelpedusthroughtheyears.

Maythisbeafruitfulendeavorforeveryone.

TELESFORO GANA, Jr., MDPresident

FoundationfortheAdvancementofSurgicalEducation,Inc.

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Message from the Chair

The Department of Surgery UP-PGH is proudto present its 49th Post Graduate Course: Mastery ofSurgery2013-BacktoBasics:PreventingComplications,Improving Outcomes. This year’s scientific program willexposetheparticipantstotheprinciplesinthepreventionofcomplicationsandimprovingsurgeryoutcomesthroughenhancementoftheirbasicskillsanditscorrelativeintegrationinsurgicaldecision-making.

The Postgraduate Course Committee has come up with another excellent course, putting together lectures and panel discussions that are interesting, exciting and informative.They also put up short courses orworkshops that will enhance the surgical skills of the participants.

ThisCDwillbeagoodreferencetoolforyoutoreviewandsharewithyourothercolleagues.

WILMA A. BALTAZAR, MDProfessor and ChairDepartmentofSurgery-UPCollegeofMedicineUP-PhilippineGeneralHospital

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Message

Onbehalfof theFoundation for theAdvancementofSurgicalEducation,Inc.andtheUP-PGHDepartmentofSurgerythroughthePost-GraduateCoursesCommittee,Iamdeeplyhonoredandprivilegedtowelcomeyoutoour49thMasteryofSurgeryPostgraduateCoursewith the theme“Back toBasics:PreventingComplications, ImprovingOutcomes”onSeptember4-6,2013attheDiamondHotelManila.Wehavepreparedacomprehensivescientificprogramcoveringtopicsof

GeneralandSubspecialtySurgery.Thisisthesecondyearofthe“MeettheProfessorDinners”wherebyselectedparticipantswillhavethechanceforacloseandinformalsmall group discussionwith sixGeneral and Subspecialty Surgery Professors.Thesimultaneousshortcoursesonthethirddaywillalsogiveanopportunityforinterestedparticipantsforfurtherdevelopmentofknowledgeandskillsaboutanyofthecoursetopicstobeoffered.Wehopethatthisyear’sthemewillbeofgreathelpagaininyourpursuitofexpertiseinthefieldofsurgeryneededtoimprovetheoveralltreatmentoutcome.

MayIthankallthemembersofthePostgraduateCoursesCommitteefortheirsincerededicationandhelpincomingupwiththisendeavorandmostespeciallytoDr.WilmaA.Baltazar,Dr.JoseMacarioV.Faylona,Dr.DennisP.Serrano,Dr.MarkRichardC.KhoandDr.RodneyB.Dofitasforfacilitatingtheattainmentofthenecessarymajorlogistical support.

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

DepartmentofSurgeryPhilippineGeneralHospitalClinicalAssociateProfessor,UPCollegeofMedicine

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scientificactivities

12 Opening CeremoniesProgramme

September 4, 2013 9:00 - 9:30am

the scientific

programme

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Scientific ProgrammeDay 1 | September 4, 2013

22Scientific Programme

Day 1 | September 4, 2013


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24 Scientific ProgrammeDay 2 | September 5, 2013

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2649th Postgraduate Course

Resident CoordinatorsDay 1

September 4, 2013

Room CoordinatorsDr.JannethTan(head)Dr.LesleyCua-PardoDr.NeilGollaba

Session CoordinatorsDr. Krista Angeli Delos Santos

Dr.MarcBueser

Assistant CoordinatorsDr.MarieShellaDeRobles

Dr.AlvinAnastasio

Meet the Professor Dinner:Dr. Reynaldo Joson

Dr.JannethTanDr. Krista Angeli Delos Santos

Dr.BayaniPasco

Meet the Professor Dinner:Dr. Alberto RoxasDr.LesleyCua-PardoDr.MarcBueserDr.DaveResoco

Meet the Professor Dinner:Dr. Wilma Baltazar

Dr.NeilGollabaDr.MarieShellaDeRobles

Dr.AlvinAnastasio

Day 2September 5, 2013

Room CoordinatorsDr.NathanielTan(head)Dr.RochelleTayag

Dr.DonnaDy-Abalajon

Session CoordinatorsDr.CarylJoyNonanDr.JobelleBaldonado

Assistant CoordinatorsDr.EmmanuelHao

Dr.AnaPatriciaVillanueva

Meet the Professor Dinner:Dr. Crisostomo ArcillaDr.DonnaDy-AbalajonDr.AnthonyDofitasDr.EmmanuelHao

Meet the Professor Dinner:Dr. Eric TalensDr. Nathaniel TanDr. Kathleen Cruz

Dr.AnaPatriciaVillanueva

Meet the Professor Dinner:Dr. Jose Gonzales

Dr.KathleenRoseDescallar-MataDr.JobelleBaldonadoDr.MayouTampo

Day 3September 6, 2013

Room CoordinatorsDr.JohnPauloNg(head)Dr.JasonRafaelMaddumba

Session CoordinatorsDr.AnthonyDofitasDr.AmabelleMoreno

Assistant CoordinatorsDr.JoseMiguelVerde

Dr. Dax Carlos Pascasio

Workshops

Breast Cancer Management WorkshopDr.JannethTan

Dr.AnthonyDofitasDr. Krsitine Paguirigan

Surgical Stapling WorkshopDr.JasonRafaelMaddumba

Dr.MarcBueserDr.JanMiguelDeogracias

Choledochoscopy WorkshopDr.DonnaDy-Abalajon

Dr. Paolo CruzDr. Mark Augustine Onglao

Ultrasound WorkshopDr.JohnPauloNg

Dr. Krista Angeli Delos SantosDr.EmmanuelHao

Vascular Access WorkshopDr.KathleenRoseDescallar-Mata

Dr.JobelleBaldonadoDr.JoseMiguelVerde

Wound Care WorkshopDr.J.KristopherZubiri

Dr.MargaritaElloso,Dr.PinkyBeranDr.JeffreyWong,Dr.JenicaSo

Dr.GeraldAbesamis,Dr.AlexandraTan

Special Committees

Souvenir Programme Layout & DesignDr.GeraldAbesamis

Programme Layout & DesignDr.JasonRafaelMaddumba

Dr.GeraldAbesamis

Documentation and PhotographyDr.MayouTampoDr.ArthurGallo

Audio-Visual CommitteeDr.GeraldAbesamisDr.MarcBueser

Dr. Mark Augustine Onglao

scientific session

abstracts

28Session ILegalIssuesinSurgicalTraining

Trainers in Surgery: Role and Legal LiabilitiesOrlando O. Ocampo, MD

Trainersinsurgeryhaveagreatresponsibilityinmoldingtheresidentstobecomecompetentandethical surgeons.Butdo theyhave legal responsibilitieswhen facedwith controversial issueswithlegalimplicationsthatariseduringresidency?Ifaresidentdisclosesinconfidencetothetrainerthathe/sheisHIVpositive,doesthetrainerhavethelegalresponsibilitytoremovehim/herfromtheprograminordertoprotectthepatients?Ifatransvestiteappliesforsurgicalresidencyandthetrainersrefusetoaccepthimbecauseheisatransvestite,aretherelegalimplicationsforthesurgeontrainers?Andwhatare the trainers legal responsibilities if a female residentaccusesaconsultantof sexual harrassment?All these issues and its collateral issueswill be discussed in this panel ofexperts.

Session 2PediatricSurgeryLectures:PerioperativeCareofthe Pediatric Patient

Blunt Abdominal Trauma in ChildrenEstherA.Saguil,MD

Bluntabdominaltraumaremainsacommonconditioninthepediatricagegroup.Vehicularcrashes,falls,andmaulingremainthetopthreemechanismsofinjury.Thechallengeinmanagingbluntabdominal trauma lies in resuscitation and thedecisionwhether the child needs surgeryor not.Non-operativemanagementforsolidorganinjurieshasbeendemonstratedtobesuccessfulevenforsevereviscerallacerationsandcontusions,providedthepatientishemodynamicallystabilizedandtherearenootherintraperitonealinjuriesthatrequireemergentsurgery. Initial resuscitation includesadministrationofcrystalloidsandcolloids, followedby imagingtodetermineextentofinternalinjuries.Theprocessofnon-operativemanagementofBATentailsvigilantmonitoringandevenrepeatedimagingstudiestodocumentpatient’sprogress.Thisavoidsthemorbidityofalaparotomy,andpossiblytheremovaloforgansthatcouldotherwisehavebeenpreserved.Delayedexplorationorinterventionalproceduresaresometimesemployedtodealwithsuchcomplicationsasabscessformationorthelike.

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Perioperative Management of Gastro-Intestinal Obstruction in ChildrenLeandroLResurreccionIII,MD

Infantsandyoungchildrenwhoarriveintheemergencydepartmentwithintestinalobstructioncanusuallyberecognizedbyhistoryaloneorbysortingthroughthepresentingsignsandsymptoms.Intestinalobstructionwillpresentwith1ormoreofthetypicaltriad;colickyabdominalpain,vomiting,and/orabdominaldistension.Because surgical interventionmaybe requiredemergently,delays indiagnosismustbeavoided.Thislecturecoverssurgicallycorrectableintestinalobstructionsininfantsandchildrenthatarecommonlyencounteredorrequireanastuteclinicianskilledtomakeatimelydiagnosis.

