Table of Contents

Foreword
Messages
49th Postgraduate Course Scientifc Activities
Opening Ceremonies Programme
13th Chancellor Alfredo T. Ramirez Memorial Lecture Programme
ScientifcProgramme
Residents Course Coordinators
Scientifc Session Abstracts
Participants Profle
Event Pictures
ScientifcActivities
Opening Ceremonies & ATR Memorial Lecture
ScientifcSessions
Meet the Professor Dinners
Workshops
Sponsors
Consultants, Residents & Staff
Participants
Department of Surgery Offcers
Consultant Staff
Resident Staff
List of Sponsors

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f or e wor d
ThefrstUP-PGHDepartmentofSurgeryPostgraduatecoursedatesback
in1969whenDr.AlfredoT.Ramirez,thentheexecutiveoffcerofthedepartment
initiated short intensive postgraduate courses in surgery. Since then it became
aregulareducationalpostgraduateactivityofthedepartment.Inthelastffteen
years,theUP-PGHpostgraduatecoursewastitledMasteryinSurgerytohighlight
exceptional surgical issues as topic content with resource speakers who are experts
intheirownfeldsaskeycomponentofthisevent.Yearly,thescientifcprogram
variesinitscontentandstrategydependinguponitstheme.WhentheFoundation
for the Advancement of Surgical Education, Inc. (FASE) was formed in 2003,
throughtheinitiativeofDr.JoseC.Gonzales,thentheChairoftheDepartment
of Surgery, UP-PGH and Dr. Eduardo R. Gatchalian, the frst FASE President, it
regularly helped sponsor this activity to realize the departments commitment
in helping surgical practitioners nationwide in advancing their knowledge and
expertiseinthecomprehensivemanagementofthedifferentsurgicaldisorders.

MasteryinSurgery2013themeisBacktoBasics:PreventingComplications,
ImprovingOutcomes.ProceedsofthiseventwillbedonatedtotheFoundation
for the Advancement of Surgical Education (FASE), which will then help fund
the indigent surgical patients of the Department of Surgery, UP-PGH; training
ofsurgicalresidentstohelpthemachievethehighestqualityofsurgicaltraining
responsivetotheneedsoftheFilipinopeople;andassistanceintheprofessional
developmentprogramsfortheconsultantstaffofthedepartment.
messages
5
Message from the Chancellor
My warmest felicitations to the members of the Foundation
for theAdvancement of Surgical Education (FASE) and the UP-PGH
DepartmentofSurgeryontheholdingofthe49thPostgraduateCourse
Mastery in Surgery 2013: Back to BasicsPreventing Complications,
ImprovingOutcomes.
On behalf of UP Manila, I welcome the surgeons from different provinces
nationwideforyourcontinueddesireandenthusiasmtoupdateyourknowledgeand
shareexperiencesandbestpracticeswithcolleagues.
There is so much to learn in health and medicine and we are fortunate that
groupssuchasFASEandourownsurgeonshavebeenexertingtheextramilethis
year to bring us another edition of this course.You can do no less than seize this
opportunitybyactivelyparticipatingandsharingwhatyouwilllearnwiththosewho
wereunabletoattendthecourse.
Finally,Ihopethat,asinpreviousyears,thecoursewillcontributegreatlyinyour
effortstodeliverthebesthealthcaretopatients.
MANUEL B. AGULTO, MD
Professor and Chancellor
UniversityofthePhilippinesManila
6
Message from the Dean
Onceagain,onbehalfoftheUPCollegeofMedicineIwould
liketocongratulatetheFoundationfortheAdvancementofSurgical
Education (FASE) and the UP-PGH Department of Surgery on
your49thPostgraduateCourse,MasteryinSurgery2013withthis
years themeBack to Basics: Preventing Complications, Improving
Outcomes.
IamgladthatyourFoundationandDepartmentcontinuetostrivetoberelevant
tothechangingtimes.WithourthemelastyearbeingFromSimpletotheSpectacular,
youattemptedtopresentthelatestandpioneeringdevelopmentsinyourfeld.This
yearstheme,however,BacktoBasicshastheclearintentionofemphasizingwhat
hasalwaysbeensignifcantinyoursaswellasinotherspecialties,thatofpreventing
complicationsandimprovingoutcomes.Thisisparticularlyimportantinthelightof
theverylimitedresourcesallottedtohealthcarebutwiththeexpectationofamore
cost-effectivetreatmentoption.Improvedoutcomes,therefore,becomesagoalforall
managementmodalitiestostrivefor.
Again,congratulationstoFASEandmorepowerinyourfutureactivities.
AGNES D. MEJIA, MD
Professor & Dean
UPCollegeofMedicine
7
Message from the Director
MyheartfeltcongratulationstotheFoundationfortheAdvancementof
SurgicalEducation(FASE)onits10thanniversary,andtheDepartmentofSurgery
onits49thAnnualPostgraduateCourse-Mastery in Surgery 2013: Back to Basics:
Preventing Complications, Improving Outcomes.

The founders of FASE initially envisioned FASE to be the funding arm
ofthenumerousprojectsandactivitiesoftheDepartmentofSurgery,allaimed
at continuing surgical education.Along the way, we discovered that advancing
educationalsomeantadvancingthequalityofpatientcarethatwedeliver.Iam
witnesstohowtirelesslyandselfesslyitsoffcersandmembershaveworkedtomaketheFoundation
thestableandreliableorganizationthatitnowis.
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 and
activities;
For the surgery consultant, it is a partner for consultant development and
postgraduatetraining;
Forthealumnus,itistheseedbywhichtheannualpostgraduatecoursegrowsand
reachesouttomanyofyoupracticingawayfromyouralma mater.
Ipraythatwiththemanyadversitiesthatbesetyourdepartmentandyourhospital,FASE
willremaintobebeaconofhopebywhicheachofuswillstrivetocontinuetodeliverthehighest
qualityofsurgicalcare,trainingandeducationinthecountry.
Mabuhay!
JOSE C. GONZALES, MD
Director
PhilippineGeneralHospital
8
!
Message from the President
Mabuhay!
Welcometothe49thMasteryinSurgeryPostgraduateCourse
embracingthetheme,BacktoBasics
Thiscoursecoversdidacticsonvariousdiseaseswithtipson
how to improve outcomes and prevent complications. This years
coursewillcommenceaveryinterestingChancellorAlfredoT.Ramirez
MemorialLecture,andtocaptheday,interactivesessionsareinplace
fortheMeettheProfessorsessions.
ItakegreatpridethattheFoundationfortheAdvancementofSurgicalEducation,
Inc.,isagaininpartnershipwiththeDepartmentofSurgery,UPCollegeofMedicine,
PhilippineGeneralHospital.WehavebeenpartnersinthisPostgraduateCoursefor
thepastdecadeandwewillcontinuethisendeavorformanymoreyears.
As long as you continue to participate in our continuing medical/surgical
educationactivities,wewillcontinuetosharetheknowledgeandresourcesofthe
PhilippineGeneralHospitalwithyou.
I wish to thank the altruistic efforts shared by the consultants and staff of
the Department of Surgery. Further, I express my appreciation to all the
sponsorsanddonorswhohavehelpedusthroughtheyears.
Maythisbeafruitfulendeavorforeveryone.
TELESFORO GANA, Jr., MD
President
FoundationfortheAdvancementofSurgicalEducation,Inc.
9
Message from the Chair
The Department of Surgery UP-PGH is proud
to present its 49th Post Graduate Course: Mastery of
Surgery2013-BacktoBasics:PreventingComplications,
Improving Outcomes. This years scientifc program will
exposetheparticipantstotheprinciplesintheprevention
ofcomplicationsandimprovingsurgeryoutcomesthrough
enhancementoftheirbasicskillsanditscorrelativeintegration
insurgicaldecision-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 or
workshops that will enhance the surgical skills of the participants.
ThisCDwillbeagoodreferencetoolforyoutoreviewandshare
withyourothercolleagues.
WILMA A. BALTAZAR, MD
Professor and Chair
DepartmentofSurgery-UPCollegeofMedicine
UP-PhilippineGeneralHospital
!
10
!
Message
On behalf of the Foundation for theAdvancement of Surgical
Education,Inc.andtheUP-PGHDepartmentofSurgerythroughthe
Post-GraduateCoursesCommittee,Iamdeeplyhonoredandprivileged
towelcomeyoutoour49thMasteryofSurgeryPostgraduateCourse
with the themeBack to Basics: Preventing Complications, Improving
OutcomesonSeptember4-6,2013attheDiamondHotelManila.We
have prepared a comprehensive scientifc program covering topics of
GeneralandSubspecialtySurgery.ThisisthesecondyearoftheMeettheProfessor
Dinnerswherebyselectedparticipantswillhavethechanceforacloseandinformal
small group discussion with six General and Subspecialty Surgery Professors.The
simultaneousshortcoursesonthethirddaywillalsogiveanopportunityforinterested
participantsforfurtherdevelopmentofknowledgeandskillsaboutanyofthecourse
topicstobeoffered.Wehopethatthisyearsthemewillbeofgreathelpagaininyour
pursuitofexpertiseinthefeldofsurgeryneededtoimprovetheoveralltreatment
outcome.
MayIthankallthemembersofthePostgraduateCoursesCommitteefortheir
sincerededicationandhelpincomingupwiththisendeavorandmostespeciallytoDr.
WilmaA.Baltazar,Dr.JoseMacarioV.Faylona,Dr.DennisP.Serrano,Dr.MarkRichard
C.KhoandDr.RodneyB.Doftasforfacilitatingtheattainmentofthenecessarymajor
logistical support.
