Enhanced Recovery After Surgery (ERAS) Update:
ERAS Society World Congress, Washington DC,May 9-12, 2015.
During the congress the Philippine delegation got together to form the ERASS Phil. Chapter.

Founding members:
Dr. Ramy Roxas - President
Dr. Connie Cruz - Vice President
Dr. Nina Siozon - Secretary
Dr. Nelson Cabaluna
Dr. Lorina Cabaluna
Dr. Hermogenes Monroy
Dr. Rodney Dofitas
Dr. Net Mariano
Dr. Celine Ancheta
Dr. Ray Resurreccion 
Dr. Noel Beley
Dr. Elena Malong
Dr. Elke Sauz
Dr. Dino Vargas

Industry partners:
Nestle - Joan Naranjo
Menerini - Dang Eclavia

Treatments for hemorrhoids | Colon and Rectal Specialist

MANILA, Philippines - Hemorrhoids are actually present in all individuals whether healthy or not. They are the vascular cushions which surround the general area of the rectum and anus.

The term hemorrhoids is associated with the symptoms when this part of the body becomes enlarged, inflamed, thrombosed or prolapsed.

Many people have them without suffering from any symptoms, and therefore these may be safely left alone. Treatment is usually required for those whose hemorrhoidal symptoms such as excruciating throbbing pain affect quality of life and daily living. 

There are many traditional remedies and non-surgical treatments for hemorrhoids. However, if none of these work, surgical procedures may be required as a last resort.

 How do hemorrhoids look and feel?

Hemorrhoidal cushions are skin, vascular and soft tissues that line the anal canal, playing a small role in defecation and continence.  Everyone has them, although with our daily travails of straining and movement, they do change over time, becoming more lax or loose as we age. 

Hemorrhoidal disease occurs when these changes result in bothersome symptoms such as bleeding, prolapsed, or pain.  Almost everyone may develop symptoms at some point in their life, but these are not life-threatening, and may be safely observed. Treatment is usually required for those whose hemorrhoidal symptoms impact on quality of life and daily living.

 

What are the symptoms of hemorrhoids? 

Bleeding from hemorrhoids is usually bright red, often dripping into the toilet bowl, or noticed when wiping. The stools themselves are normal looking, indicating that the bleeding is originating only from the anorectal area.  Sludge of dark blood and stool mixed thoroughly together is usually from a source within the small and large intestines and not hemorrhoids. Hemorrhoidal bleeding is painless, and this differentiates it from anal fissures, which is also a very common anal condition that presents with similar bright red bleeding during defecation, but with anal pain.

Hemorrhoids only become painful when they thrombosed or incarcerated.  Thrombosed hemorrhoids occur when blood clots within the hemorrhoids, causing very obvious swelling and pain.  While surgery for this may be effective during the first 4 days of the attack, if left alone the swelling and pain gradually subside and disappear after 2 weeks.  Usually this occurs just once or twice in a person’s lifetime, and it is uncommon to have repeated episodes of thrombosis. 

Doctors often classify patients as to having either external or internal hemorrhoids.  External hemorrhoids are located just outside the anus, and hence are always visible on routine inspection.  Many people have them without suffering from any symptoms, and therefore these may be safely left alone.  Sometimes external hemorrhoids may make cleaning difficult, allowing sweat and anal discharge to hide between folds, resulting in anal itching.

Internal hemorrhoids arise from inside the anus and are therefore only visible when, because of excessive laxity, they protrude outside.  This condition is called prolapsed, and usually occurs during defecation.  When internal hemorrhoids prolapsed they may either slip back inside on their own, or require manipulation by the person for it goes back in.  When the prolapsed hemorrhoids cannot be returned, they become trapped outside, resulting in pain and swelling.  This scenario is called incarcerated hemorrhoids.

 

What are the forms of treatment for hemorrhoids– surgical and non-surgical?

Hemorrhoids only require treatment when there are symptoms.  And the type of treatment depends on the severity of symptoms.  Mild symptoms may be managed just by eating a lot of fiber and taking in bulk laxatives such as psyllium to improve the consistency of stools and ease bowel movement.  Some over-the-counter creams may provide symptomatic relief.