IncidenceTheoverall incidence of pediatric intestinal obstruction is difficult to estimate because it

resultsfromsuchavarietyofembryonicanomaliesandfunctionalabnormalities.However,intestinalobstruction is themost commonsurgicalemergencyof thenewborn.The incidenceofneonatalintestinalobstruction isapproximately1caseperevery500-1000 livebirths.Approximately50%oftheseneonateshave intestinalatresiaorstenosis.Duodenalatresiaand jejunalatresiaoccur inapproximately equal numbers, although some authors report that jejunoileal atresia is themorecommon.

Clinical PresentationThemajorityofpediatricpatientswithintestinalobstructionpresentshortlyafterbirth,yet

prenatal diagnosis of obstructive gastrointestinal lesions is possible in selected patients. Proximalobstructing lesions can produce proximal bowel dilation with hyperperistalsis that is readilyidentifiablebyprenatalultrasonography.Theclassic“doublebubble”appearanceofduodenalatresiacanbeidentifiedinuterowithultrasonography.Distalintestinalobstructionsarelesslikelytocausepolyhydramnios,butonoccasiondilated loopsofbowelmaybe identifiedasanechoicmasses. Incasesofmeconiumileus,dilatedloopsofbowelfilledwithechogenicmeconiummaybeidentified.

Fiveclinicalfindingssuggestintestinalobstructionintheneonate:maternalpolyhydramnios,excessivegastricaspirant,abdominaldistension,biliousvomitingandobstipation.Thepresenceorabsenceofeachoftheseclinicalfindingsdependslargelyuponthelevelofgastrointestinalobstruction.Earlyrecognitionofintestinalobstructionisimperativeifthecomplicationsofrespiratorycompromiseandsepsisaretobeavoided.

30 Session 3GS2Lectures:PerioperativeCareoftheColorectalSurgeryPatient

Anatomy of the Pelvic Floor: Structures to Identify and AvoidMarcPaulJ.Lopez,MD Theconductofsurgeryforcolorectaldisease,bothbenignandmalignant,requiresknowledgeoftheanatomyofthecolonandrectum,andadjacentstructures.Anadequateunderstandingoftheanatomywillallowforamoreexpeditiousresection,withminimalriskforiatrogenicinjury.

Preventing Complications in Colorectal SurgeryManuelFranciscoTRoxas,MD

Complicationsareunexpectedandunwantedoutcomesinpatients.Theymaybeclassifiedasbeingeithercomplicationsgeneraltoabdominalsurgery,orthosespecifictocolorectalsurgery.Theymayalsobeclassifiedbasedonoccurrence,whetherintraoperativeorpost-operative.

Themostdreadedcomplicationsspecifictocolorectalsurgeryareanastomoticleaks.Ausefulmnemonichighlightingthetechnicalfactorsrelatedtoincreasedriskforanastomoticleakis“TEPID”(TensionEdemaPeritonitisIschemiaandDrains).Lowanastomosessituatedbelowtheperitonealreflectionarealsoassociatedwithanincreasedriskforanastomoticleaks.Thepresenceofthesefactorsmaythereforewarrant thecreationofadivertingordefunctionalizingstomatominimizetheseveresequelaeofanastomoticleaks.Thereisalsorobustevidencethatimmunonutritionwithformulascontainingarginine,omega3fattyacids,andnucleotidesgiven5to7dayspreoperatively(and continued postoperatively in malnourished patients) decreases the incidence of infectiouscomplicationsfollowingsurgery,includinganastomoticleaks.

Intraoperativecomplications include iatrogenic injuriestothebowels,solidorganssuchasthespleen,majorbloodvesselsandurinarytract.Thereisevidencetoshowthatsuchcomplicationsarebestavoidedand/ormanagedbyhighvolumehospitalswithhighlyexperiencedsurgeons.Closesupervision for less experienced surgeons is therefore critical in preventingmany intraoperativecomplications.

Post-operativecomplications,aswellascomplicationscommontoanyabdominal surgery,includesurgicalsiteinfections,pneumonias,urinarytractinfections,deepvenousthrombosis,pulmonaryembolism, various other severe cardiovascular events, prolonged ileus and severe pain. Specific

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bundlesofqualityassuranceprogramshavebeenshowntosignificantlydecreasethesecomplications.Comprehensiveunit-basedsafetyprograms(CUSP)havebeendesignedtoaddressspecificpotentialcomplicationsoneata time. Thecommon threadunderlying the successfulpreventionof suchcomplicationsistherigorousacquisitionofvalidoutcomesdata,analyzingthencomparingthemtoestablishedbenchmarks,andmakingsuchfindingstransparent.IntheUS,boththeNationalVeteransAssociation Surgical Risk Study and theAmericanCollegeof SurgeonsNational SurgicalQualityImprovementProgrm(NSQIP)haveclearlydemonstratedthatreviewingdataandpubliclyreportingthemleadstoimprovedsurgicaloutcomes.

For Philippine hospitals and surgeons therefore, the most critical steps in preventingcomplicationsaretorigorouslycollectreliableandvaliddataonsurgicaloutcomes;comparethemtosetinternationalbenchmarks;andthenprovidedirectfeedbacktosurgeonsandhospitals.Oncespecific complication rates are identified as requiring appropriate correctivemeasures, focusedqualityimprovementprogramscannowbeimplementedandre-evaluated.

Enhanced Recovery After Surgey (ERAS) for Colorectal SurgeryHermogenesDJ.MonroyIII,MD

EnhancedRecoveryAfterSurgery (ERAS)has transformedperioperativecare inmodernsurgicalpracticebyemphasizingthepatients’optimalreturntonormalfunctionaftermajorsurgery.ThetermERASwascoined in2001byagroupofacademicclinicians toreplace the termsFastTrackSurgery/ClinicalorCriticalPathwaysforstandardizationandputmoreemphasisonthequalityofthepatients’recoveryratherthanthespeedofdischarge.Conventionalperioperativemetaboliccarehasacceptedthatastressresponsetomajorsurgery is inevitable.Thisconcepthasrecentlybeenchallengedwith theview that a substantial elementof the stress responsecanbeavoidedwiththeappropriateapplicationofmodernanesthetic,analgesicandmetabolicsupporttechniques.Conventionalpostoperativecarehasalsoemphasizedprolongedrestforboththepatientandtheirgastrointestinal tract. Similarly, this concept has recently been challenged. In the catabolic patient,medium-termfunctionaldeclinewillensueifactivestepsarenottakentoreturnthepatienttofullfunctionassoonaspossible.Againstthisbackground,Dr.HenrikKehletfromDenmarkstartedtoquestionwhypatientsundergoingelectiveabdominalsurgeryfailtogohomesooner.Hewentontodescribeaclinicalpathwaytoacceleraterecoveryaftercolonicresectionsbasedonamultimodalprogramwithoptimalpain relief, stress reductionwith regional anesthesia, earlyenteralnutritionandearlymobilization.With this, hewas able todemonstrate improvements inpatient’sphysicalperformance,pulmonary function,bodycompositionandamarkedreduction in lengthof stay.Asubsequentrandomizedtrialusingasimilarprotocoldemonstratedasignificantreductioninmedianlength of stay from 7 to 3 days. Since thenmany different groups have published effective andoptimal“fast-track”orenhancedrecoveryprograms.Usingamultidisciplinaryteamapproachwithafocusonstressreductionandpromotionofreturntofunction,anERASprotocolaimstoallowpatientstorecovermorequicklyfrommajorsurgery,avoidmedium-termsequelaeofconventionalpostoperative care (e.g. decline in nutritional status and fatigue) and reduce healthcare costs by

32reducinghospital stay.Todate, themost frequentlyusedmodel forERhasbeenopencolorectalresection.However,thereisnodoubtthatthesameprinciplescanbeappliedsuccessfullytootherformsofmajorsurgery(e.g.uppergi,hepaticresection,pancreaticsurgeryetc.)

The key elements of an enhanced recovery program start preoperativelywith adequatepatienteducationfromboththesurgeonsandwhereappropriatestomanurses.Mechanicalbowelpreparationandprolongedpreoperativestarvingareavoidedandcarbohydrateloadingisadministered.Intraoperatively,openorlaparoscopicsurgeryareusedwithminimalbloodlossandtissuetrauma;epiduralanalgesiaandcarefulintraoperativefluidmanagementarenecessary.Postoperativelyopioidanalgesicsareavoided,earlyandsupplementedfeeding isstartedandaggressivemobilizationandrehabilitationcommenced.

Thereisnowextensiveevidenceintheliteraturethatenhancedrecoveryprogramsbenefit

therecoveryofcolorectalpatients,cliniciansandhealthcaresystem.Awell-runprogramreducesthephysiologicalresponsetothetissueinsultfromsurgeryandasaresultthereislesspostoperativepain,fewercomplications,ashorterhospitalstayandfasterrecoveryandreturntowork.Althoughthe case for laparoscopic surgery remains to be proven explicity, the attendant advantages thatminimalaccesssurgerybringsandthereducedtissuetraumainherenttothisapproachwouldseemtomakeitanidealpartofanenhancedrecoveryprogramincolorectalsurgery.