ORLINO C. BISQUERA, JR., MD, FPSGS, FPCS
Chairman Postgraduate Courses Committee
DepartmentofSurgeryPhilippineGeneralHospital
ClinicalAssociateProfessor,UPCollegeofMedicine
!
scientific
activities
12
Opening Ceremonies
Programme
September 4, 2013 9:00 - 9:30am
the
scientific
programme
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Scientifc Programme
Day 1 | September 4, 2013
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Scientifc Programme
Day 1 | September 4, 2013
Scientifc Programme
Day 2 | September 5, 2013
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24
Scientifc Programme
Day 2 | September 5, 2013
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Scientifc Programme
Day 3 | September 6, 2013
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49th Postgraduate Course
Resident Coordinators
Day 1
September 4, 2013
Room Coordinators
Dr.JannethTan(head)
Dr.LesleyCua-Pardo
Dr.NeilGollaba
Session Coordinators
Dr. Krista Angeli Delos Santos
Dr.MarcBueser
Assistant Coordinators
Dr.MarieShellaDeRobles
Dr.AlvinAnastasio
Meet the Professor Dinner:
Dr. Reynaldo Joson
Dr.JannethTan
Dr. Krista Angeli Delos Santos
Dr.BayaniPasco
Meet the Professor Dinner:
Dr. Alberto Roxas
Dr.LesleyCua-Pardo
Dr.MarcBueser
Dr.DaveResoco
Meet the Professor Dinner:
Dr. Wilma Baltazar
Dr.NeilGollaba
Dr.MarieShellaDeRobles
Dr.AlvinAnastasio
Day 2
September 5, 2013
Room Coordinators
Dr.NathanielTan(head)
Dr.RochelleTayag
Dr.DonnaDy-Abalajon
Session Coordinators
Dr.CarylJoyNonan
Dr.JobelleBaldonado
Assistant Coordinators
Dr.EmmanuelHao
Dr.AnaPatriciaVillanueva
Meet the Professor Dinner:
Dr. Crisostomo Arcilla
Dr.DonnaDy-Abalajon
Dr.AnthonyDoftas
Dr.EmmanuelHao
Meet the Professor Dinner:
Dr. Eric Talens
Dr. Nathaniel Tan
Dr. Kathleen Cruz
Dr.AnaPatriciaVillanueva
Meet the Professor Dinner:
Dr. Jose Gonzales
Dr.KathleenRoseDescallar-Mata
Dr.JobelleBaldonado
Dr.MayouTampo
Day 3
September 6, 2013
Room Coordinators
Dr.JohnPauloNg(head)
Dr.JasonRafaelMaddumba
Session Coordinators
Dr.AnthonyDoftas
Dr.AmabelleMoreno
Assistant Coordinators
Dr.JoseMiguelVerde
Dr. Dax Carlos Pascasio
Workshops
Breast Cancer Management
Workshop
Dr.JannethTan
Dr.AnthonyDoftas
Dr. Krsitine Paguirigan
Surgical Stapling Workshop
Dr.JasonRafaelMaddumba
Dr.MarcBueser
Dr.JanMiguelDeogracias
Choledochoscopy Workshop
Dr.DonnaDy-Abalajon
Dr. Paolo Cruz
Dr. Mark Augustine Onglao
Ultrasound Workshop
Dr.JohnPauloNg
Dr. Krista Angeli Delos Santos
Dr.EmmanuelHao
Vascular Access Workshop
Dr.KathleenRoseDescallar-Mata
Dr.JobelleBaldonado
Dr.JoseMiguelVerde
Wound Care Workshop
Dr.J.KristopherZubiri
Dr.MargaritaElloso,Dr.PinkyBeran
Dr.JeffreyWong,Dr.JenicaSo
Dr.GeraldAbesamis,Dr.AlexandraTan
Special Committees
Souvenir Programme Layout & Design
Dr.GeraldAbesamis
Programme Layout & Design
Dr.JasonRafaelMaddumba
Dr.GeraldAbesamis
Documentation and Photography
Dr.MayouTampo
Dr.ArthurGallo
Audio-Visual Committee
Dr.GeraldAbesamis
Dr.MarcBueser
Dr. Mark Augustine Onglao
scientific
session
abstracts
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Session I
LegalIssuesinSurgicalTraining
Trainers in Surgery: Role and Legal Liabilities
Orlando O. Ocampo, MD
Trainersinsurgeryhaveagreatresponsibilityinmoldingtheresidentstobecomecompetent
and ethical surgeons. But do they have legal responsibilities when faced with controversial issues
withlegalimplicationsthatariseduringresidency?Ifaresidentdisclosesinconfdencetothetrainer
thathe/sheisHIVpositive,doesthetrainerhavethelegalresponsibilitytoremovehim/herfrom
theprograminordertoprotectthepatients?Ifatransvestiteappliesforsurgicalresidencyandthe
trainersrefusetoaccepthimbecauseheisatransvestite,aretherelegalimplicationsforthesurgeon
trainers?And what are the trainers legal responsibilities if a female resident accuses a consultant
of sexual harrassment?All these issues and its collateral issues will be discussed in this panel of
experts.
Session 2
Pediatric Surgery Lectures: Perioperative Care of
the Pediatric Patient
Blunt Abdominal Trauma in Children
EstherA.Saguil,MD
Bluntabdominaltraumaremainsacommonconditioninthepediatricagegroup.Vehicular
crashes,falls,andmaulingremainthetopthreemechanismsofinjury.Thechallengeinmanagingblunt
abdominal trauma lies in resuscitation and the decision whether the child needs surgery or not.
Non-operativemanagementforsolidorganinjurieshasbeendemonstratedtobesuccessfuleven
forsevereviscerallacerationsandcontusions,providedthepatientishemodynamicallystabilizedand
therearenootherintraperitonealinjuriesthatrequireemergentsurgery.

Initial resuscitation includes administration of crystalloids and colloids, followed by imaging
todetermineextentofinternalinjuries.Theprocessofnon-operativemanagementofBATentails
vigilantmonitoringandevenrepeatedimagingstudiestodocumentpatientsprogress.This avoids
themorbidityofalaparotomy,andpossiblytheremovaloforgansthatcouldotherwisehavebeen
preserved.Delayedexplorationorinterventionalproceduresaresometimesemployedtodealwith
suchcomplicationsasabscessformationorthelike.
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Perioperative Management of Gastro-Intestinal
Obstruction in Children
LeandroLResurreccionIII,MD
Infantsandyoungchildrenwhoarriveintheemergencydepartmentwithintestinalobstruction
canusuallyberecognizedbyhistoryaloneorbysortingthroughthepresentingsignsandsymptoms.
Intestinalobstructionwillpresentwith1ormoreofthetypicaltriad;colickyabdominalpain,vomiting,
and/or abdominal distension. Because surgical intervention may be required emergently, delays in
diagnosismustbeavoided.Thislecturecoverssurgicallycorrectableintestinalobstructionsininfants
andchildrenthatarecommonlyencounteredorrequireanastuteclinicianskilledtomakeatimely
diagnosis.
Incidence
The overall incidence of pediatric intestinal obstruction is diffcult to estimate because it
resultsfromsuchavarietyofembryonicanomaliesandfunctionalabnormalities.However,intestinal
obstruction is the most common surgical emergency of the newborn.The incidence of neonatal
intestinal obstruction is approximately 1 case per every 500-1000 live births.Approximately 50%
of these neonates have intestinal atresia or stenosis. Duodenal atresia and jejunal atresia occur in
approximately equal numbers, although some authors report that jejunoileal atresia is the more
common.
Clinical Presentation
Themajorityofpediatricpatientswithintestinalobstructionpresentshortlyafterbirth,yet
prenatal diagnosis of obstructive gastrointestinal lesions is possible in selected patients. Proximal
obstructing lesions can produce proximal bowel dilation with hyperperistalsis that is readily
identifablebyprenatalultrasonography.Theclassicdoublebubbleappearanceofduodenalatresia
canbeidentifedinuterowithultrasonography.Distalintestinalobstructionsarelesslikelytocause
polyhydramnios, but on occasion dilated loops of bowel may be identifed as anechoic masses. In
casesofmeconiumileus,dilatedloopsofbowelflledwithechogenicmeconiummaybeidentifed.
Fiveclinicalfndingssuggestintestinalobstructionintheneonate:maternalpolyhydramnios,
excessive gastric aspirant, abdominal distension, bilious vomiting and obstipation.The presence or
absenceofeachoftheseclinicalfndingsdependslargelyuponthelevelofgastrointestinalobstruction.
Earlyrecognitionofintestinalobstructionisimperativeifthecomplicationsofrespiratorycompromise
andsepsisaretobeavoided.
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Session 3
GS2Lectures:PerioperativeCareoftheColorectal
SurgeryPatient
Anatomy of the Pelvic Floor: Structures to Identify and
Avoid
MarcPaulJ.Lopez,MD

Theconductofsurgeryforcolorectaldisease,bothbenignandmalignant,requiresknowledge
oftheanatomyofthecolonandrectum,andadjacentstructures.Anadequateunderstandingofthe
anatomywillallowforamoreexpeditiousresection,withminimalriskforiatrogenicinjury.
Preventing Complications in Colorectal Surgery
ManuelFranciscoTRoxas,MD

Complicationsareunexpectedandunwantedoutcomesinpatients.Theymaybeclassifed
asbeingeithercomplicationsgeneraltoabdominalsurgery,orthosespecifctocolorectalsurgery.
Theymayalsobeclassifedbasedonoccurrence,whetherintraoperativeorpost-operative.
Themostdreadedcomplicationsspecifctocolorectalsurgeryareanastomoticleaks.Auseful
mnemonichighlightingthetechnicalfactorsrelatedtoincreasedriskforanastomoticleakisTEPID
(TensionEdemaPeritonitisIschemiaandDrains).Lowanastomosessituatedbelowtheperitoneal
refectionarealsoassociatedwithanincreasedriskforanastomoticleaks.Thepresenceofthese
factors may therefore warrant the creation of a diverting or defunctionalizing stoma to minimize
theseveresequelaeofanastomoticleaks.Thereisalsorobustevidencethatimmunonutritionwith
formulascontainingarginine,omega3fattyacids,andnucleotidesgiven5to7dayspreoperatively
(and continued postoperatively in malnourished patients) decreases the incidence of infectious
complicationsfollowingsurgery,includinganastomoticleaks.
Intraoperative complications include iatrogenic injuries to the bowels, solid organs such as
thespleen,majorbloodvesselsandurinarytract.Thereisevidencetoshowthatsuchcomplications
arebestavoidedand/ormanagedbyhighvolumehospitalswithhighlyexperiencedsurgeons.Close
supervision for less experienced surgeons is therefore critical in preventing many intraoperative
complications.
Post-operative complications, as well as complications common to any abdominal surgery,
includesurgicalsiteinfections,pneumonias,urinarytractinfections,deepvenousthrombosis,pulmonary
embolism, various other severe cardiovascular events, prolonged ileus and severe pain. Specifc
31
bundlesofqualityassuranceprogramshavebeenshowntosignifcantlydecreasethesecomplications.
Comprehensiveunit-basedsafetyprograms(CUSP)havebeendesignedtoaddressspecifcpotential
complications one at a time. The common thread underlying the successful prevention of such
complicationsistherigorousacquisitionofvalidoutcomesdata,analyzingthencomparingthemto
establishedbenchmarks,andmakingsuchfndingstransparent.IntheUS,boththeNationalVeterans
Association Surgical Risk Study and theAmerican College of Surgeons National Surgical Quality
ImprovementProgrm(NSQIP)haveclearlydemonstratedthatreviewingdataandpubliclyreporting
themleadstoimprovedsurgicaloutcomes.
For Philippine hospitals and surgeons therefore, the most critical steps in preventing
complicationsaretorigorouslycollectreliableandvaliddataonsurgicaloutcomes;comparethem
tosetinternationalbenchmarks;andthenprovidedirectfeedbacktosurgeonsandhospitals.Once
specifc complication rates are identifed as requiring appropriate corrective measures, focused
qualityimprovementprogramscannowbeimplementedandre-evaluated.
Enhanced Recovery After Surgey (ERAS) for Colorectal
Surgery
HermogenesDJ.MonroyIII,MD

Enhanced RecoveryAfter Surgery (ERAS) has transformed perioperative care in modern
surgicalpracticebyemphasizingthepatientsoptimalreturntonormalfunctionaftermajorsurgery.