Non-surgical and almost painless treatments for hemorrhoids include injection sclerotherapy, infrared photocoagulation (often mislabeled as “laser treatment”), and rubber band ligation, any of which can be done safely in the clinic as an out-patient procedure.  In scientific studies comparing these methods, rubber band ligation was found to be the most effective and cheap, which is why it is the most common non-surgical procedure for hemorrhoids in the world today.

Non-surgical treatment is often ineffective for large, incarcerated or thrombosed hemorrhoids.  Surgery is usually recommended in these situations, and also when non-surgical treatment has failed to relieve symptoms.  Traditional surgery requires cutting out the hemorrhoid using a variety of instruments such as scissors, knives, cautery, and ultrasonic dissectors. Unfortunately, any wound created in the outer skin of the anus results in often Sever post-operative pain, which is responsible for the reputation of hemorrhoid surgery being one of the most painful of operations.

FIRST ANNOUNCEMENT

WHAT   :  7th Biennial Congress of Asean Society of Colorectal Surgeons

WHEN   :  July 16-18, 2014

WHERE :  Singapore

Tuesday, 05 November 2013 11:29

Ano ang Colonoscopy?

Written by

Ano ang Colonoscopy?

Ang colonoscopy ay isang panloob na pagsusuri ng malaking bituka at tumbong, gamit ang isang instrumentong tinatawag na colonoscope.

Paano isinagawa ang pagsusuri?

 

Ang colonoscope ay may kalakip na isang maliit na kamerang nakakabit sa isang nababaluktot na tubo.  Hindi tulad ng sigmoidoscopy na ang naaabot lamang ay ang ikatlong ibabang bahagi ng malaking bituka, ang colonoscopy ay nagsusuri ng buong kahabaan ng colon.


Ang pasyente ay mahihiga nang patagilid sa kaliwang bahagi at ang mga tuhod ay ititiklop patungo sa dibdib. Pagkatapos mabigyan ng gamot na pampakalma at pang-alis ng kirot, ang colonoscope ay padadaanin sa puwitan. Ito ay dahan-dahan at maingat na ipapasok sa bukana ng malaking bituka at kung minsan ay pinaaabot sa pinakamababang bahagi ng maliit na bituka.


Nagpapakawala ng hangin ang scope upang mas maging malinaw ang pagtingin sa loob ng bituka. May kasama ring panghigop (suction) ang instrumento upang maalis ang mga dumi at tubig. Mas malinaw sa paningin ng nagsusuri kung ang scope ay papalabas kung kaya’t  kalimitang mas masusing eksaminasyon ang ginagawa sa ganitong pagkakataon. Gamit ang colonoscope, maaaring kumuha ng tissue samples sa pamamagitan ng maliliit na biopsy forceps. Maaaring magtanggal ng mga polyps gamit ang electrocautery snares.  Pwede ring kumuha ng litrato at magsagawa ng laser therapy.

 

Paano maghanda para sa pagsusuri?

 

Kailangang ganap na linisin ang bituka. Ang manggagamot ay magbibigay ng mga tagubilin para sa pagsasagawa nito. Ito ay maaaring kumbinasyon ng mga labatiba (enema); hindi pagkain ng solid food sa loob ng 2 o 3 araw bago ang pagsusuri; at paggamit ng laxatives. Karaniwang ipapatigil ang pag-inom ng aspirin, ibuprofen, naproxen, o iba pang mga gamot na nagpapalabnaw ng dugo ilang araw bago ang colonoscopy.

Hihilingin din ang  pag-inom ng maraming malinaw na likido(liquids) sa loob ng 1-3 araw bago ang procedure. Ang mga halimbawa ng malinaw na likido ay:

    * Kape o tsaa na walang gatas o creamer
    * Bouillon o sabaw na walang taba o mantika
    * Dyelatin (gelatin)
    * Sports drink
    * Sinalang katas ng prutas (strained fruit juices)
    * Tubig

Maliban na lang kung ipagbawal ng doktor, regular na inumin ang anumang resetang gamot. Itigil ang paggamit ng iron supplements ilang linggo bago ang test, maliban din kung sabihin ng doktor na ipagpatuloy. Ang iron ay maaaring magpaitim ng dumi na magpapalabo ng view sa loob ng bituka. Maghanap ng makakasama sa pag-uwi. Maaaring makaramdam ng pagkahilo at hindi makapagmaneho pagkatapos ng pagsusuri.