Session 4GS2PanelDiscussion:OptimalManagementof Patients with Colorectal Conditions Threerepresentativecasesnamelyrectalcancer,colovesicalfistulaandobstructingsigmoidtumor,willbediscussedwithspecialemphasisondiagnosticexamination,preoperativeriskassessment,nutritionalupbuilding,operativemanagement,andenhancedrecoveryaftersurgery.

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Session 5GS1PanelDiscussionMultidiciplinary Approach to Head and Neck Squamous Cell CarcinomaModerator: NelsonD.Cabaluna,MD,FPCSPanelists: NeresitoT.Espiritu,MD,FPCS,HenriCartierS.Co,MD,IrisylOrolfo-Real,MD SharonD.Ignacio,MDCasePresenter :ShielaS.Macalindong,MD,DPBS Globally,634,746estimatednewcasesofmalignanciesintheheadandneck(H&N)region(lipandoralcavity,nasopharynx,otherpharynx,andlarynx)occurredin2008,accountingfor5%ofnewcancercases(GLOBOCAN2008). Inthesameyear,anestimated356,705deathsoccurreddueH&Nmalignancies.Squamouscellcarcinomascomprisethemajorhistologictype(>90%)ofmalignanciesfoundintheregion.ThelocaldataonH&Nmalignanciescloselyparalleltheinternationaldata, accounting for 6%of new cancer cases and 6.4%of new cancer deaths in the same timeperiod.Headandneckcancersperspecifictumorsitemaynotbeascommonasothercancersbut,collectively,theyaccountforalargeproportionofmalignanciesinthecountrycomparabletoincidenceofcervicalcancerandmortalityassociatedwithcolorectalcancer. Thetreatmentofheadandnecksquamouscellcarcinoma(HNSCC)dependsonseveralfactorsincludingtheexacttumorsite,thestage,andthepatient’sgeneralmedicalcondition.Goaloftherapygoesbeyondoncologiccontrol.Equallyimportantisthepreservationoffunctionasmuchpossibletomaintainthebestqualityoflifeforpatientswithoutcompromisingsurvivaloutcomes. Fromthestandpointof locoregionalcontrol, theH&Nregionposesdifficultiesdue to itslimitedspace,hencetheproximityofstructurestoeachotherandtocriticalneurovascularstructures,makingachievementofwidesurgicalmarginsnotalwaysfeasible.Furthermore,majorityofHNSCCinthecountryarediagnosedinthelocally-advancedstage. Management of HNSCC is complex and requires a multi-disciplinary approach to tailormanagementforeachpatient.Severaloptionsincludingsurgery,radiotherapyandchemotherapyassinglemodalityorincombinationareavailableandchoicedependsonaccurateassessmentofseveralfactorsinlightofcurrentavailableevidence.Forinstance,severaltrialshaveshownthatsurgeryandradiotherapyhavesimilarsurvivaloutcomesinearlydiseaseinspecifictumorsitessuchasthelarynx.Combinationtherapyisusuallyemployedinthelocoregionallyadvancedcaseswithsurgeryplayinga roleeither asprimary treatment, treatment followingneoadjuvant chemotherapy/radiotherapy/combined chemoradiotherapy or as salvage treatment. Not to be neglected are health-relatedqualityoflifeissuesthatarevitalinsuccessfulmanagementofHNSCC.HNSCCinitselfandtheirtreatment impact thebasicphysiologic functionssuchasbreathing, speechandswallowing,whichwouldrequireearlyassessmentandmanagementwhichshouldbeincorporatedinthetreatmentplan of patients.

34Session 6GS1Lecture

Preventing Surgical Complications of Modified Radical Mastectomy – Improving Outcomes, How I Usually Do itReynaldoO.Joson,MD,MHA,MHPEd,MScSurg

Tipsonhowtoproducegood-excellentpostoperativeoutcomesafteramodifiedradicalmastectomywillbepresented.Thegoaliscompleteextirpationwithnosurgicalcomplicationsandunwantedside-effects.Keystrategiesincludegoodplanning,execution,andcontingencyadjustmentsin the followingmajorstepsof theMRM:asepsis; incision;flapcreation; totalmastectomy;axillarydissection;drain;andincisionrepair.Good-excellentoutcomesincludenolocalrecurrence;nosurgicalcomplications (such as dehiscence; flap necrosis; hematoma; infection;major axillary vascular andnerveinjury);andnounwantedside-effects(suchasseroma;dog-eardeformity).

Session 7Burns/PlasticSurgeryLectureSkin Grafting EssentialsGerardoG.Germar,MD,FPCS,FPAPRAS

Skin grafting is an essential procedure often chosen to close open wounds. Manual skin graft knivesandpowerdermatomesenable surgeons toharvestgraftsof varying thicknessdependingon the patient’s needs.There are 3 phases of skin graft“take”: plasmatic imbibition, inosculationandneovascularization.Basicrequirementsforskingraft“take”areagoodvascularbed,absenceofinfectionandadequateimmobilizationoftheskingraft.Corollarytothis,commoncausesofskingraftlossinclude:hematomaunderthegraft,infectionandfailuretoimmobilize.Donorsitecareshouldbe given importance to ensure adequate re-epithelialization andminimize scarring. In free handharvesting,tensionsonthedonorsitebytrainedassistantsgreatlyfacilitatetheharvest.Usingregular,shortstrokes,whilemaintainingtheplaneoftheknife–similartoslicingroastbeef,enablesasurgeontoharvestanadequatesizedgraftofeventhickness. Whenlargeskindefectsaretobegrafted,surgeonsshouldconsidermeshing(toexpandthesizeofthegraft),reharvestingdonorsites,andbankinganyexcessskintoconservelimiteddonorsites.Withtheuseofpowerdermatomesskingraftharvesthasbecomeeasier,enablingsurgeonstoharvest long stripsof skinwithminimaldonor sitewastage.Whetherusingmanualorpowerdermatomes, the indications, principles and care of skin grafts remain the same.

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Session 8UrologyLecture

Urinary Tract Involvement in Colorectal CancerAnaMelissaH.Cabungcal,MD,FPUA

Colorectalcancer isoneof the leadingcausesofdisease todayandapproximately5%ofprimarycolorectalcancersinvolvetheurinarysystem.Thesecasesposeauniquesetofproblems.We present the findings of a retrospective descriptive study that aims to describe the cases ofcolorectalcancerwithurinarytractinvolvementinatertiarygovernmenthospitalintermsofpre-operative evaluation, intra-operative findings, surgicalmanagement and immediate post-operativeoutcome. This study shows that most of the patients with colorectal cancer with urinary tractinvolvementaremaleswhobelongtothemiddleadultgroup,presentingwithnourinarysymptomsbut have evidence of urinary tract involvement by pre-operative imaging studies or cystoscopicfindings.Majorityofthepatientsweremanagedwithexcisionofthetumorwithenblocresectionoftheinvolvedurinarytractorgan.Theoverallmorbidityrateis20%andmortalityrateis1.3%. Thereisaneedtogiveemphasisonacquiringknowledgeandskillsonpre-operativediagnosisandsurgicalmanagementgiventhecomplexityofthesecases.

Session 9Transplant LectureManaging Issues for Transplant Patients Undergoing General Surgical Procedures JunicoT.Visaya,MD

Renal transplant recipientsareauniqueandpeculiar setofpatients. Mosthavediabetes,hypertensionandglomerulonephritisasprimarycausesoftheirkidneyfailure.Monthsandyearsofchronickidneydisease(CKD)management,evenpriortoeventualdialysisand/orkidneytransplant,haveresultedinapatientwithamyriadofdifficultconditions–asymptomatictosevereischemicheartdisease,weakenedrespiratorysystem,immunosuppressedstateleadingtoincreasedrisksforinfectionandmaligancy,anemiaandcoagulationdisorders,andapropensityfordevelopinganumberofgastrointestinalconditionsthatcanbeofsurgicalnature. Themostcommonsurgicalconditionsthatmayaffecttherenaltransplantrecipientincludeperforated peptic ulcer, diverticulitis, cholecystitis, pancreatitis, and one ormore of the commoncancersoccuringpost-transplantasaresultofprolongedandexcessive immunosuppression(skin

36cancer,lymphoma,post-transplantlymphoproliferativediseaseorPTLD,etc.).Whilediagnosisandtreatmentof these surgical conditions are not any different from the general population, it is ofutmostimportancethatthegeneralsurgeonremindhimselfofthepeculariatiesofthepatient.Inallrenaltransplantrecipientswhopresentwithanacuteabdomen,steroidsmaymaskthesymptomsnotedbythepatient.Ifthisfactisnotremembered,diagnosisofdiverticulosisoraperforatedpepticulcermaybedelayed,withdisastrousresults.Preoperativeassessmentshouldleadtooptimizationofanypersistentseriouscondition.Intraoperatively,andeventhewholeoftheperioperativeperiod,remember that theonly useful protective approach against renal damage is to ensure adequatecirculatoryvolumeandoptimalrenalbloodflow.Meticuloussurgicaltechniqueandgentlehandlingoftissueswillalwaysprovetobethebestmethodsofpreventingsurgicalcomplicationsandthushelpingpreservetherenalfunctionoftherenaltransplantpatient.