The term ERAS was coined in 2001 by a group of academic clinicians to replace the terms Fast
TrackSurgery/ClinicalorCriticalPathwaysforstandardizationandputmoreemphasisonthequality
ofthepatientsrecoveryratherthanthespeedofdischarge.Conventionalperioperativemetabolic
care has accepted that a stress response to major surgery is inevitable.This concept has recently
been challenged with the view that a substantial element of the stress response can be avoided
withtheappropriateapplicationofmodernanesthetic,analgesicandmetabolicsupporttechniques.
Conventionalpostoperativecarehasalsoemphasizedprolongedrestforboththepatientandtheir
gastrointestinal tract. Similarly, this concept has recently been challenged. In the catabolic patient,
medium-termfunctionaldeclinewillensueifactivestepsarenottakentoreturnthepatienttofull
functionassoonaspossible.Againstthisbackground,Dr.HenrikKehletfromDenmarkstartedto
questionwhypatientsundergoingelectiveabdominalsurgeryfailtogohomesooner.Hewenton
todescribeaclinicalpathwaytoacceleraterecoveryaftercolonicresectionsbasedonamultimodal
program with optimal pain relief, stress reduction with regional anesthesia, early enteral nutrition
and early mobilization.With this, he was able to demonstrate improvements in patients physical
performance, pulmonary function, body composition and a marked reduction in length of stay.A
subsequentrandomizedtrialusingasimilarprotocoldemonstratedasignifcantreductioninmedian
length of stay from 7 to 3 days. Since then many different groups have published effective and
optimalfast-trackorenhancedrecoveryprograms.Usingamultidisciplinaryteamapproachwith
afocusonstressreductionandpromotionofreturntofunction,anERASprotocolaimstoallow
patientstorecovermorequicklyfrommajorsurgery,avoidmedium-termsequelaeofconventional
postoperative care (e.g. decline in nutritional status and fatigue) and reduce healthcare costs by
32
reducing hospital stay.To date, the most frequently used model for ER has been open colorectal
resection.However,thereisnodoubtthatthesameprinciplescanbeappliedsuccessfullytoother
formsofmajorsurgery(e.g.uppergi,hepaticresection,pancreaticsurgeryetc.)
The key elements of an enhanced recovery program start preoperatively with adequate
patienteducationfromboththesurgeonsandwhereappropriatestomanurses.Mechanicalbowel
preparationandprolongedpreoperativestarvingareavoidedandcarbohydrateloadingisadministered.
Intraoperatively,openorlaparoscopicsurgeryareusedwithminimalbloodlossandtissuetrauma;
epiduralanalgesiaandcarefulintraoperativefuidmanagementarenecessary.Postoperativelyopioid
analgesics are avoided, early and supplemented feeding is started and aggressive mobilization and
rehabilitationcommenced.

Thereisnowextensiveevidenceintheliteraturethatenhancedrecoveryprogramsbeneft
therecoveryofcolorectalpatients,cliniciansandhealthcaresystem.Awell-runprogramreducesthe
physiologicalresponsetothetissueinsultfromsurgeryandasaresultthereislesspostoperative
pain,fewercomplications,ashorterhospitalstayandfasterrecoveryandreturntowork.Although
the case for laparoscopic surgery remains to be proven explicity, the attendant advantages that
minimalaccesssurgerybringsandthereducedtissuetraumainherenttothisapproachwouldseem
tomakeitanidealpartofanenhancedrecoveryprogramincolorectalsurgery.
Session 4
GS2PanelDiscussion:OptimalManagement
of Patients with Colorectal Conditions
Threerepresentativecasesnamelyrectalcancer,colovesicalfstulaandobstructingsigmoid
tumor,willbediscussedwithspecialemphasisondiagnosticexamination,preoperativeriskassessment,
nutritionalupbuilding,operativemanagement,andenhancedrecoveryaftersurgery.
33
Session 5
GS1PanelDiscussion
Multidiciplinary Approach to Head and Neck Squamous
Cell Carcinoma
Moderator: NelsonD.Cabaluna,MD,FPCS
Panelists: NeresitoT.Espiritu,MD,FPCS,HenriCartierS.Co,MD,IrisylOrolfo-Real,MD
SharonD.Ignacio,MD
CasePresenter:ShielaS.Macalindong,MD,DPBS

Globally,634,746estimatednewcasesofmalignanciesintheheadandneck(H&N)region
(lipandoralcavity,nasopharynx,otherpharynx,andlarynx)occurredin2008,accountingfor5%of
new cancer cases (GLOBOCAN 2008). In the same year, an estimated 356,705 deaths occurred
dueH&Nmalignancies.Squamouscellcarcinomascomprisethemajorhistologictype(>90%)of
malignanciesfoundintheregion.ThelocaldataonH&Nmalignanciescloselyparalleltheinternational
data, accounting for 6% of new cancer cases and 6.4% of new cancer deaths in the same time
period. Head and neck cancers per specifc tumor site may not be as common as other cancers
but,collectively,theyaccountforalargeproportionofmalignanciesinthecountrycomparableto
incidenceofcervicalcancerandmortalityassociatedwithcolorectalcancer.
The treatment of head and neck squamous cell carcinoma (HNSCC) depends on several
factorsincludingtheexacttumorsite,thestage,andthepatientsgeneralmedicalcondition.Goalof
therapygoesbeyondoncologiccontrol.Equallyimportantisthepreservationoffunctionasmuch
possibletomaintainthebestqualityoflifeforpatientswithoutcompromisingsurvivaloutcomes.
From the standpoint of locoregional control, the H&N region poses diffculties due to its
limitedspace,hencetheproximityofstructurestoeachotherandtocriticalneurovascularstructures,
makingachievementofwidesurgicalmarginsnotalwaysfeasible.Furthermore,majorityofHNSCC
inthecountryarediagnosedinthelocally-advancedstage.
Management of HNSCC is complex and requires a multi-disciplinary approach to tailor
managementforeachpatient.Severaloptionsincludingsurgery,radiotherapyandchemotherapyas
singlemodalityorincombinationareavailableandchoicedependsonaccurateassessmentofseveral
factorsinlightofcurrentavailableevidence.Forinstance,severaltrialshaveshownthatsurgeryand
radiotherapyhavesimilarsurvivaloutcomesinearlydiseaseinspecifctumorsitessuchasthelarynx.
Combinationtherapyisusuallyemployedinthelocoregionallyadvancedcaseswithsurgeryplaying
a role either as primary treatment, treatment following neoadjuvant chemotherapy/radiotherapy/
combined chemoradiotherapy or as salvage treatment. Not to be neglected are health-related
qualityoflifeissuesthatarevitalinsuccessfulmanagementofHNSCC.HNSCCinitselfandtheir
treatment impact the basic physiologic functions such as breathing, speech and swallowing, which
wouldrequireearlyassessmentandmanagementwhichshouldbeincorporatedinthetreatment
plan of patients.
34
Session 6
GS1Lecture
Preventing Surgical Complications of Modifed Radical
Mastectomy Improving Outcomes, How I Usually Do it
ReynaldoO.Joson,MD,MHA,MHPEd,MScSurg
Tips on how to produce good-excellent postoperative outcomes after a modifed radical
mastectomywillbepresented.Thegoaliscompleteextirpationwithnosurgicalcomplicationsand
unwantedside-effects.Keystrategiesincludegoodplanning,execution,andcontingencyadjustments
in the following major steps of the MRM: asepsis; incision; fap creation; total mastectomy; axillary
dissection;drain;andincisionrepair.Good-excellentoutcomesincludenolocalrecurrence;nosurgical
complications (such as dehiscence; fap necrosis; hematoma; infection; major axillary vascular and
nerveinjury);andnounwantedside-effects(suchasseroma;dog-eardeformity).
Session 7
Burns/PlasticSurgeryLecture
Skin Grafting Essentials
GerardoG.Germar,MD,FPCS,FPAPRAS
Skin grafting is an essential procedure often chosen to close open wounds. Manual skin graft
knives and power dermatomes enable surgeons to harvest grafts of varying thickness depending
on the patients needs.There are 3 phases of skin grafttake: plasmatic imbibition, inosculation
andneovascularization.Basicrequirementsforskingrafttakeareagoodvascularbed,absenceof
infectionandadequateimmobilizationoftheskingraft.Corollarytothis,commoncausesofskingraft
lossinclude:hematomaunderthegraft,infectionandfailuretoimmobilize.Donorsitecareshould
be given importance to ensure adequate re-epithelialization and minimize scarring. In free hand
harvesting,tensionsonthedonorsitebytrainedassistantsgreatlyfacilitatetheharvest.Usingregular,
shortstrokes,whilemaintainingtheplaneoftheknifesimilartoslicingroastbeef,enablesasurgeon
toharvestanadequatesizedgraftofeventhickness.
Whenlargeskindefectsaretobegrafted,surgeonsshouldconsidermeshing(toexpandthe
sizeofthegraft),reharvestingdonorsites,andbankinganyexcessskintoconservelimiteddonor
sites.Withtheuseofpowerdermatomesskingraftharvesthasbecomeeasier,enablingsurgeons
to harvest long strips of skin with minimal donor site wastage.Whether using manual or power
dermatomes, the indications, principles and care of skin grafts remain the same.
35
Session 8
UrologyLecture
Urinary Tract Involvement in Colorectal Cancer
AnaMelissaH.Cabungcal,MD,FPUA
Colorectal cancer is one of the leading causes of disease today and approximately 5% of
primarycolorectalcancersinvolvetheurinarysystem.Thesecasesposeauniquesetofproblems.
We present the fndings of a retrospective descriptive study that aims to describe the cases of
colorectalcancerwithurinarytractinvolvementinatertiarygovernmenthospitalintermsofpre-
operative evaluation, intra-operative fndings, surgical management and immediate post-operative
outcome.
This study shows that most of the patients with colorectal cancer with urinary tract
involvementaremaleswhobelongtothemiddleadultgroup,presentingwithnourinarysymptoms
but have evidence of urinary tract involvement by pre-operative imaging studies or cystoscopic
fndings.Majorityofthepatientsweremanagedwithexcisionofthetumorwithenblocresectionof
theinvolvedurinarytractorgan.Theoverallmorbidityrateis20%andmortalityrateis1.3%.
Thereisaneedtogiveemphasisonacquiringknowledgeandskillsonpre-operativediagnosis
andsurgicalmanagementgiventhecomplexityofthesecases.
Session 9
Transplant Lecture
Managing Issues for Transplant Patients Undergoing
General Surgical Procedures
JunicoT.Visaya,MD
Renal transplant recipients are a unique and peculiar set of patients. Most have diabetes,
hypertensionandglomerulonephritisasprimarycausesoftheirkidneyfailure.Monthsandyearsof
chronickidneydisease(CKD)management,evenpriortoeventualdialysisand/orkidneytransplant,
haveresultedinapatientwithamyriadofdiffcultconditionsasymptomatictosevereischemic
heartdisease,weakenedrespiratorysystem,immunosuppressedstateleadingtoincreasedrisksfor
infectionandmaligancy,anemiaandcoagulationdisorders,andapropensityfordevelopinganumber
ofgastrointestinalconditionsthatcanbeofsurgicalnature.