 

 Ano ang mararamdaman?

 

 Ang mga gamot na pampakalma at pangkirot ay nakapagpapa-relax at nagpapa-antok. Maraming pasyente ang hindi maka-alalang sila ay nag-colonoscopy. Bago ang pagsusuri, ang doktor ay nagsasagawa ng rectal exam upang makatiyak na walang mga pangunahing pagbabara (blockages) sa loob ng puwit. Maaring makaramdam na parang madudumi habang ang daliri o ang colonoscope ay ipinapasok sa loob ng puwit.

 

 Maaari makaramdam ng presyon habang ang scope ay gumagalaw sa loob ng bituka. Maaari ring makaranas ng bahagyang pagkirot at kabag habang nagpapakawala ng hangin ang colonoscope o habang ito ay itinutulak papaloob. Ang pag-utot ay kailangan at dapat na asahan.

Maaari makaginhawa ang pagsasagawa ng mabagal at malalim na paghinga. Ito ay makakatulong din upang ma-relax ang
abdominal muscles. Patuloy ding magkakaroon ng bahagyang pagkirot at kabag matapos ang procedure. Madadalas din ang pag-utot. Ang pagka-antok ay lilipas pagkaraan ng ilang oras. Dahil sa pagkakahimbing maaring walang maalala ang pasyente sa natapos na procedure.

Bakit isinagawa ang pagsusuri?

Ang colonoscopy ay maaaring gamitin para sa mga sumusunod na kadahilanan:

    * Pagsakit ng tiyan, pagbabago sa regular na pagdumi, o pagbaba ng timbang
    * Abnormal na pagbabago (tulad ng polyps) na nakita sa sigmoidoscopy o x-ray test (CT scan o barium enema)
    * Anemya dahil sa kakulangan sa iron (karaniwan kapag walang ibang dahilan ang nahanap)
    * Dugo sa dumi, o ma-itim na dumi
    * follow-up sa isang nakaraang karamdaman, tulad ng polyps o colon kanser

    * Inflammatory bowel disease (ulcerative colitis and Crohn's disease)
    * Screening para sa colorectal kanser


 
  
* Kumunsulta sa espesyalista upang talakayin ang colonoscopy.

 

 

2nd Floor, Podium Building, The Medical City,

Ortigas Avenue, Pasig City, Metro Manila

Tel No. (632) 9881000 or (632) 6356789 ext. 7789

www.colonandrectalspecialists.com , www.crsi.com.ph

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.

Clinic Hours: Mondays to Saturdays – 8:00 AM to 5:00 PM except Wednesdays

Ang Mga Espesiyalista

Manuel Francisco T. Roxas, M.D.

Robert L. Chang, M.D.

Catherine S. Co, M.D.

Carlo C. Cajucom, M.D.

Marc Paul J. Lopez, M.D.

Dione P. Sacdalan, M.D.

 

 

MANILA, Philippines - Hemorrhoids are
actually present in all individuals whether healthy or not. They are the
vascular cushions which surround the general area of the rectum and
anus.
The term hemorrhoids is associated with the symptoms when this part
of the body becomes enlarged, inflamed, thrombosed or prolapsed.
Many people have them without suffering from any symptoms, and
therefore these may be safely left alone. Treatment is usually required
for those whose hemorrhoidal symptoms such as excruciating throbbing
pain affect quality of life and daily living.
There are many traditional remedies and non-surgical treatments for
hemorrhoids. However, if none of these work, surgical procedures may be
required as a last resort.
Below are some misconceptions about hemorrhoids treatment and the truth behind each:
Misconception No. 1. All surgical procedures for hemorrhoids are very painful. Due
to this reputation of a painful operation, advances in
hemorrhoid surgery have focused on making it less painful. One such
operation is stapled hemorrhoidectomy. Using a specially designed,
single-use stapler instrument, hemorrhoids are excised and the anus
repaired from the inside. The end-result is that the surgical wound is
inside, and no wound is visible outside the anus. Scientific studies
have proven that this is less painful than traditional surgery.
Another advanced surgical technique is ****transarterial hemorrhoidal
dearterialization (THD). Using a Doppler ultrasound, the blood vessel
supplying the hemorrhoid is identified and ligated with stitches.
Deprived of its blood supply, the hemorrhoid then shrinks and shrivels.
Again there is no wound outside and is therefore almost painless.
Misconception No. 2. Another more common misconception about surgery
for hemorrhoids is that it can cause fecal incontinence, or the
inability to control farting or defecation. Again this is not true. When hemorrhoid
surgery is done properly, incontinence won’t develop.