Session 10Trauma Panel Discussion

Itanong Mo Kay Doctorney: Medico-legal Issues in Trauma Case ManagementOrlando O. Ocampo, MD Surgeonshaveaveryimportantroleinthecorrectidentification,labeling,classificationandgradingof injuries. It isusually this labelingandclassificationwhichguides the lawyersduring thelitigationofmedicolegalcases.Thepreservationofevidenceandthe“chainofcustody”oftheevidenceinmanycasesstartswiththesurgeonsandispartlytheirresponsibility.Thispanelof“Doctorneys”and a forensic pathologistwill address the legal implications for the surgeons should there be amislabelingor incorrectclassificationofan injuryorabreak inprotocol forthepreservationandcustodyoftheevidence.

Session 11SICULectures:CriticalCareofTraumaPatientsEvolution of the Concept of SIRSEduardoR.Bautista,MD

TheconceptofSIRS(systemicinflammatoryresponse)hasevolvedthroughtheyears.

Theobjectivesofthispresentationareto:

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1. DiscusstheevolutionofSIRS. 2. Discussinterventionssoastoavoidcomplications&improveoutcome.

Dr.BenEisemanfirstusedthetermMultiorganFailureSyndromein1977.SurgeonsthoughtthatthecauseofthisMOFisintraabdominalinfection.However,patientswhohadcontrolledornointraabdominalinfectionstilldevelopedMOF. In the80’s, the conceptof shock causingbowel ischemia andbacterial translocationwasintroduced. Inthe90’s,BoneintroducedtheconceptofSIRS.Anyformofinsulttothebody(e.g.trauma,infection, stressetc.)would trigger a cascadeof inflammation in thebody. It is equatedbymostsurgeonstoafirerapidlyspreading.Numerousstudiesonhowtoputoutthecascadeweredonebutnotmuchbreakthoughwasachieved.Moorein1996describedthe2ndhitphenomenonwherepatientsintheICUgetsickagainonthe6to8postopday.The2ndhitisnowknowntobeiatrogenic(causedbysurgeons) In2005,Moorenotedthatthe2ndHitinICUpatientsdisappeared.ThisisattributedtotheimprovedcareoftraumapatientsontheinitialinjuryandintheICU.Thiswillbediscussedfurtherinthe presentation. With the improvement in themortality rate in advanced Surgical ICU’s, new subsets ofpatientsareemerging.Patientswhoareinacatabolicstate,weak,notverysickbutdoesnotrecoveryfully.Theirwoundsbreakdownandtheyhaveon/offpulmonaryinfection.TheystayintheICUlongerandeventually get betteror transfer to a stepdown facility but barely functional.This subsetofpatientsislabeled-PICS(persistentinflammatory,immunosuppressioncatabolicsyndrome).Thiswillbeanewchallengethatsurgeonswillbefacingin2013onwards.

Massive Blood Loss and TransfusionAdrian Manapat, MD

Hemorrhagicshockaccountsfortheleadingcauseofdeathintraumaataround40%.Apatientwithmassivebleedingpresentsrepresentsoneofthebiggestclinicalchallengesinthemanagementof trauma. Ourobjectivesare:1)Todescribethedevelopmentofhemodilutionandcoagulopathy inmassivebleeding,2)Toreviewtheconsequencesofmassivebloodtransfusionandtheirmanagement,3)Topresenttrendsandconceptsinmassivebloodlossandtransfusion. Theevolutionofcoagulopathyinamassivelybleedingpatientstartswitharapidconsumptionofcoagulationfactorsandplatelets.Theiractivityisalsoreducedasaresultofhypothermia,acidosisanddilution.Formedclotsmaybebrokendowninappropriatelybymanipulationofwoundsandfibrinolysis. Volumehomeostasisthroughautologousfluidshiftsintointravascularspaceandresuscitationwith crystalloids cause further hemodilution.As volume replacement is achieved, bloodpressurerisesandthencausesmoreprofusebleeding.Additionalbloodlossisreplacedwithmorefluidsinaviciouscycle. Massivebloodtransfusion,apotentiallylifesavingmeasure,comesataprice.Thefollowingarecomplicationsassociatedwithtransfusion–hemolytic(acuteanddelayed)andnon-hemolytic

38reactions,disease transmission, immunomodulation, andphysiologiceffects suchascitrate toxicity,acidosis,andhyperkalemia. Numerous reports support massive transfusion protocols that employ high fixed ratiosFFP:PRBCtransfusion.Thesecite improvedresults intermsofsurvivalduetodecreasedratesofcoagulopathy. Fromtheanestheticside,hypotensiveresuscitationstrategyhasbeenadvocatedinhemorrhagicshocktolimitbloodlosswithoutsacrificingtissueperfusion.

Approach to a Patient with Hypotension in the Surgical ICUAllan Dante M. Concejero, MD

ThecommoncausesofhypotensionandshockinatraumapatientintheICUarevolumeloss (blood andbodyfluids), hypothermia and coagulopathy, hypoglycemia, and sepsis and septicshock.Shockresultsprimarilyfrominadequateoxygendelivery,thereby,producinglacticacidosis.Thisisinitiallyseenattheorganlevelasalteredmentalstatusanddecreasedurineoutputinbrainandkidneydysfunctions,respectively.Earlygoal-directedtherapyshouldbeginassoonasthesyndromeisrecognizedandshouldnotbedelayedpendingICUadmission.Anelevatedserumlactateconcentrationidentifiestissuehypo-perfusion inpatientsatriskwhoarenothypotensive.Bicarbonate levelandbasedeficit(takenfromanABG)aregoodsurrogateindicators.A500-mlbolusofcrystalloidshouldbegivenevery30minutestomaintainaCVPof8-12mmHg.Ameanarterialpressureof65-90mmHgisdesirable.Whenanappropriatefluidchallengefailstorestoreadequatebloodpressureandorganperfusion,therapywithvasopressoragentsshouldbestarted.Vasopressorsmayalsoberequiredtosustainlifeandmaintainperfusioninthefaceoflife-threateninghypotension,evenwhenafluidchallengeisinprogressandhypovolemiahasnotyetbeencorrected.

End of Life Care in the Surgical ICUAtty.JoelU.Macalino,MD

Asthepopulationinourcountryagesandmedicalsciencepushtheboundariesofhumanphysiology,wehavetoconsiderthatourprolongedexistencemayinvolveincapacities,particularlyattheend-of-lifeintheintensivecareunit.Thisarenainvolvesnotonlypatientsandfamilies,butalsocaregivers.Itinvolvestopicsfromeconomicstoexistentialism,andsurgerytospiritualism.Itrequireseducation,communication,acceptanceofdiversity,andanultimateacquiescencetotheinevitable.Forthenexttenminutes,thelecturerwillpresentanoverviewofENDOFLIFEISSUESespeciallyintheSurgicalICU.(ThomasJ.Papadimos,IntJCritIllnInjSci.201)

Session 12

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TCVSLecture:Anatomy&SurgicalExposuresofMajorBloodVesselsinTraumaExposure of the Subclavian and Axillary VesselsAdrian Manapat, MD

Thesubclavianandaxillaryvesselsareuncommonlyinvolvedintrauma.Mostinjuriesareduetopenetratingtraumaandcarryahighmortalitywithasmuchas60%dyingbeforereachingthehospital. Our objectives are: 1)To review the anatomy of the subclavian and axillary vessels, 2)Todescribedifferent incisionsused toobtainadequateexposureof thesevesselsduring traumasurgery. The subclavian artery is divided into three portions in relation to the scalenius anteriormuscle.Thefirstportioncommonlyarisesfromthebrachiocephalic(innominate)arteryontherightanddirectlyfromtheaorticarchontheleftandliesmedialtothescaleniusanteriormuscle.Thesecondportionliesontopofthebrachialplexusandunderthescaleniusanteriormuscle.Thethirdportionislocatedlateraltothescaleniusanteriormuscle.Thesubclavianveinislocatedinfrontandbelowthearteryoverthescaleniusanteriormuscle.Theaxillaryarteryislikewisedividedintothreeparts in relation to the pectoralis minor muscle. Severalincisionsareavailableforsubclavian/axillaryvesselexposure–includingsupraclavicular,infraclavicular, median sternotomy, thoracotomy and trapdoor.The choice of incision should betailoredtothesituation,dependingonthelocationofinjury,trajectoryofthemissileorweaponandexperience of the operator. In cases of suspected subclavian vein injury, venous access should be inserted in thecontralateralarmtopreventspillageofinfusedresuscitativefluidsandthepatientshouldbeplacedinTrendelenburgpositiontopreventairembolism.