Themostcommonsurgicalconditionsthatmayaffecttherenaltransplantrecipientinclude
perforated peptic ulcer, diverticulitis, cholecystitis, pancreatitis, and one or more of the common
cancers occuring post-transplant as a result of prolonged and excessive immunosuppression (skin
36
cancer,lymphoma,post-transplantlymphoproliferativediseaseorPTLD,etc.).Whilediagnosisand
treatment of these surgical conditions are not any different from the general population, it is of
utmostimportancethatthegeneralsurgeonremindhimselfofthepeculariatiesofthepatient.Inall
renaltransplantrecipientswhopresentwithanacuteabdomen,steroidsmaymaskthesymptoms
notedbythepatient.Ifthisfactisnotremembered,diagnosisofdiverticulosisoraperforatedpeptic
ulcermaybedelayed,withdisastrousresults.Preoperativeassessmentshouldleadtooptimization
ofanypersistentseriouscondition.Intraoperatively,andeventhewholeoftheperioperativeperiod,
remember that the only useful protective approach against renal damage is to ensure adequate
circulatoryvolumeandoptimalrenalbloodfow.Meticuloussurgicaltechniqueandgentlehandling
oftissueswillalwaysprovetobethebestmethodsofpreventingsurgicalcomplicationsandthus
helpingpreservetherenalfunctionoftherenaltransplantpatient.
Session 10
Trauma Panel Discussion
Itanong Mo Kay Doctorney: Medico-legal Issues in Trauma
Case Management
Orlando O. Ocampo, MD

Surgeonshaveaveryimportantroleinthecorrectidentifcation,labeling,classifcationand
grading of injuries. It is usually this labeling and classifcation which guides the lawyers during the
litigationofmedicolegalcases.Thepreservationofevidenceandthechainofcustodyoftheevidence
inmanycasesstartswiththesurgeonsandispartlytheirresponsibility.ThispanelofDoctorneys
and a forensic pathologist will address the legal implications for the surgeons should there be a
mislabeling or incorrect classifcation of an injury or a break in protocol for the preservation and
custodyoftheevidence.
Session 11
SICULectures:CriticalCareofTraumaPatients
Evolution of the Concept of SIRS
EduardoR.Bautista,MD
TheconceptofSIRS(systemicinfammatoryresponse)hasevolvedthroughtheyears.
Theobjectivesofthispresentationareto:
37
1. DiscusstheevolutionofSIRS.
2. Discussinterventionssoastoavoidcomplications&improveoutcome.
Dr.BenEisemanfrstusedthetermMultiorganFailureSyndromein1977.Surgeonsthought
thatthecauseofthisMOFisintraabdominalinfection.However,patientswhohadcontrolledorno
intraabdominalinfectionstilldevelopedMOF.
In the 80s, the concept of shock causing bowel ischemia and bacterial translocation was
introduced.
Inthe90s,BoneintroducedtheconceptofSIRS.Anyformofinsulttothebody(e.g.trauma,
infection, stress etc.) would trigger a cascade of infammation in the body. It is equated by most
surgeonstoafrerapidlyspreading.Numerousstudiesonhowtoputoutthecascadeweredone
butnotmuchbreakthoughwasachieved.Moorein1996describedthe2ndhitphenomenonwhere
patientsintheICUgetsickagainonthe6to8postopday.The2ndhitisnowknowntobeiatrogenic
(causedbysurgeons)
In2005,Moorenotedthatthe2ndHitinICUpatientsdisappeared.Thisisattributedtothe
improvedcareoftraumapatientsontheinitialinjuryandintheICU.Thiswillbediscussedfurtherin
the presentation.
With the improvement in the mortality rate in advanced Surgical ICUs, new subsets of
patientsareemerging.Patientswhoareinacatabolicstate,weak,notverysickbutdoesnotrecovery
fully.Theirwoundsbreakdownandtheyhaveon/offpulmonaryinfection.TheystayintheICUlonger
and eventually get better or transfer to a step down facility but barely functional.This subset of
patientsislabeled-PICS(persistentinfammatory,immunosuppressioncatabolicsyndrome).Thiswill
beanewchallengethatsurgeonswillbefacingin2013onwards.
Massive Blood Loss and Transfusion
Adrian Manapat, MD
Hemorrhagicshockaccountsfortheleadingcauseofdeathintraumaataround40%.Apatient
withmassivebleedingpresentsrepresentsoneofthebiggestclinicalchallengesinthemanagement
of trauma.
Our objectives are: 1)To describe the development of hemodilution and coagulopathy in
massivebleeding,2)Toreviewtheconsequencesofmassivebloodtransfusionandtheirmanagement,
3)Topresenttrendsandconceptsinmassivebloodlossandtransfusion.
Theevolutionofcoagulopathyinamassivelybleedingpatientstartswitharapidconsumption
ofcoagulationfactorsandplatelets.Theiractivityisalsoreducedasaresultofhypothermia,acidosis
anddilution.Formedclotsmaybebrokendowninappropriatelybymanipulationofwoundsand
fbrinolysis.
Volumehomeostasisthroughautologousfuidshiftsintointravascularspaceandresuscitation
with crystalloids cause further hemodilution.As volume replacement is achieved, blood pressure
risesandthencausesmoreprofusebleeding.Additionalbloodlossisreplacedwithmorefuidsina
viciouscycle.
Massivebloodtransfusion,apotentiallylifesavingmeasure,comesataprice.Thefollowing
are complications associated with transfusion hemolytic (acute and delayed) and non-hemolytic
38
reactions, disease transmission, immunomodulation, and physiologic effects such as citrate toxicity,
acidosis,andhyperkalemia.
Numerous reports support massive transfusion protocols that employ high fxed ratios
FFP:PRBCtransfusion.Theseciteimprovedresultsintermsofsurvivalduetodecreasedratesof
coagulopathy.
Fromtheanestheticside,hypotensiveresuscitationstrategyhasbeenadvocatedinhemorrhagic
shocktolimitbloodlosswithoutsacrifcingtissueperfusion.
Approach to a Patient with Hypotension in the Surgical
ICU
Allan Dante M. Concejero, MD
ThecommoncausesofhypotensionandshockinatraumapatientintheICUarevolume
loss (blood and body fuids), hypothermia and coagulopathy, hypoglycemia, and sepsis and septic
shock.Shockresultsprimarilyfrominadequateoxygendelivery,thereby,producinglacticacidosis.This
isinitiallyseenattheorganlevelasalteredmentalstatusanddecreasedurineoutputinbrainand
kidneydysfunctions,respectively.Earlygoal-directedtherapyshouldbeginassoonasthesyndromeis
recognizedandshouldnotbedelayedpendingICUadmission.Anelevatedserumlactateconcentration
identifes tissue hypo-perfusion in patients at risk who are not hypotensive. Bicarbonate level and
basedefcit(takenfromanABG)aregoodsurrogateindicators.A500-mlbolusofcrystalloidshould
begivenevery30minutestomaintainaCVPof8-12mmHg.Ameanarterialpressureof65-90
mmHgisdesirable.Whenanappropriatefuidchallengefailstorestoreadequatebloodpressure
andorganperfusion,therapywithvasopressoragentsshouldbestarted.Vasopressorsmayalsobe
requiredtosustainlifeandmaintainperfusioninthefaceoflife-threateninghypotension,evenwhen
afuidchallengeisinprogressandhypovolemiahasnotyetbeencorrected.
End of Life Care in the Surgical ICU
Atty.JoelU.Macalino,MD
Asthepopulationinourcountryagesandmedicalsciencepushtheboundariesofhuman
physiology,wehavetoconsiderthatourprolongedexistencemayinvolveincapacities,particularly
attheend-of-lifeintheintensivecareunit.Thisarenainvolvesnotonlypatientsandfamilies,butalso
caregivers.Itinvolvestopicsfromeconomicstoexistentialism,andsurgerytospiritualism.Itrequires
education,communication,acceptanceofdiversity,andanultimateacquiescencetotheinevitable.For
thenexttenminutes,thelecturerwillpresentanoverviewofENDOFLIFEISSUESespeciallyinthe
SurgicalICU.(ThomasJ.Papadimos,IntJCritIllnInjSci.201)
Session 12
39
TCVS Lecture:Anatomy & Surgical Exposures of
MajorBloodVesselsinTrauma
Exposure of the Subclavian and Axillary Vessels
Adrian Manapat, MD
Thesubclavianandaxillaryvesselsareuncommonlyinvolvedintrauma.Mostinjuriesaredue
topenetratingtraumaandcarryahighmortalitywithasmuchas60%dyingbeforereachingthe
hospital.
Our objectives are: 1)To review the anatomy of the subclavian and axillary vessels, 2)
To describe different incisions used to obtain adequate exposure of these vessels during trauma
surgery.
The subclavian artery is divided into three portions in relation to the scalenius anterior
muscle.Thefrstportioncommonlyarisesfromthebrachiocephalic(innominate)arteryontheright
anddirectlyfromtheaorticarchontheleftandliesmedialtothescaleniusanteriormuscle.The
secondportionliesontopofthebrachialplexusandunderthescaleniusanteriormuscle.Thethird
portionislocatedlateraltothescaleniusanteriormuscle.Thesubclavianveinislocatedinfrontand
belowthearteryoverthescaleniusanteriormuscle.Theaxillaryarteryislikewisedividedintothree
parts in relation to the pectoralis minor muscle.
Severalincisionsareavailableforsubclavian/axillaryvesselexposureincludingsupraclavicular,
infraclavicular, median sternotomy, thoracotomy and trapdoor.The choice of incision should be
tailoredtothesituation,dependingonthelocationofinjury,trajectoryofthemissileorweaponand
experience of the operator.
In cases of suspected subclavian vein injury, venous access should be inserted in the
contralateralarmtopreventspillageofinfusedresuscitativefuidsandthepatientshouldbeplaced
inTrendelenburgpositiontopreventairembolism.
Exposure of the IVC and Retrohepatic Cava
Allan Dante M. Concejero, MD
Abdominalvasculartraumaisoneofthemorecommonlethalinjuriesencounteredbythe
modern-daytraumasurgeon.Penetratingvasculartraumaaccountsfor60%-90%ofthemajorityof
vascularinjuries.Injurytothevenacavacarriesamortalityof60%-100%.Thekeystosurvivalare
basedongoodproximalanddistalcontroloftheinjuryandadequateexposureoftheabdominal
vasculature.Thecommonvascularexposureapproachesincludeleftvisceralrotationtoexposethe
celiac,retroperitonealaortaandIVC,KochermaneuvertovisualizetheIVCandrightrenalvein,and
rightvisceralrotationtoexposetheaorta.InjurytotheretrohepaticIVCcouldbeapproachedthrough
rightatrial,infrahepaticIVC,saphenofemoral,andby-passprocedures.Thepreferredapproachwould
dependontheclinicalconditionofthepatient,materialsavailable,andexperienceofthesurgeon.
Propertimingisimportantwhendecidingtouseacavalshunt.