Exposure of the IVC and Retrohepatic CavaAllan Dante M. Concejero, MD

Abdominalvasculartraumaisoneofthemorecommonlethalinjuriesencounteredbythemodern-daytraumasurgeon.Penetratingvasculartraumaaccountsfor60%-90%ofthemajorityofvascularinjuries.Injurytothevenacavacarriesamortalityof60%-100%.Thekeystosurvivalarebasedongoodproximalanddistalcontroloftheinjuryandadequateexposureoftheabdominalvasculature.Thecommonvascularexposureapproachesincludeleftvisceralrotationtoexposetheceliac,retroperitonealaortaandIVC,KochermaneuvertovisualizetheIVCandrightrenalvein,andrightvisceralrotationtoexposetheaorta.InjurytotheretrohepaticIVCcouldbeapproachedthroughrightatrial,infrahepaticIVC,saphenofemoral,andby-passprocedures.Thepreferredapproachwoulddependontheclinicalconditionofthepatient,materialsavailable,andexperienceofthesurgeon.Propertimingisimportantwhendecidingtouseacavalshunt.

40Anatomy & Surgical Exposure of the Abdominal AortaEduardoR.Bautista,MD

The abdominal aorta is amidline structurewhich has a complex relationshipwithotherorgansintheabdomen.Itisretroperitonealinlocationandissemi-circularlyenvelopedbyseveralimportantstructures.Masteryoftheanatomyandexposureoftheabdominalaortaanditsbranchesisamustintraumasurgery.

Theobjectivesofthepresentationare:1. TodiscusstheanatomyoftheAbdominalAortaanditsadjacentstructures.2. TodiscusstheExposureofUpperAbdominalAortaanditsbranches.3. TodiscusstheExposureoftheLowerAbdominalAorta.

ReviewofAnatomyTheabdominalaortaisdividedinto: I.UpperAbdominal a. Supraceliac b.Visceral 1. Celiac 2. SMA c.Juxtarenal 1. Left Renal 2. Right Renal II.LowerAbdominal a.Infrarenal 1.IMA

Thepresentationcoverstipsandstrategiesonhowtoaccessthesedifferentsegmentsoftheaorta.Pitfallsinthesurgicalexposurewillbeemphasized.

Anatomy & Surgical Exposure of the Iliac, Femoral and Popliteal VesselsJaimeF.Esquivel,MD

Lowerextremityvasculartraumaresultsinsignificantmortality,morbidityandlimbloss.Theseinjuriesarecommonlyencounteredbygeneralsurgeons.Thekeytopropersurgicalmanagementisgoodproximalanddistalvascularcontrolandadequateexposureoftheinjuredsegment.Vascularexposurerequiresfundamentalanatomicknowledgeofthelowerextremity.Thecommonapproachesto expose the iliac, femoral and popliteal arteries are presented.

Session 13

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GS3PanelDiscussion

Basic and Advances in the Management of CholangitisDanteAng,MD,CrisostomoArcilla, Jr.,MD,A’EricsonBerberabe,MD, JoseMacarioFaylona,MD,DerreckResurreccion,MD,RamonL.deVera,MD

Bydefinitionacutecholangitisisdefinedasamorbidconditionwithacuteinflammationandinfectioninthebileduct.

EtiologyCholelithiasisBenignbiliarystrictureCongenital factorsPost-operativefactors(damagedbileduct,stricturedcholedojejunostomy,etc.)Inflammatoryfactors(orientalcholangitis,etc.)MalignantocclusionBileducttumorGallbladdertumorAmpullarytumorPancreatic tumorDuodenal tumor Pancreatitis EntryofparasitesintothebileductsExternalpressureFibrosisofthepapillaDuodenaldiverticulumBloodclotSumpsyndromeafterbiliaryentericanastomosisIatrogenicfactors

42DiagnosisThediagnosisofcholangitismaybeconfirmedbyfollowingthediagnosticcriteriastipulatedbelow.

Management Inthemanagementofacutecholangitis, it is importanttoassessthedegreeofseverityofcholangitis (see table below) to tailor themanagement according to severity. Despite differentdegreesof severity, themainstay in themanagementof cholangitis is immediate drainageof thebileduct.Thisworksinconjunctionwithantibioticcoverageaswellothersupportivemanagement.Drainageofthebileductisachievedbyseveralmeans.TheleastinvasiveisthroughERCPstentingornasobiliarydrainagefollowedbypercutaneousapproachesandthensurgery.

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Severity Classification of Cholangitis

Source: HepatobiliaryPancreatSci(2013)20

44Session 14Endosurgery Lecture: Avoiding and ManagingComplications in LaparoscopicCholecystectomy:LessonsfromtheLast20YearsAnthonyR.PerezMD

Theadventoflaparoscopyandendoscopicsurgeryhasbroughttremendousadvancesinthefieldofmedicine,evolvingfromasimplediagnostictooltoanindispensablemodalityinthediagnosis,treatmentandfollow-upofseveraldiseases.Sinceitsintroductionin1985,laparoscopiccholecystectomyhasbecomethestandardofcareforthetreatmentofgallstones.TheUP-PGHDepartmentofSurgeryhasdistinguisheditselfbypioneeringlaparoscopiccholecystectomyinthecountryandithasbeenmorethan20yearssincethe1stlaparoscopicsurgerywasperformedinPGH.Thesucceedingyearsmarkedtremendousimprovementintrainingandinstrumentation,andconsequently,thefrequencyoflaparoscopiccholecystectomyhasincreased.Thisisattributablebothtotheincreasedincidenceofgallstonediseaseandtotheincreasingnumberofsurgeonsperforminglaparoscopicsurgeryinthecountry.Ithasbecomeapparenthoweverthatwiththerapidadoptionofthisnovelprocedurebyalargenumberofsurgeonsinashortperiodoftime,theadvancesinthefieldoflaparoscopyhasnotdecreasedtheincidenceofcomplicationsattributabletolaparoscopiccholecystectomy.

TheonehoursessionsponsoredbytheDivisionofEndosurgeryfocusesonthepreventionofcomplicationsandintraoperativestrategiestoaddresscomplicatedsituationsintheperformanceoflaparoscopiccholecystectomy.Adiscussionbyarenownedexpertinthemanagementofbileductinjuriesdrawnfromanexperienceofseveraldecadeswillthesession.Theformatwillincorporateshortlecturesandanensuingpaneldiscussionintendedtobeinteractivewiththeaudience.

The1stlecturewilldiscusstheexperiencewithgenerallaparoscopicsurgerycomplicationsincludingproblemsduetoCO2pneumoperitoneum,hemorrhageduringsurgery,trocarandtrocarsiterelatedcomplications,infectionandotherprocedurespecificinjuries.Itwillalsoincludeadiscussiononspecialproblemswhichmaycomplicatelaparoscopiccholecystectomy-previoussurgery,inflammation,morbidobesity,pregnancy,intraoperativebleeding,stonesandobscureanatomy.Strategiestoavoidandaddressthesecomplicatedsituationstopreventmorbidityandmortalitywillbediscussed.

Thehighlightofthesessionisalectureandensuinginteractivediscussiononbileductinjuries.Strategiestoavoidbileductinjurieswillbediscussed,includingpatientandsurgeonrelatedriskfactors,intraoperativedecisionmakingandtheneedforconversion.Theclassificationofbileductinjurieswillbereviewedandcorrelatedwiththeappropriatemanagementofthetypesofinjury.Moreimportantly,theoperativemanagementofbileductinjuriesasrelatedtothemorethan20yearsexperienceofthefacultywillbesharedwiththeparticipants.

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GS1 WorkshopPrincipleofBreastCancerManagement:Back toBasics Breastcancerremainstobeasignificanthealthprobleminthecountry.BasedontheGlobocan2008report,breastcancerwastheleadingcancersiteforbothsexescombinedandthefirstamongwomen in2010.Moreover, itwas the3rdmostcommoncauseofcancerdeaths forbothsexesandthe1stamongwomeninthesameyear.Theagestandardizedincidencerateofbreastcancerinthecountryisat31.9per100,000population.Thisrate,whilelowerthanmostofthedevelopedcountriesintheworldandintheAsiaPacificregion,ishigherthansomeofthelessdevelopedAsiannations. In recognition of the tremendous burdenof breast cancer disease in the country in thecontextofapopulationwithlimitedaccesstohealthcare,theDivisionofSurgicalOncology,Head&Neck,Breast,Skin&SoftTissue,andEsophagogastricSurgeryoftheDepartmentofSurgeryoftheUniversityof thePhilippines - PhilippineGeneralHospital, in partnershipwith thePhilippineCancerSocietyandtheprivatesectorpartner,AvonPhilippines,haveestablishedtheUP-PGHBreastCareCenterinOctober2002tocatertothehealthneedsoftheunderservedpatientswithbreastproblems.Thecenterisdesignedtobeaone-stopshopforpatientswithbreastcomplaints,fromdiagnosistomanagementincludingsurgeryandchemotherapy.Itismannedbysurgicalresidentandfellowstaffof thedivision,underthedirectsupervisionofthedivisionconsultants.From2004to2012,therehasbeen184,575consultsinthecenter,withanannualaverageof20,508.Ofthetotalnumberofconsultations,58%(107,520total,11,946annualaverage)areduetobreastcancer.Ontheaverage,thecentergives1,869chemotherapysessionsand1860breastbiopsiespredominantlycoreneedlebiopsiesperyear.About500to600modifiedradicalmastectomiesand5-10breastconservingsurgeriesareperformedannuallyforbreastcancer. Sinceitsestablishment,theBreastCareCenter,whilecontinuinglydeliversservicestomanypatientswithvariousbreastdisorders,hasalsoallowedthedivisiontogaintremendousexperienceinthetreatmentofbreastcancer.Therefore,throughthissymposium,weaimtosharethisexperiencethroughdiscussionofthebasicprinciplesofthedifferentmodalitiesofbreastcancermanagementwithintegrationofthelatestlocalandinternationalclinicalpracticeguidelinesinordertoimprovetheoverallmanagementoutcomes.

46Diagnosis, Pathology, and StagingShielaS.Macalindong,MD,DPBS

Biopsyremainstobethecornerstoneofbreastcancerdiagnosis.ThePhilippineCollegeofSurgeonsBreastCancerGuidelinesrecommendfineneedleaspiration(FNA)astheinitialdiagnosticproceduregiven itsexcellent testcharacteristicsandwideavailability.Coreneedlebiopsy,whereavailable, isequally valuable andhas the advantageofproviding tissuediagnosis thereby additionally allowinghormonereceptor(estrogenandprogesteronereceptor;HR)andhumanepidermalgrowthfactorreceptor 2 (HER2) tumor status determination. Invasive ductal carcinoma represents the mostcommontypeofinvasivebreastcancer.Severalhistologictypesofbreastcancersuchastubularandmucinouscarcinomaareconsideredfavorablehistologiesandareassociatedwithbetterprognosis.Hormone receptor andHER2 status are predictive and prognostic factors that guide choice ofadjuvanttherapy.HRstatusisdeterminedusingimmunohistochemistryandresultsarescoredandinterpretedaccordingtotheAllredscoringsystem.HER2overexpressioncanbeassessedusingIHCorfluoresecentinsituhybridization(FISH)techniques.BreastcancerstagingfollowstheAmericanJointCommitteonCancer(AJCC)StagingManual7theditionandisbasedontumor(T),regionalnodes(N),andmetastases(M)statusofthecancer.

Breast Conservation Therapy in the Management of Invasive Breast CancerNelsonD.Cabaluna,MD,FPCS

Several prospective randomized trials comparing breast conservation therapy versusmastectomyhavedemonstratedequivalence inoverallanddisease freesurvival forappropriatelyselectedpatientswithearlystageinvasivebreastcancer.Importantelementsinpatientselectionare:historyandphysicalexamination,assessmentofpatient’sexpectations,accuratebreastimagingandthoroughhistologicassessmentofresectedbreastspecimen.Asidefromgoodsurvivaloutcomes,anaddedgoalofthesurgicalandradiationproceduresisminimalcosmeticdeformity.

Immediate or Delayed Breast Reconstruction: What is Recommended? NeresitoT.Espiritu,MD,FPCS

Itisbecomingapparentthatbreastreconstructioncanimprovethepsychosocialwell-beingandqualityoflifeofthepatient.Breastreconstructioncanbedoneusingautologoustissueorprostheticsoracombinationofthetwo.Autologousreconstructionusestissueflapswhereasprostheticsusesimplants.Breastreconstructioncanbedoneimmediatelyordelayed.However,patientrequiringpost-operativeradiotherapyposesachallengesinceitisassociatedwithincreasewoundcomplicationandalteredcosmeticoutcome.Whenpost-mastectomyradiationisrequired,delayedreconstructionisgenerallypreferredaftercompletionofradiationtherapyinautologoustissuereconstruction,becauseof reported loss in reconstruction cosmesis. When implant reconstruction is used, immediate rather thandelayedreconstructionispreferredtoavoidtissueexpansionofradiatedskinflaps.

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Role of Surgery in Stage IV Breast CancerRodneyB.DofitasMD,FPCS

Metastatic breast cancer is widely considered an incurable disease. Often, it is generallyacceptedthatlocaltherapyprovidesnosurvivaladvantageoncemetastaseshaveoccurredandthat,in fact,tumorexcisionmayfurtherstimulatethegrowthofthemetastases. Butthisparadigmisnottrueintumorsofcolorectal,renalcell,gastricandovarianoriginwheresurgicalmanagementofStageIVdiseasehasbeenfoundtoimprovesurvival.So,atthispointintimeWhatisthetheevidencefortheroleofSurgeryinstageIVBreastcancer?SeveralreviewsandretrospectivestudieshavebeendonethatshowsurgicalmanagementinstageIVbreastcancerimprovespatientsurvival.Anobservationalstudylikewiseshowedthatsurgeryoftheprimarytumorcanactuallyimprovesurvivalofmetastaticbreastcancer.Meta-analysisofdata(populationbasedandsingleinstitutiondata)demonstratedimprovedsurvivalinpatientswhounderwentsurgicalresectionoftheprimarytumor.Primarytumorresectionwithclearmargins,youngerageofpatients,smallersizedtumorandsolitaryor single site metastases contributed tobetter survival.However, in the absenceofprospectiverandomizedclinical trials, theresults that show improvedsurvivalasbeingdue toselectionbias ,cannotbetotallydiscounted.DataonsurgicalmanagementofstageIVbreastcancerisdebatablebutthetrendtowardsimprovedsurvivalcannotbeignored.

Principles of Adjuvant & Neoadjuvant Treatment for Breast CancerGemmaLeonoraB.Uy,MD,FPCS

Despiteearlydiagnosis and increasingly effective treatment forbreast cancer, a significantproportionofwomenrelapseandeventuallydieofthedisease.Thus,systemictherapyhasbecomeanintegralpartoftheadjuvanttreatmentforbreastcancer.Assessmentofthebenefitagainsttheknownrisksisessentialforeveryclinicianbeforerecommendinganytreatmenttoapatient.Currentrecommendationsbasedon international guidelines such as theNCCNand theSt.Gallen2013Consensusontheuseofadjuvanttreatmentthatwillbehelpfultothesurgeonsinthemanagementoftheirpatientswillbediscussed,specificallyontheindicationsforuseofchemotherapy,endocrinetherapyandradiotherapy.TheUP-PGHBreastCareCenterexperienceonneoadjuvantchemotherapyforlocallyadvancedbreastcancerwillalsobepresented.

Strategy for Surveilance After Breast Cancer Primary TherapyOrlinoC.BisqueraJr.,MD,FPCS

Early identificationof recurrence,whether local, regional or distant site, anddetectionofmetachronous contralateral breast cancer are themain reasons for continued surveillance afterprimarytherapyofbreastcancer. Thenodalstatusisthemostimportantindicatornotonlyforsurvivalbutalsofortheriskof

48recurrence,withnodepositivepatientshavingaremarkablyhigherrisk.Majorityofrecurrencesaremanifestedbymetastasistodistantsitessuchasthebones,lungs,pleura,softtissueandtheliverindecreasingorderoffrequency;metastasisintheloco-regionalareaisseeninfewercases.Whereasmostoftherecurrencesoccurwithinthefirstthreeyearsoftreatment,theonsetmaytakeseveralyearsinsomepatientsthereforerequiringlong-termfollowup.Furthermore,severalstudiesshowedthe risk for subsequent contralateral breast cancer to be 0.5% to 1.0% per year necessitating astringenteffortofscreeningforitsearlydetection. Themainmodality indetecting recurrenceafterprimary treatment is still anappropriateanddetailedhistoryandphysicalexamination.Data fromvarious reports revealed that signsandsymptomsidentifiedtheonsetofrecurrenceinmostofthepatients.Signsandsymptomssuggestiveofrecurrencearedirectlyrelatedtotheorganinvolvedandmustbepickedupbytheexaminingsurgeon.Thesemayincludebonepains/tendernessforbonemetastasis,cough/dyspneaforlungorpleuralmetastasis,abdominalrightupperquadrantpain/jaundiceforlivermetastasis,andheadache/dizzinessforbrainmetastasis.Asymptomaticrecurrencesaredetectedthroughlaboratorytestsandimagingproceduresinonlysmallpercentageofpatients.Thesefindingstogetherwiththeassociatedhigh cost of surveillance testing bring out the question on whether postoperative follow up insearch for recurrence shouldbedone in a SYMPTOM-DIRECTEDAPPROACH, that is, ancillarymetastaticworkupsarerequestedasindicatedonlybysignsandsymptoms,orthroughaROUTINE/INTENSIVEAPPROACH,whichisdoneevenintheabsenceofsymptoms.Equallyrelevantquestionis,ifarecurrencewasdetectedintheasymptomaticstage,willearlydetectionalterthenaturalcourseofthedisease?Severalrandomizedtrialshaveaddressedthesequestionsandtheresultssuggestedthat the overall survival of patients with recurrent disease were comparable regardless of whether they were diagnosed when symptoms developed or when they were asymptomatic. In addition, the valueof thedifferent routine tests suchascompletebloodcount,liverandrenalchemistrystudies,chestx-ray,bonescan,cranialCTscan,liverultrasoundandbreastcancertumormarkers(CA15-3&CEA)indetectingasymptomatic recurrenceshasbeenevaluated.Whiletheymaydetecttherecurrenceabout4to6monthspriortotheonsetofsigns&symptoms,institutionofrecurrence-specifictreatmentatthisasymptomaticstagelikewisedidnotshowimprovementintheoverallsurvival.Thesetestsonlyincreasedpatients’anxietyandcostoffollow-upwithnoaddedclinicalbenefit.Hence,thesetestsarenot routinely recommended. Therefore,thecurrentrecommendationforfollow-upisviaasymptom-directedapproach.It is attained through careful history andphysical examinationevery3 to6months for thefirst3yearsafterprimarytherapy,thenevery6to12monthsforthenext2years,andthenannuallythereafter.Laboratorytestsandimagingmodalitiesarenotroutinelyrecommendedinasymptomaticpatients.Furthermore,screeningformetachronouscontralateralbreastcancer isdonethroughawell-instructedMonthlyBreastself-Examinationandyearlycontralateralmammography.