40
Anatomy & Surgical Exposure of the Abdominal Aorta
EduardoR.Bautista,MD
The abdominal aorta is a midline structure which has a complex relationship with other
organsintheabdomen.Itisretroperitonealinlocationandissemi-circularlyenvelopedbyseveral
importantstructures.Masteryoftheanatomyandexposureoftheabdominalaortaanditsbranches
isamustintraumasurgery.
Theobjectivesofthepresentationare:
1. TodiscusstheanatomyoftheAbdominalAortaanditsadjacentstructures.
2. TodiscusstheExposureofUpperAbdominalAortaanditsbranches.
3. TodiscusstheExposureoftheLowerAbdominalAorta.
ReviewofAnatomy
Theabdominalaortaisdividedinto:
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 Vessels
JaimeF.Esquivel,MD
Lowerextremityvasculartraumaresultsinsignifcantmortality,morbidityandlimbloss.These
injuriesarecommonlyencounteredbygeneralsurgeons.Thekeytopropersurgicalmanagementis
goodproximalanddistalvascularcontrolandadequateexposureoftheinjuredsegment.Vascular
exposurerequiresfundamentalanatomicknowledgeofthelowerextremity.Thecommonapproaches
to expose the iliac, femoral and popliteal arteries are presented.
Session 13
41
GS3PanelDiscussion
Basic and Advances in the Management of Cholangitis
DanteAng, MD, CrisostomoArcilla, Jr., MD,A Ericson Berberabe, MD, Jose Macario Faylona, MD,
DerreckResurreccion,MD,RamonL.deVera,MD
Bydefnitionacutecholangitisisdefnedasamorbidconditionwithacuteinfammationand
infectioninthebileduct.
Etiology
Cholelithiasis
Benignbiliarystricture
Congenital factors
Post-operativefactors(damagedbileduct,stricturedcholedojejunostomy,etc.)
Infammatoryfactors(orientalcholangitis,etc.)Malignantocclusion
Bileducttumor
Gallbladdertumor
Ampullarytumor
Pancreatic tumor
Duodenal tumor
Pancreatitis
Entryofparasitesintothebileducts
Externalpressure
Fibrosisofthepapilla
Duodenaldiverticulum
Bloodclot
Sumpsyndromeafterbiliaryentericanastomosis
Iatrogenicfactors
42
Diagnosis
Thediagnosisofcholangitismaybeconfrmedbyfollowingthediagnosticcriteriastipulatedbelow.
Management
Inthemanagementofacutecholangitis,itisimportanttoassessthedegreeofseverityof
cholangitis (see table below) to tailor the management according to severity. Despite different
degrees of severity, the mainstay in the management of cholangitis is immediate drainage of the
bileduct.Thisworksinconjunctionwithantibioticcoverageaswellothersupportivemanagement.
Drainageofthebileductisachievedbyseveralmeans.TheleastinvasiveisthroughERCPstenting
ornasobiliarydrainagefollowedbypercutaneousapproachesandthensurgery.
43
Severity Classifcation of Cholangitis
Source: HepatobiliaryPancreatSci(2013)20
44
Session 14
Endosurgery Lecture: Avoiding and Managing
Complications in Laparoscopic Cholecystectomy:
LessonsfromtheLast20Years
AnthonyR.PerezMD
Theadventoflaparoscopyandendoscopicsurgeryhasbroughttremendousadvancesin
thefeldofmedicine,evolvingfromasimplediagnostictooltoanindispensablemodalityinthe
diagnosis,treatmentandfollow-upofseveraldiseases.Sinceitsintroductionin1985,laparoscopic
cholecystectomyhasbecomethestandardofcareforthetreatmentofgallstones.TheUP-PGH
DepartmentofSurgeryhasdistinguisheditselfbypioneeringlaparoscopiccholecystectomyinthe
countryandithasbeenmorethan20yearssincethe1stlaparoscopicsurgerywasperformed
inPGH.Thesucceedingyearsmarkedtremendousimprovementintrainingandinstrumentation,
andconsequently,thefrequencyoflaparoscopiccholecystectomyhasincreased.Thisisattributable
bothtotheincreasedincidenceofgallstonediseaseandtotheincreasingnumberofsurgeons
performinglaparoscopicsurgeryinthecountry.Ithasbecomeapparenthoweverthatwith
therapidadoptionofthisnovelprocedurebyalargenumberofsurgeonsinashortperiodof
time,theadvancesinthefeldoflaparoscopyhasnotdecreasedtheincidenceofcomplications
attributabletolaparoscopiccholecystectomy.
TheonehoursessionsponsoredbytheDivisionofEndosurgeryfocusesontheprevention
ofcomplicationsandintraoperativestrategiestoaddresscomplicatedsituationsintheperformance
oflaparoscopiccholecystectomy.Adiscussionbyarenownedexpertinthemanagementof
bileductinjuriesdrawnfromanexperienceofseveraldecadeswillthesession.Theformatwill
incorporateshortlecturesandanensuingpaneldiscussionintendedtobeinteractivewiththe
audience.
The1stlecturewilldiscusstheexperiencewithgenerallaparoscopicsurgerycomplications
includingproblemsduetoCO2pneumoperitoneum,hemorrhageduringsurgery,trocarand
trocarsiterelatedcomplications,infectionandotherprocedurespecifcinjuries.Itwillalsoinclude
adiscussiononspecialproblemswhichmaycomplicatelaparoscopiccholecystectomy-previous
surgery,infammation,morbidobesity,pregnancy,intraoperativebleeding,stonesandobscure
anatomy.Strategiestoavoidandaddressthesecomplicatedsituationstopreventmorbidityand
mortalitywillbediscussed.
Thehighlightofthesessionisalectureandensuinginteractivediscussiononbileduct
injuries.Strategiestoavoidbileductinjurieswillbediscussed,includingpatientandsurgeonrelated
riskfactors,intraoperativedecisionmakingandtheneedforconversion.Theclassifcationofbile
ductinjurieswillbereviewedandcorrelatedwiththeappropriatemanagementofthetypesof
injury.Moreimportantly,theoperativemanagementofbileductinjuriesasrelatedtothemore
than20yearsexperienceofthefacultywillbesharedwiththeparticipants.
45
GS1 Workshop
Principle of Breast Cancer Management: Back to
Basics
Breastcancerremainstobeasignifcanthealthprobleminthecountry.BasedontheGlobocan
2008report,breastcancerwastheleadingcancersiteforbothsexescombinedandthefrstamong
women in 2010. Moreover, it was the 3rd most common cause of cancer deaths for both sexes
andthe1stamongwomeninthesameyear.Theagestandardizedincidencerateofbreastcancer
inthecountryisat31.9per100,000population.Thisrate,whilelowerthanmostofthedeveloped
countriesintheworldandintheAsiaPacifcregion,ishigherthansomeofthelessdevelopedAsian
nations.
In recognition of the tremendous burden of breast cancer disease in the country in the
contextofapopulationwithlimitedaccesstohealthcare,theDivisionofSurgicalOncology,Head
&Neck,Breast,Skin&SoftTissue,andEsophagogastricSurgeryoftheDepartmentofSurgeryof
the University of the Philippines - Philippine General Hospital, in partnership with the Philippine
CancerSocietyandtheprivatesectorpartner,AvonPhilippines,haveestablishedtheUP-PGHBreast
CareCenterinOctober2002tocatertothehealthneedsoftheunderservedpatientswithbreast
problems.Thecenterisdesignedtobeaone-stopshopforpatientswithbreastcomplaints,from
diagnosistomanagementincludingsurgeryandchemotherapy.Itismannedbysurgicalresidentand
fellow staff of the division, under the direct supervision of the division consultants. From 2004 to
2012,therehasbeen184,575consultsinthecenter,withanannualaverageof20,508.Ofthetotal
numberofconsultations,58%(107,520total,11,946annualaverage)areduetobreastcancer.On
theaverage,thecentergives1,869chemotherapysessionsand1860breastbiopsiespredominantly
core needle biopsies per year.About 500 to 600 modifed radical mastectomies and 5-10 breast
conservingsurgeriesareperformedannuallyforbreastcancer.
Sinceitsestablishment,theBreastCareCenter,whilecontinuinglydeliversservicestomany
patientswithvariousbreastdisorders,hasalsoallowedthedivisiontogaintremendousexperiencein
thetreatmentofbreastcancer.Therefore,throughthissymposium,weaimtosharethisexperience
throughdiscussionofthebasicprinciplesofthedifferentmodalitiesofbreastcancermanagement
withintegrationofthelatestlocalandinternationalclinicalpracticeguidelinesinordertoimprove
theoverallmanagementoutcomes.
46
Diagnosis, Pathology, and Staging
ShielaS.Macalindong,MD,DPBS
Biopsyremainstobethecornerstoneofbreastcancerdiagnosis.ThePhilippineCollegeofSurgeons
BreastCancerGuidelinesrecommendfneneedleaspiration(FNA)astheinitialdiagnosticprocedure
given its excellent test characteristics and wide availability. Core needle biopsy, where available, is
equally valuable and has the advantage of providing tissue diagnosis thereby additionally allowing
hormonereceptor(estrogenandprogesteronereceptor;HR)andhumanepidermalgrowthfactor
receptor 2 (HER2) tumor status determination. Invasive ductal carcinoma represents the most
commontypeofinvasivebreastcancer.Severalhistologictypesofbreastcancersuchastubularand
mucinouscarcinomaareconsideredfavorablehistologiesandareassociatedwithbetterprognosis.
Hormone receptor and HER2 status are predictive and prognostic factors that guide choice of
adjuvanttherapy.HRstatusisdeterminedusingimmunohistochemistryandresultsarescoredand
interpretedaccordingtotheAllredscoringsystem.HER2overexpressioncanbeassessedusingIHC
orfuoresecentinsituhybridization(FISH)techniques.BreastcancerstagingfollowstheAmerican
JointCommitteonCancer(AJCC)StagingManual7theditionandisbasedontumor(T),regional
nodes(N),andmetastases(M)statusofthecancer.
Breast Conservation Therapy in the Management of
Invasive Breast Cancer
NelsonD.Cabaluna,MD,FPCS
Several prospective randomized trials comparing breast conservation therapy versus
mastectomy have demonstrated equivalence in overall and disease free survival for appropriately
selectedpatientswithearlystageinvasivebreastcancer.Importantelementsinpatientselectionare:
historyandphysicalexamination,assessmentofpatientsexpectations,accuratebreastimagingand
thoroughhistologicassessmentofresectedbreastspecimen.Asidefromgoodsurvivaloutcomes,an
addedgoalofthesurgicalandradiationproceduresisminimalcosmeticdeformity.
Immediate or Delayed Breast Reconstruction: What is
Recommended?
NeresitoT.Espiritu,MD,FPCS
Itisbecomingapparentthatbreastreconstructioncanimprovethepsychosocialwell-beingand
qualityoflifeofthepatient.Breastreconstructioncanbedoneusingautologoustissueorprosthetics
oracombinationofthetwo.Autologousreconstructionusestissuefapswhereasprostheticsuses
implants.Breastreconstructioncanbedoneimmediatelyordelayed.However,patientrequiringpost-
operativeradiotherapyposesachallengesinceitisassociatedwithincreasewoundcomplicationand
alteredcosmeticoutcome.Whenpost-mastectomyradiationisrequired,delayedreconstructionis
generallypreferredaftercompletionofradiationtherapyinautologoustissuereconstruction,because
of reported loss in reconstruction cosmesis. When implant reconstruction is used, immediate rather
thandelayedreconstructionispreferredtoavoidtissueexpansionofradiatedskinfaps.
47
Role of Surgery in Stage IV Breast Cancer
RodneyB.DoftasMD,FPCS
Metastatic breast cancer is widely considered an incurable disease. Often, it is generally
acceptedthatlocaltherapyprovidesnosurvivaladvantageoncemetastaseshaveoccurredandthat,
in fact, tumor excision may further stimulate the growth of the metastases. But this paradigm is
nottrueintumorsofcolorectal,renalcell,gastricandovarianoriginwheresurgicalmanagement
ofStageIVdiseasehasbeenfoundtoimprovesurvival.So,atthispointintimeWhatisthethe
evidencefortheroleofSurgeryinstageIVBreastcancer?Severalreviewsandretrospectivestudies
havebeendonethatshowsurgicalmanagementinstageIVbreastcancerimprovespatientsurvival.
Anobservationalstudylikewiseshowedthatsurgeryoftheprimarytumorcanactuallyimprove
survivalofmetastaticbreastcancer.Meta-analysisofdata(populationbasedandsingleinstitutiondata)
demonstratedimprovedsurvivalinpatientswhounderwentsurgicalresectionoftheprimarytumor.
Primarytumorresectionwithclearmargins,youngerageofpatients,smallersizedtumorandsolitary
or single site metastases contributed to better survival. However, in the absence of prospective
randomized clinical trials, the results that show improved survival as being due to selection bias ,
cannotbetotallydiscounted.DataonsurgicalmanagementofstageIVbreastcancerisdebatablebut
thetrendtowardsimprovedsurvivalcannotbeignored.
Principles of Adjuvant & Neoadjuvant Treatment for
Breast Cancer
GemmaLeonoraB.Uy,MD,FPCS
Despite early diagnosis and increasingly effective treatment for breast cancer, a signifcant
proportionofwomenrelapseandeventuallydieofthedisease.Thus,systemictherapyhasbecome
anintegralpartoftheadjuvanttreatmentforbreastcancer.Assessmentofthebeneftagainstthe
knownrisksisessentialforeveryclinicianbeforerecommendinganytreatmenttoapatient.Current
recommendations based on international guidelines such as the NCCN and the St. Gallen 2013
Consensusontheuseofadjuvanttreatmentthatwillbehelpfultothesurgeonsinthemanagement
oftheirpatientswillbediscussed,specifcallyontheindicationsforuseofchemotherapy,endocrine
therapyandradiotherapy.TheUP-PGHBreastCareCenterexperienceonneoadjuvantchemotherapy
forlocallyadvancedbreastcancerwillalsobepresented.
Strategy for Surveilance After Breast Cancer Primary
Therapy
OrlinoC.BisqueraJr.,MD,FPCS
Early identifcation of recurrence, whether local, regional or distant site, and detection of
metachronous contralateral breast cancer are the main reasons for continued surveillance after
primarytherapyofbreastcancer.
Thenodalstatusisthemostimportantindicatornotonlyforsurvivalbutalsofortheriskof
48
recurrence,withnodepositivepatientshavingaremarkablyhigherrisk.Majorityofrecurrencesare
manifestedbymetastasistodistantsitessuchasthebones,lungs,pleura,softtissueandtheliverin
decreasingorderoffrequency;metastasisintheloco-regionalareaisseeninfewercases.Whereas
mostoftherecurrencesoccurwithinthefrstthreeyearsoftreatment,theonsetmaytakeseveral
yearsinsomepatientsthereforerequiringlong-termfollowup.Furthermore,severalstudiesshowed
the risk for subsequent contralateral breast cancer to be 0.5% to 1.0% per year necessitating a
stringenteffortofscreeningforitsearlydetection.
The main modality in detecting recurrence after primary treatment is still an appropriate
and detailed history and physical examination. Data from various reports revealed that signs and
symptomsidentifedtheonsetofrecurrenceinmostofthepatients.Signsandsymptomssuggestive
ofrecurrencearedirectlyrelatedtotheorganinvolvedandmustbepickedupbytheexamining
surgeon.Thesemayincludebonepains/tendernessforbonemetastasis,cough/dyspneaforlungor
pleuralmetastasis,abdominalrightupperquadrantpain/jaundiceforlivermetastasis,andheadache/
dizzinessforbrainmetastasis.Asymptomaticrecurrencesaredetectedthroughlaboratorytestsand
imagingproceduresinonlysmallpercentageofpatients.Thesefndingstogetherwiththeassociated
high cost of surveillance testing bring out the question on whether postoperative follow up in
search for recurrence should be done in a SYMPTOM-DIRECTEDAPPROACH, that is, ancillary
metastaticworkupsarerequestedasindicatedonlybysignsandsymptoms,orthroughaROUTINE
/INTENSIVEAPPROACH,whichisdoneevenintheabsenceofsymptoms.Equallyrelevantquestion
is,ifarecurrencewasdetectedintheasymptomaticstage,willearlydetectionalterthenaturalcourse
ofthedisease?Severalrandomizedtrialshaveaddressedthesequestionsandtheresultssuggested
that 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 value of the different routine tests such
ascompletebloodcount,liverandrenalchemistrystudies,chestx-ray,bonescan,cranialCTscan,
liverultrasoundandbreastcancertumormarkers(CA15-3&CEA)indetectingasymptomatic
recurrenceshasbeenevaluated.Whiletheymaydetecttherecurrenceabout4to6monthsprior
totheonsetofsigns&symptoms,institutionofrecurrence-specifctreatmentatthisasymptomatic
stagelikewisedidnotshowimprovementintheoverallsurvival.Thesetestsonlyincreasedpatients
anxietyandcostoffollow-upwithnoaddedclinicalbeneft.Hence,thesetestsarenot routinely
recommended.
Therefore,thecurrentrecommendationforfollow-upisviaasymptom-directedapproach.
It is attained through careful history and physical examination every 3 to 6 months for the frst
3yearsafterprimarytherapy,thenevery6to12monthsforthenext2years,andthenannually
thereafter.Laboratorytestsandimagingmodalitiesarenotroutinelyrecommendedinasymptomatic
patients.Furthermore,screeningformetachronouscontralateralbreastcancerisdonethrougha
well-instructedMonthlyBreastself-Examinationandyearlycontralateralmammography.
49
BACK TO THE FUTURE: Recent Basic and Not-so-basic
issues in Breast Surgical Oncology
MarkRichardC.Kho,MD,FPCS
Aswelookbacktothebasics,werealizethatsurgerydoesremaintheoldesttreatmentfor
breastcanceranduntiltherecentpast,wastheonlytreatmentthatcouldcurepatientswithcancer.
Andasthesurgicaltreatmentforbreastcancercontinuestoevolvethroughoutthenewmillennium,
the surgeon still occupies a central role in the prevention, screening, diagnosis, multidisciplinary
management,palliationandrehabilitationofthebreastcancerpatient.Thefast-paceddevelopment
andimprovementsinmodernoncologysuchasinsystemicandradiationtherapy,haveprompteda
re-assertionofthatkeybasicroleofthesurgeon.
Nonehasbeenasbasicanissueinbreastcancerasthemanagementoftheaxilla.Sentinellymph
nodebiopsy(SLNB)inappropriateclinicallynodenegativepatientsusingintraoperativeradioactive
lymphatic mapping with or without blue dye staining, has emerged as an option to axillary nodal
dissection(AND)albeititsdrawbackstowidespreadapplicationhereinthePhilippines.Itisimperative
thattheproperindicationandapplication,aswellasanadequatediscussionwiththepatientofthe
risks,benefts,costsandpossiblecomplications,bemadeforthisprocedure.Oddlyenoughthough,
when one considers the recent results of the ACOSOG Z0011 trial proving completion AND
unnecessaryinselectedSLNB+breastcancerpatientsandthenot-so-recentresultsoftheNSABP
B04trialshowingnosurvivalbeneftintheadditionofANDtomastectomyaloneorradiotherapy,
onewonderswhetherbothSLNBandANDareinandbythemselvessuperfuous.
TherecentdoublemastectomyundertakenbymegastarAngelinaJolieforpreventionofBRCA
mutation-associated breast cancer underscores another basic application of surgery as a primary
modality.DubbedtheAngelinaeffect,thisintrepidactnodoubtsinglehandedlyadvancedthecause
ofcancerawarenessandpreventiontowherenomanhasgonebefore.Makingheadlinesallaround
theglobe,thesideissuesofBRCAtestingandgenepatentinghavealsosharedthelimelight.The
recentUSSupremeCourtdecisiononwhichspecifcareasofgenomicresearchmaybecopyrighted
hasbeensaidtohaveforgedfuturedevelopmentofnovelapproachestogenetherapyandmade
BRCAmappingmoreaffordableandavailableworldwide.
Finally,aswetakealooktothefutureofbreastcancermanagement,wecannotbutberuffed
bywhatisprobablythemostcontroversialissuewithinthemedicalcommunitynowadaystoutedto
bethefutureofmedicine,thatofstemcelltherapy.Itisindeedtragicthatdespitetheevidence
againstitsuseoutsideofaclinicaltrialastherapyforbreastcancer,somephysicians/surgeonshave
encouraged the supposed panacea for therapy alone or alongside standard cancer treatments to
eager and desperate patients, some even for not-so-meager fnancial gain. On the other hand, it
isinspiringtoseetheferventandjustoppositionfromcourageouscolleaguesspeakingoutonthe
misuse of this potentially benefcial yet unproven and possibly dangerous proverbialfountain of
youth.
50
GS2 Workshop
SurgicalStaplingTechniquesinColorectalSurgery
Attheendofthesession,theparticipantsareexpectedto:
Understandtheprinciplesofsurgicalstaplingwiththeaidoflectureandvideodemonstration
Demonstratethedifferenttypesofsurgicalstaplingtechniquesduringtheworkshopusingcows
intestine
Side to side anastomosis 1.
Transection of the rectum 2.
Intraluminalstapling 3.
Laparoscopicstapling(optional) 4.