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BACK TO THE FUTURE: Recent Basic and Not-so-basic issues in Breast Surgical OncologyMarkRichardC.Kho,MD,FPCS

Aswelookbacktothebasics,werealizethatsurgerydoesremaintheoldesttreatmentforbreastcanceranduntiltherecentpast,wastheonlytreatmentthatcouldcurepatientswithcancer.Andasthesurgicaltreatmentforbreastcancercontinuestoevolvethroughoutthenewmillennium,the surgeon still occupies a central role in the prevention, screening, diagnosis, multidisciplinarymanagement,palliationandrehabilitationofthebreastcancerpatient.Thefast-paceddevelopmentandimprovementsinmodernoncologysuchasinsystemicandradiationtherapy,havepromptedare-assertionofthatkeybasicroleofthesurgeon.

Nonehasbeenasbasicanissueinbreastcancerasthemanagementoftheaxilla.Sentinellymphnodebiopsy(SLNB)inappropriateclinicallynodenegativepatientsusingintraoperativeradioactivelymphaticmappingwithorwithoutbluedyestaining,hasemergedasanoptiontoaxillarynodaldissection(AND)albeititsdrawbackstowidespreadapplicationhereinthePhilippines.Itisimperativethattheproperindicationandapplication,aswellasanadequatediscussionwiththepatientoftherisks,benefits,costsandpossiblecomplications,bemadeforthisprocedure.Oddlyenoughthough,when one considers the recent results of theACOSOGZ0011 trial proving completionANDunnecessaryinselectedSLNB+breastcancerpatientsandthenot-so-recentresultsoftheNSABPB04trialshowingnosurvivalbenefitintheadditionofANDtomastectomyaloneorradiotherapy,onewonderswhetherbothSLNBandANDareinandbythemselvessuperfluous.

TherecentdoublemastectomyundertakenbymegastarAngelinaJolieforpreventionofBRCAmutation-associatedbreastcancerunderscoresanotherbasicapplicationof surgeryasaprimarymodality.Dubbedthe‘Angelinaeffect’,thisintrepidactnodoubtsinglehandedlyadvancedthecauseofcancerawarenessandpreventiontowherenomanhasgonebefore.Makingheadlinesallaroundtheglobe,thesideissuesofBRCAtestingandgenepatentinghavealsosharedthelimelight.TherecentUSSupremeCourtdecisiononwhichspecificareasofgenomicresearchmaybecopyrightedhasbeensaidtohaveforgedfuturedevelopmentofnovelapproachestogenetherapyandmadeBRCAmappingmoreaffordableandavailableworldwide.

Finally,aswetakealooktothefutureofbreastcancermanagement,wecannotbutberuffledbywhatisprobablythemostcontroversialissuewithinthemedicalcommunitynowadaystoutedtobethe“futureofmedicine”,thatofstemcelltherapy.Itisindeedtragicthatdespitetheevidenceagainstitsuseoutsideofaclinicaltrialastherapyforbreastcancer,somephysicians/surgeonshaveencouragedthesupposedpanacea for therapyaloneoralongsidestandardcancer treatments toeageranddesperatepatients,someevenfornot-so-meagerfinancialgain. Ontheotherhand, itisinspiringtoseetheferventandjustoppositionfromcourageouscolleaguesspeakingoutonthemisuse of this potentially beneficial yet unproven and possibly dangerous proverbial“fountain ofyouth”.

50GS2 WorkshopSurgicalStaplingTechniquesinColorectalSurgeryAttheendofthesession,theparticipantsareexpectedto:

Understandtheprinciplesofsurgicalstaplingwiththeaidoflectureandvideodemonstration•Demonstratethedifferenttypesofsurgicalstaplingtechniquesduringtheworkshopusingcow’s•intestine

Side to side anastomosis1. Transection of the rectum2. Intraluminalstapling3. Laparoscopicstapling(optional)4.

PSUS WorkshopBasicUltrasoundCourseforSurgeons

Ultrasonography is a very useful tool in the practice of clinical medicine.The use ofultrasonographyhashelped in thediagnosisandmanagementofmanypatients. Improvements inultrasoundtechnologyandtechniquesmakepatientmanagementformerlydeemeddifficultmorestraightforward.Learningthebasicprinciplesofultrasonographyanduseoftheultrasoundmachinewillhelpthegeneralsurgeoninmanagingthesimpleandcomplexcasesthatheorshefacesdaytoday.Ultrasonographyandperformanceofultrasound-guidedproceduresare important tools thatclinicians should arm themselveswith especially in this era ofminimally invasive procedures andsurgeries.Thissessionaimstohelptheparticipantunderstandthephysicsbehindultrasonographyaswellastoprovidetheparticipantwithbasicworkingknowledgewithmanipulationoftheultrasoundmachine. Italsoaimsto familiarizetheparticipantwithbasicnormalfindingsaswellasabnormalfindingsincommondiseasesofthehepatobiliarytractandthebreast.Attheendofthesessiontheparticipantswillbegivenacertifyingexaminationonthebasicprinciples,techniquesandpracticesofsurgicalultrasoundconductedyearlybythePhilippineSocietyofUltrasoundinSurgery(PSUS).

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GS3 WorkshopCholedochoscopy Choledochoscopyisaproceduredonetodirectlyvisualizethebiliarytractwithanendoscopethrough a t-tube or incision into the common bile duct. It has both diagnostic importance andtherapeuticvalueformostdiseasesofthehepato-biliarytractsystem.Thetechniqueprovidesdirectexaminationofthebiliarytract,whichwillhelpvalidatethediagnosis,andatthesametime,itallowstherapeuticendoscopicproceduressuchasbiopsyorcytology,stoneextraction,balloondilatation,electrocoagulation,stentremovalorplacement.Theprocedureisrelativelysafeandeasytousewithalowmorbidityrateof<5%.

TCVS WorkshopVascularAccessWorkshop

Introduction

Directaccesstothevascularsystemisconsideredoneofthefoundationsofmodernclinicalpractice.Inbroadterms,vascularaccessincludesanyformofcannulationofarteriesorveins.

Thedecisiontoobtainvascularaccesscanbeamajorchallengetotheattendingsurgeon.Factors,suchasthepatient’sageandsize,theavailabilityofvenousaccesssites,the indicationforaccess, and even the anticipated length of use, can potentially complicate the decision.Althoughobtainingvascularaccessisgenerallyasafeprocedure,itisnotwithoutcomplications,someofwhichcanbelifethreatening.

Therefore,theobjectivesofthissessionarethefollowing:

Tobrieflyreviewtheindicationsforpercutaneousvascularaccess1. To provide practical considerations on the various options and techniques for2. percutaneous accessTo discuss the possible complications and ways to avoid or minimize these3. complications

52Indications

Theindicationsforvascularaccessarenumerous.Ingeneral,theseincludeadministrationorfacilitationofthefollowing:

Total parenteral nutrition1. Chemotherapy2. Venous access for the chronically ill requiring repeated venipunctures for blood3. sampling and medicationsLongtermantibiotics(longerthan3-4weeks)4. Emergencyaccess(e.g.tomanagecardiopulmonaryarrestortrauma)5. Critical care monitoring6. Plasmapheresis7. Hemodialysis8.

Vascular Access Options Withmoderntechnologicaladvancesinvascularaccess,avarietyofoptionsarenowavailabletophysicians.Ingeneral,vascularaccesscanessentiallybedividedinto2broadcategories:peripheraland central venous. Peripheral, short-termcatheters are safe for givingmany IVmedications (eg,antibiotics),forprovidingmaintenanceIVfluids,andforbloodsamplingforlaboratorytests.However,numerousfluidsandmedications(eg,hyperosmolarsolutions,resuscitativedrugs)cannotbegiventhroughperipheralcathetersbecauseoflocalandvenousirritation.Likewise,certainindicationssuchaspatients needing long-term treatment (eg, antibiotics), chemotherapy, andTPN require centralvenousaccess.Table1comparesthevariousoptionsavailableforvascularaccess.