PSUS Workshop
BasicUltrasoundCourseforSurgeons
Ultrasonography is a very useful tool in the practice of clinical medicine. The use of
ultrasonography has helped in the diagnosis and management of many patients. Improvements in
ultrasoundtechnologyandtechniquesmakepatientmanagementformerlydeemeddiffcultmore
straightforward.Learningthebasicprinciplesofultrasonographyanduseoftheultrasoundmachine
willhelpthegeneralsurgeoninmanagingthesimpleandcomplexcasesthatheorshefacesdayto
day. Ultrasonography and performance of ultrasound-guided procedures are important tools that
clinicians should arm themselves with especially in this era of minimally invasive procedures and
surgeries.Thissessionaimstohelptheparticipantunderstandthephysicsbehindultrasonographyas
wellastoprovidetheparticipantwithbasicworkingknowledgewithmanipulationoftheultrasound
machine. It also aims to familiarize the participant with basic normal fndings as well as abnormal
fndingsincommondiseasesofthehepatobiliarytractandthebreast.Attheendofthesessionthe
participantswillbegivenacertifyingexaminationonthebasicprinciples,techniquesandpracticesof
surgicalultrasoundconductedyearlybythePhilippineSocietyofUltrasoundinSurgery(PSUS).
51
GS3 Workshop
Choledochoscopy
Choledochoscopyisaproceduredonetodirectlyvisualizethebiliarytractwithanendoscope
through a t-tube or incision into the common bile duct. It has both diagnostic importance and
therapeuticvalueformostdiseasesofthehepato-biliarytractsystem.Thetechniqueprovidesdirect
examinationofthebiliarytract,whichwillhelpvalidatethediagnosis,andatthesametime,itallows
therapeuticendoscopicproceduressuchasbiopsyorcytology,stoneextraction,balloondilatation,
electrocoagulation,stentremovalorplacement.Theprocedureisrelativelysafeandeasytousewith
alowmorbidityrateof<5%.
TCVS Workshop
VascularAccessWorkshop
Introduction
Directaccesstothevascularsystemisconsideredoneofthefoundationsofmodernclinical
practice.Inbroadterms,vascularaccessincludesanyformofcannulationofarteriesorveins.
Thedecisiontoobtainvascularaccesscanbeamajorchallengetotheattendingsurgeon.
Factors,suchasthepatientsageandsize,theavailabilityofvenousaccesssites,theindicationfor
access, and even the anticipated length of use, can potentially complicate the decision.Although
obtainingvascularaccessisgenerallyasafeprocedure,itisnotwithoutcomplications,someofwhich
canbelifethreatening.

Therefore,theobjectivesofthissessionarethefollowing:
Tobriefyreviewtheindicationsforpercutaneousvascularaccess 1.
To provide practical considerations on the various options and techniques for 2.
percutaneous access
To discuss the possible complications and ways to avoid or minimize these 3.
complications
52
Indications
Theindicationsforvascularaccessarenumerous.Ingeneral,theseincludeadministrationor
facilitationofthefollowing:
Total parenteral nutrition 1.
Chemotherapy 2.
Venous access for the chronically ill requiring repeated venipunctures for blood 3.
sampling and medications
Longtermantibiotics(longerthan3-4weeks) 4.
Emergencyaccess(e.g.tomanagecardiopulmonaryarrestortrauma) 5.
Critical care monitoring 6.
Plasmapheresis 7.
Hemodialysis 8.
Vascular Access Options

Withmoderntechnologicaladvancesinvascularaccess,avarietyofoptionsarenowavailable
tophysicians.Ingeneral,vascularaccesscanessentiallybedividedinto2broadcategories:peripheral
and central venous. Peripheral, short-term catheters are safe for giving many IV medications (eg,
antibiotics),forprovidingmaintenanceIVfuids,andforbloodsamplingforlaboratorytests.However,
numerousfuidsandmedications(eg,hyperosmolarsolutions,resuscitativedrugs)cannotbegiven
throughperipheralcathetersbecauseoflocalandvenousirritation.Likewise,certainindicationssuch
as patients needing long-term treatment (eg, antibiotics), chemotherapy, andTPN require central
venousaccess.Table1comparesthevariousoptionsavailableforvascularaccess.
Technique
Varioustipsandtrickstofacilitatepercutaneousvascularaccesswillbediscussedtoensure
successandsafetyoftheprocedure.Thiswillbediscussedatlength
Complications (central venous access)
Complications for vascular access can be divided into acute (during the insertion period
or shortly after) or long term (seeTable 2).The physician should have a thorough knowledge of
the anatomy and of the potential complications from the procedure to identify and quickly treat
anycomplicationsthatmayarise.Inaddition,thephysicianshouldhaveworkingknowledgeofthe
vascular-accessdevicetobeusedtoavoidconfusionandpotentialmishandlingofthecatheter.Finally,
athoroughpreoperativeevaluationshouldbeundertaken.Itshouldincludeareviewoftheresults
ofcoagulationstudiesandattentiontotheplacementofpreviousvascular-accessdevices.Informed
consentshouldbeobtainedanddocumentedonthepatientschart.
53
Table 1. ComparisonofOptionsforVascularAccess
54
Burn Workshop
InnovationsinWoundManagement
(WhatisCurrentandWhatisAvailable)
Attheendoftheworkshop,theparticipantsshouldbeableto:
knowtheelementsofastructuredapproachtowoundmanagement(the TIMEconcept)
o Tissuemanagement(debridementtechniques)
o Infection/infammationcontrol
o Moisturebalance
o Edge of wound management
determinetheindicationsandutilizationofcurrentlyavailableinnovativetechniquesinwound
management
performtheactualwoundmanagementtechniques
Table 2. ComplicationsofInsertingCathetersforVascularAccess
55
Participants Profle
Total Number of Participants: 271
Pre-registered 156
On site registration 115
Profle of Participants:
Alumni 15
Consultants 129
Residents 121
Participants by type of Hospital Affliation:
GovernmentHospital 134
PrivateHospital 130
NotSpecifed 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 Participants
GS1PrinciplesofBreastCancerManagement:BacktoBasics 39
GS2SurgicalStaplingTechniquesinColorectalSurgery 13
GS3Choledochoscopy 18
PSUSBasicUltrasoundCourseforSurgeons 11
TCVSVascularWorkshop 21
BurnInnovationsinWoundManagement 91
EVENT
PICTURES
Scientifc
Activities
Day1:September4,2013
Registration Team
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.Baltazarwelcomingallparticipants
in the 49th Postgraduate course
PGHDirector&TCVSconsultantDr.JoseGonzalescongratulatesFASE&
the department for organizing the annual postgraduate course
Dr.Bisquera,ChairofthePostgraduateCoursesCommitteegivesanorientationtoall
participants
13th ATR Memorial Lecture
Dr.Berberabehoststhe13thATRMemorialLecture
Dr.SerafnHilvano,ProfessorEmeritusoftheDepartmentofSurgerydelivershislec-
tureTheRoleofInformationTechnologyinPresentDaySurgery
Dr.RamonDeVeraintroducing
Dr.SerafnHilvano
MrsBellaRamirez,wifeofChancellor
Dr.AlfredoT.Ramirez,givesaheartfelt
message
Dr.TonyOposa&wifewithDr.FernandoMelendres
Dr.WilmaBaltazarwithDr.PorongGana&Mrs.BellaRamirez
awardstheplaqueofrecongnitiontoDr.SerafnHilvano
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
ScientifcSessions
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.NelsonCabalunamoderatedthediscussionwith
Dr.TitoEspirituasoneofthepanelists
Dr.ShielaMacalindong,pastchiefresidentandcurrentseniorSurgicalOncologyfellow
presents the case for discussion
GS1Consultants:(L-R)Dr.GemmaUy,Dr.TitoEspiritu,
Dr.NelsonCabaluna&Dr.JunBisquera
Dr.RodneyDoftasandDr.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.Raquel
Fortun(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..Ed
Bautista,Dr.AllanConcejero,Dr.JaimeEsquivel&Dr.AdrianManapat
Session13:GS3PanelDiscussion,moderatedbyDr.EricBerberabewithpanelistsDr.
DanteAng,Dr.,Dr.MondeVera,Dr.MackyFaylona&Dr.DerekResurrecion
Session14:EndosurgeryPanelDiscussionbyDr.TonyPerez,Dr.JojoArcilla,Dr.Macky
Faylona&Dr.DanteAng
Meet the Professor
Dinners
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:SurgicalStapling
TechniquesinColorectalSurgery
PSUSWorkshop:BasicUltrasound
Course for Surgeons
PSUSWorkshop:BasicUltrasound
Course for Surgeons
GS1Workshop:PrinciplesofBreast
CancerManagement:BacktoBasics
GS1Workshop:PrinciplesofBreast
CancerManagement:BacktoBasics
TCVSVascularWorkshop
BurnWorkshop:Innovationsin
Wound Management
Sponsors
Consultants
Residents &
Staff
PediaSurgeryResidentswithDr.WilmaBaltazar(L-R):Dr.Migs
Deogracias,Dr.DottieDumlao(Fellow),Dr.JasonCastro(Fellow)&
Dr.AlvinAnatastacio
Dra.JojoAlmonte(standing)withDr.JaimeEsquivel
(L-R):Dr.Baltazar,Dr.Arcadio(previousUPManila
Chancellor),Dr.TonyOposa&wife
(L-R):Dr.Baltazar,Dr.Arcadio(previousUPManila
Chancellor),Dr.TonyOposa&wife
Day1Team
Dr.GemmaUyintroducingDr.ReyJoson
(L-R):Dr.Baltazar,Dr.Arcadio(previousUPManila
Chancellor),Dr.TonyOposa&wife
(L-R):Dr.Baltazar,Dr.Arcadio(previousUPManila
Chancellor),Dr.TonyOposa&wife
PlasticSurgery:Dr.Germar,Dr.Sudario&Dr.Tansipek
GS1Consultants:Dr.Bisquera,Dr.Joson&
Dr.Doftas
Dr.BaltazarwithDr.Ocampo&Dr.Serrano
(L-R):Ms.NetteMercado,Dr.Matias,Dr.Abalajon,Dr.Aldana,Dr.Tayag&
Ms.JuvyMarquez
(L-R):Dr.Gallo,Dr.Ng,Dr.Ang,Dr.Firmalino,Dr.Macalindong,Dr.Hao&Dr.DelosSantos Dr.BaltazarwithDr.Ocampo&Dr.Serrano
(L-R):Dr.Ng,Dr.DeVera,Dr.Firmalino&Dr.Macalindong
Dr.JojoArcilla(left)&Dr.TonyPerez(right)
(L-R):Ms.JuvyMarquez,Ms.NetteMercado,Dr.CheTayag&Dr.RodneyDoftas
(L-R):Dr.WengSudario,Dr.FayeDavid-Paloyo,Dr.PinkyDirain-Beran&Dr.MargaritaElloso
(L-R):Dr.BabieTalip-Lucero,Dr.JoyJerusalem,Ms.NetteMercado&Dr.GemmaUy
(L-R):Dr.SabrinaGonzalez,Dr.TwinkleDescallar,Dr.MarkMelendres(Chief),Dr.RainierLutangco
ConsultantsoftheGS1Division:
Dr.JunBisquera,Dr.ReyJoson,Dr.GemmaUy&Dr.TitoEspiritu
Dr.FelixLukban&Dr.SherwinAlamo Dr.WilmaBaltazar&Dr.MarcOnglao
Dr.MarkBerses,Dr.ShielaMacalindong,Dr.GemmaUy&Dr.RodneyDoftas
Dr.JeffWong&Dr.GlennGenuino
GS2Consultants:Dr.AncoyLopez,Dr.BertRoxas&Dr.NonengMonroy
FourthYears
Dr.JannethTan,Dr.NathanielTan,Dr.LesleyCua-Pardo&Dr.RaffyMaddumba
Dr.TinePaguirigan,Dr.JannethTan,Dr.JenicaSo&Dr.AlvinAnastacio
Dr.JannethTan,Dr.OrlinoBisquera&Dr.LesleyCua-Pardo
Dr.AldineBasa-Ocampo&Dr.BokOcampo
ResidentswithDr.JojoArcilla
Dr.KathleenCruz,Dr.AnezaMaglangit,Dr.JobelleBaldonado&Dr.TwinkleMata
GS3:DivisionofHepatobiliary,PancreaticandHerniaSurgery
Dr.RammyRoxas&Dr.WilmaBaltazar
Dr.RammyRoxas&Dr.WilmaBaltazar
Alumni
Participants
156
Offcers of the Foundation for the Advancement of Surgical Education, Inc.