Technique

Varioustipsandtrickstofacilitatepercutaneousvascularaccesswillbediscussedtoensuresuccessandsafetyoftheprocedure.Thiswillbediscussedatlength

Complications (central venous access) Complications for vascular access can be divided into acute (during the insertion periodor shortlyafter)or long term(seeTable2).Thephysicianshouldhavea thoroughknowledgeoftheanatomyandof thepotentialcomplications fromtheprocedure to identifyandquickly treatanycomplicationsthatmayarise.Inaddition,thephysicianshouldhaveworkingknowledgeofthevascular-accessdevicetobeusedtoavoidconfusionandpotentialmishandlingofthecatheter.Finally,athoroughpreoperativeevaluationshouldbeundertaken.Itshouldincludeareviewoftheresultsofcoagulationstudiesandattentiontotheplacementofpreviousvascular-accessdevices.Informedconsentshouldbeobtainedanddocumentedonthepatient’schart.

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Table 1. ComparisonofOptionsforVascularAccess

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Burn WorkshopInnovationsinWoundManagement(WhatisCurrentandWhatisAvailable)Attheendoftheworkshop,theparticipantsshouldbeableto:

knowtheelementsofastructuredapproachtowoundmanagement(the• TIMEconcept)o Tissuemanagement(debridementtechniques)o Infection/inflammationcontrolo Moisturebalanceo Edge of wound management

determinetheindicationsandutilizationofcurrentlyavailableinnovativetechniquesinwound•managementperformtheactualwoundmanagementtechniques•

Table 2. ComplicationsofInsertingCathetersforVascularAccess

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Participants’ ProfileTotal Number of Participants: 271 Pre-registered 156 On site registration 115

Profile of Participants: Alumni 15 Consultants 129 Residents 121

Participants by type of Hospital Affiliation: GovernmentHospital 134 PrivateHospital 130 NotSpecified 1

Participants by Region: Luzon 160 NationalCapitalRegion(NCR): 54 CAR(CordilleraAdministrativeRegion) 18 RegionI:IlocosRegion 9 RegionII:CagayanValley 12 RegionIII:CentralLuzon 26 RegionIV-A:CALABARZON 20 RegionIV-B:MIMAROPA 10 RegionV:BicolRegion 11 Visayas 51 EasternVisayas 13 RegionVI(WesternVidsayas) 27 RegionVII(CentralVisayas) 11 RegionVIII(EasternVisayas) 13 Mindanao 60 RegionIX(ZamboangaPeninsula) 13 RegionX(NorthernMindanao) 9 RegionXI(DavaoRegion) 13 RegionXII(SOCCSKSARGEN) 19 CARAGARegion 4 ARMM 2

Workshop ParticipantsGS1“PrinciplesofBreastCancerManagement:BacktoBasics” 39GS2“SurgicalStaplingTechniquesinColorectalSurgery” 13GS3“Choledochoscopy” 18PSUS“BasicUltrasoundCourseforSurgeons” 11TCVS“VascularWorkshop” 21Burn“InnovationsinWoundManagement” 91

EVENTPICTURES

ScientificActivities

Day1:September4,2013

Registration Team

Dr.Esquivel&Dr.Baltazar

TheAudio-VisualTeam

Opening Ceremonies

Dr.JunicoVisayaashostfortheOpeningCeremonies

Dr.ArjelRamirezrenderingaheartfeltdoxologyandleadingtheNationalAnthem

Dr.Bisquera,Dr.Gonzales&Dr.Querol

FormerDepartmentChairDr.GatchalianwithDr.Faylona

Dr.GanadeliveringhiswelcomespeechasPresidentofFASE,Inc.

DepartmentChairmanDr.Baltazarwelcomingallparticipantsin the 49th Postgraduate course

PGHDirector&TCVSconsultantDr.JoseGonzalescongratulatesFASE&the department for organizing the annual postgraduate course

Dr.Bisquera,ChairofthePostgraduateCoursesCommitteegivesanorientationtoallparticipants

13th ATR Memorial Lecture

Dr.Berberabehoststhe13thATRMemorialLecture

Dr.SerafinHilvano,ProfessorEmeritusoftheDepartmentofSurgerydelivershislec-ture“TheRoleofInformationTechnologyinPresentDaySurgery”

Dr.RamonDeVeraintroducingDr.SerafinHilvano

MrsBellaRamirez,wifeofChancellorDr.AlfredoT.Ramirez,givesaheartfeltmessage

Dr.TonyOposa&wifewithDr.FernandoMelendres

Dr.WilmaBaltazarwithDr.PorongGana&Mrs.BellaRamirezawardstheplaqueofrecongnitiontoDr.SerafinHilvano

TheDepartmentofSurgeryConsultants&Alumni

Posing with the portrait of Dr. Alfredo T. Ramirez

Dr.MarioDeVilla,Dr.PorongGana,Dr.AntonioLimson,Dr.MarcelinoFojas&Dr.EdGatchalian

Past & current Department Chairmen Dr. Antonio Limson & Dra.WilmaBaltazarleadtheopeningoftheexhibits

ScientificSessions

Session1:LegalIssuesinSurgicalTrainingmoderatedbyDr.Ocampo

Dr.JojoArcilla,Dr.JoelMacalino&Dr.TonyPerez

Session2:PediatricSurgeryLectures:PerioperativeCareofthePediatricPatientmod-eratedbyDr.TonyCatanguiwithlecturersDr.EstherSaguil&Dr.JunResurrecion

Sessions3&4:GS2Lecture&PanelDiscussionsleadbytheGS2consultants:Dr.MarkLopez,Dr.BertRoxas,Dr.RammyRoxas&Dr.NonengMonroy

Dr.ArmandCrisostomomoderatingtheGS2PanelDiscussion

Session5:GS1PanelDiscussionwithguestsfromotherdepartments:Dr.Ignacio(Re-habMedicine),Dr.Orolfo-Real(MedicalOncology)&Dr.Co(RadiationOncology)

Dr.NelsonCabalunamoderatedthediscussionwithDr.TitoEspirituasoneofthepanelists

Dr.ShielaMacalindong,pastchiefresidentandcurrentseniorSurgicalOncologyfellowpresents the case for discussion

GS1Consultants:(L-R)Dr.GemmaUy,Dr.TitoEspiritu,Dr.NelsonCabaluna&Dr.JunBisquera

Dr.RodneyDofitasandDr.ReyJosondiscussespreventionofcomplicationsinMRM

Session7:SkinGraftingEssentialsbyDr.GerryGermar,moderatedbyDr.BernieTansipek

Session8:UrologyLecturebyDr.LinnieCabungcal,moderatedbyDr.JoelAldana

Session9:TransplantLecturebyDr.JunicoVisaya,moderatedbyDr.DonPaloyo

Johnson&JohnsonLunchSymposiumlecturebyDr.HermogenesMonroy

Session10:ItanongmokayDoctorneypresentedalivelydiscussiononthemedico-legalaspectsofSurgery,moderatedbyDr.BokOcampo,withpanelistsDr.RaquelFortun(ForensicPathology)&ourownDoctorneyJoelMacalino,MD,JD.

Session11:SICULectures,moderatedbyDr.JunKaw,lecturesfromDr..EdBautista(Asst.ChairforAcademics,UP-PGHSurgery),Dr.AllanConcejero,Dr.JoelMacalino&Dr.AdrianManapat(TCVSChair)

Session12:TCVSLectures,moderatedbyDr.RandyNicolasandlecturesfromDr..EdBautista,Dr.AllanConcejero,Dr.JaimeEsquivel&Dr.AdrianManapat

Session13:GS3PanelDiscussion,moderatedbyDr.EricBerberabewithpanelistsDr.DanteAng,Dr.,Dr.MondeVera,Dr.MackyFaylona&Dr.DerekResurrecion

Session14:EndosurgeryPanelDiscussionbyDr.TonyPerez,Dr.JojoArcilla,Dr.MackyFaylona&Dr.DanteAng

Meet the ProfessorDinners

MeettheProfessor:Dr.AlbertoB.Roxas(GetzBros.Dinner)

MeettheProfessor:Dr.WilmaA.Baltazar(PharmazelDinner)

MeettheProfessor:Dr.ReynaldoO.Joson(MSDDinner)

MeettheProfessor:Dr.JoseC.Gonzales(BBraunDinner)

MeettheProfessor:Dr.EricS.M.Talens(MundipharmaDinner)

MeettheProfessor:Dr.CrisostomoE.Arcilla(NovartisDinner)

Workshops

GS3Workshop:Choledochoscopy

GS3Workshop:Choledochoscopy

GS2Workshop:SurgicalStaplingTechniquesinColorectalSurgery

PSUSWorkshop:BasicUltrasoundCourse for Surgeons

GS1Workshop:PrinciplesofBreastCancerManagement:BacktoBasics

TCVSVascularWorkshop

BurnWorkshop:InnovationsinWound Management

up-pgh department of surgery's 49th postgraduate course souvenir programme

Documents

surgical practitioners

int surgical issues

resource speakers

topic content

departments commitmentin

behalf of upmanila