President
Vice-President
Secretary
Treasurer
ExecutiveDirector
Department of Surgery Offcers
Chair
ExecutiveVice-Chair
ExecutiveAssistant
FinanceOffcer
Assistant Chair for Academic Affairs
Assistant Chair for Training
AssistantChairforServices
Assistant Chair for Special Projects
Assistant Chair for Research
Division Chiefs of the Department of Surgery
SurgicalOncology,Head&Neck,Breast,
Skin&SoftTissue,&EsophagogastricSurgery
ColorectalSurgery
HepatobiliaryandPancreaticSurgery
Endosurgery
Trauma
Surgical Critical Care
ThoracicandCardiovascularSurgery
Urology
PediatricSurgery
PlasticSurgery
Burns
Organ Transplant
Postgraduate Courses Committee
Chair OrlinoC.Bisquera,Jr.,MD
Co-Chair JoseMacarioV.Faylona,MD
Members:
MarkRichardC.Kho,MD,CatherineS.Co,MD,DanteG.Ang,MD,EdgardoG.Gonzales,MD,
AnaMelissaH.Cabungcal,MD,LeoncioL.Kaw,MD,Ma.CelineIsobelA.Villegas,MD,
BernardU.Tansipek,MD,Ma.AdelaNable-Aguilera,MD,AllanDanteM.Concejero,MD,
JunicoT.Visaya,MD,AnthonyR.Perez,MD,MarkFrancisA.Melendres,MD,
AireenPatriciaM.Madrid,MD,JannethT.Tan,MD,Ms.EleanorR.MercadoandMs.JuvyM.Concepcion
TelesforoE.Gana,Jr.,MD
JaimeF.Esquivel,MD
GerardoG.Germar,MD
Dennis P. Serrano, MD
Ms.TeresitaT.Venturina
WilmaA.Baltazar,MD
NelsonD.Cabaluna,MD
AEricsonB.Berberabe,MD
Dennis P. Serrano, MD
EduardoR.Bautista,MD
AnthonyR.Perez,MD
JoseMacarioV.Faylona,MD
NikkoJ.Magsanoc,MD
Marie Carmela M. Lapitan, MD
RodneyB.Doftas,MD

HermogenesDJMonroy,MD
RamonL.deVera,MD
AnthonyR.Perez,MD
EricSMTalens,MD
EduardoR.Bautista,MD
AdrianE.Manapat,MD
Dennis P. Serrano, MD
Antonio DR. Catangui , MD
GerardoG.Germar,MD
GlennAngeloS.Genuino,MD
Dennis P. Serrano, MD
157
UP-PGH Department of Surgery
Consultant Staf 2013-2014
JoelPatrickA.Aldana,M.D.
JosefnaR.Almonte,M.D.
DanteG.Ang,M.D.
CrisostomoE.Arcilla,Jr.,M.D.
EricPerpetuoE.Arcilla,M.D.
EduardoC.Ayuste,Jr.,M.D.
JeaneJ.Azarcon,M.D.
WilmaA.Baltazar,M.D.
EduardoR.Bautista,M.D.
AEricsonB.Berberabe,M.D.
OrlinoC.Bisquera,Jr.,M.D.
BrianSamuelS.Buckley,M.D.
AlvinB.Caballes,M.D.
NelsonD.Cabaluna,M.D.
GiselT.Catalan,M.D.
Antonio D.R. Catangui, M.D.
Catherine S. Co, M.D.
Allan Dante M. Concejero, M.D.
RafaelIsidroDJ.Consunji,M.D.
Armando C. Crisostomo, M.D.
JoseJovenV.Cruz,M.D.
JoseLuisL.Danguilan,M.D.
JoseDanteP.Dator,M.D.
FerriP.David-Paloyo,M.D.
RamonL.deVera,M.D.
DanielA.delaPaz,Jr.,M.D.
ArturoS.delaPea,M.D.
RodneyB.Doftas,M.D.
NeresitoT.Espirito,M.D.
JaimeF.Esquivel,M.D.
JoseMacarioV.Faylona,M.D.
TelesforoE.Gana,Jr.,M.D.
EduardoR.Gatchalian,M.D.
GlennAngeloS.Genuino,M.D.
GerardoG.Germar,M.D.
EdgardoG.Gonzales,M.D.
JoseC.Gonzales,M.D.
TeodoroJ.Herbosa,M.D.
SerafnC.Hilvano,M.D.
AnaMelissaF.Hilvano-Cabungcal,M.D.
ReynaldoO.Joson,M.D.
LeoncioL.Kaw,Jr.,M.D.
Mark Richard C. Kho, M.D.
Marie Carmela M. Lapitan, M.D.
AdrianoVictorG.Laudico,M.D.
MarcPaulJ.Lopez,M.D.
FelixbertoS.Lukban,M.D.
JoelU.Macalino,M.D.
NikkoJ.Magsanoc,M.D.
FranciscoC.Manalo,M.D.
AdrianE.Manapat,M.D.
AlvinD.B.Marcelo,M.D.
HermogenesD.J.MonroyIII,M.D.
MariaAdelaA.Nable-Aguilera,M.D.
Richard S. Nicolas, M.D.
Orlando O. Ocampo, M.D.
SiegfredoR.Paloyo,M.D.
MarieDioneA.Parreno-Sacdalan,M.D.
AnthonyR.Perez,M.D.
RacelIreneoLuisC.Querol,M.D.
MariaElizaM.Raymundo,M.D.
Derek C. Resurreccion, M.D.
LeandroL.ResurreccionIII,M.D.
AlbertoB.Roxas,M.D.
ManuelFranciscoT.Roxas,M.D.
EstherA.Saguil,M.D.
Dennis P. Serrano, M.D.
EricS.M.Talens,M.D.
BernardU.Tansipek,M.D.
GemmaLeonoraB.Uy,M.D.
Ma.CelineIsobelA.Villegas,M.D.
JunicoT.Visaya,M.D.
158
UP-PGH Surgery
Resident Staf 2013-2014
CHIEF RESIDENT
MarkFrancisA.Melendres,M.D.
Senior Subspecialty Residents
ShielaMacalindong,M.D.(GS1-SurgicalOncology)
SherwinAlamo,M.D.(GS2-ColororectalSurgery)
BerniceNavarro,M.D.(GS1-SurgicalOncology)
JeromeNapoles,M.D.(GS1-SurgicalOncology)
AlRadjidJamiri,M.D.(GS2-ColorectalSurgery)
RoyJasonMontecillo,M.D.(GS3-HepatobiliarySurgery)
GraceFirmalino,M.D.(GS3-HepatobiliarySurgery)
DorothyAnneDumlao,M.D.(PediatricSurgery)
JasonCastro,M.D.(PediatricSurgery)
JonaldNadal,M.D.(PlasticSurgery)
RowenaSudario,M.D.(PlasticSurgery)
AldusInriCabasa,M.D.(TCVS)
MarkJosephAbalajon,M.D.(Urology)
RoyLascano,M.D.(Urology)
Fifth Years
LizzaOliviaMayApolinar,M.D.
NeilBacaltos,M.D.
JeffreyGonzales,M.D.
Rainier Lutanco, M.D.
Aireen Patricia Madrid, M.D.
MarkFrancisMelendres,M.D.
ClarencePioReyYacapin,M.D.
J.KristofferZubiri,M.D.
MargaritaElloso,M.D.
PinkyDirain-Beran,M.D.
SabrinaAnneGonzalez,M.D.
PatrickLouieMaglaya,M.D.
PatrickJosephMatias,M.D.
Al Melkins Peco, M.D.
RobertChristianBravo,M.D.
Fourth Years
Nathaniel Carl Tan, M.D.
JannethTan,M.D.
JohnPauloNg,M.D.
NeilGollaba,M.D.
DonnaMarieDy,M.D.
JasonRafaelMaddumba,M.D.
LesleyAnneDominiqueCua-Pardo,M.D.
RochelleElizabethTayag,M.D.
MariaJenicaSo,M.D.
JeffreyMichaelWong,M.D.
KathleenRoseDescallar-Mata,M.D.
JohnPaulEmersonMarinas,M.D.
MarkBrianRoa,M.D.
Third Years
MarkFlorenBueser,M.D.
JanPaoloCruz,M.D.
Krista de los Santos, M.D.
AnthonyDoftas,M.D.
AmabelleMoreno,M.D.
CarylJoyNonan,M.D.
BayaniPasco,Jr.,M.D.
DaveResoco,M.D.
GeraldMarionAbesamis,M.D.
Alexandra Monica Tan, M.D.
JobelleJoyceAnneBaldonado,M.D.
Kathleen Cruz, M.D.
Ly-AnnDiwa,M.D.
ChitoSemblante,M.D.
Second Years
JuanCarlosAbon,M.D.
JanMiguelDeogracias,M.D.
Mark Augustine Onglao, M.D.
Kristine Paguirigan, M.D.
JoseMiguelVerde,M.D.
EmmanuelHaoII,M.D.
MayouMartinTampo,M.D.
MarieShelladeRobles,M.D.
Dax Carlos Pascasio, M.D.
AnaPatriciaVillanueva,M.D.
AlvinAnthonyAnastacio,M.D.
IvanLemueldeGrano,M.D.
First Years
Angel Paulo Amante, M.D.
Leonard Christopher Sena, M.D.
Arjel Ramirez, M.D.
Carlos Miguel Perez, M.D.
LeonaBettinaDungca,M.D.
Sittie Aneza Camille Maglangit, M.D.
RaymondJosephDeVera,M.D.
ElissaGaspar,M.D.
MarioEmmanuelLopezdeLeon,M.D.
JustinLeoCarpio,M.D.
ArthurGallo,M.D.
RaphaelBenjaminArada,M.D.
RayJosephBadulis,M.D.
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(02)8290175, (02)3963691,
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49th Postgraduate Course Secretariat
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Department of Surgery
University of the Philippines Manila - Philippine General Hospital
Taft Avenue, Manila
Phone: 554-8472 / 554-8400 loc. 2250
Email: mastery_of_surgery@yahoo.com
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