Pagtitistis ng Malaking Bituka at Tumbong (Colorectal Surgery)

 

Ang pagtitistis o pag-oopera ng malaking bituka (colon)at tumbong (rectum)ay ang pagsasaayos ng mga pinsalang natamo ng alin mang bahagi ng malaking bituka, tumbong, o puwit sanhi ng mga sakit tulad ng kanser, diverticulitis, inflammatory bowel disease (ulcerative colitis and Crohn's disease) at iba pa, sa pamamagitan ng iba’t-ibang pamamaraan. Ang mga aksidenteng pinsala, pagbabara, pagkapunit o pagkabutas, mga bukol o peklat na dahilan ng pagbabara ay maari ring mangailangan ng operasyon. Ang pagsasaayos ng mga pinsala ay magpapanumbalik sa normal na sistema ng pagdumi. Ang iba pang mga kundisyon na maaaring mangailangan ng pagtitistis ay almuranas, anal fissures, prolaps, kawalan ng pagpipigil sa pagdumi (bowel incontinence), at kulugo sa puwit (anal warts).

Mga Uri ng Pagtitistis

 

May iba’t ibang pamamaraang ginagamit ang mga siruhano (surgeon) upang gamutin ang mga pinsala ng  malaking bituka at puwit. Noong mga naunang panahon, kalimitang ang pagtitistis ay ginagawa sa pamagitan ng isang malaking paghiwa sa tiyan at pagsasa-ayos ng mga pinsala sa bituka.  Ang karaniwang ginagawa ay ang pagputol at pagtanggal ng apektadong parte ng bituka (resection) at pagkabitin ang mga hindi napinsalang parte (anastomosis). Ang iba pang klase ng operasyon ay ang pagtahi ng mga punit sa puwit, pagtanggal ng almoranas  at pagpapasikip ng spincter muscle.

Karaniwan din noon ang paglalagay ng ostomy. Ito ay ang paglalagay ng butas mula sa loob ng katawan palabas upang tanggalin ang mga ihi at dumi  (urine and feces) ng katawan. May mga uri din ang ostomy. Ang colostomy ay ang paglabas ng bahagi ng malaking bituka sa may tiyan upang mailabas ang dumi ng katawan patungo sa isang lalagyan (pouch). Sa ileostomy naman, ang lahat ng parte ng malaking bituka, tumbong at puwit ay inaalis at ang pinakadulong bahagi ng maliit na bituka (ileum) ang siyang nagiging stoma.

 

Sa kasalukuyan, ang laparoscopic surgery ay ginagamit sa maraming sakit at pinsala ng bituka kabilang na ang mga maagang kanser. Sa ganitong operasyon, ang siruhano ay nagpapasok ng instrumentong may nakakabit na maliit na kamera (laparoscope) sa maliit na hiwa sa tiyan. Ang operasyon ay may mas kakaunting komplikasyon, mas mabilis, mas hindi masakit, at mas may maliit na pilat. Ito ay nangangahulugan din ng mas maikling araw ng pananatili sa loob ng ospital.

 

Makailan lamang, mayroong mas makabagong pagsulong sa teknolohiya ng pag-oopera. Ito ay ang robotic surgery. Dito, ang siruhano ay gumagamit ng computer na nagkokontrol ng mga maliliit na instrumentong nakakabit sa robot.

 

Desisyon sa Pagtitistis

 

Ang ilang mga kondisyon ng may sakit ay maaaring matugunan ng minimally-invasive surgery.  Samantala,  ang ibang mga sakit tulad ng kanser ay maaring mangailangan ng ostomy, isang mas mabigat na operasyon.  Ang desisyon ng doktor upang irekomenda ang operasyon ay nakasalalay sa iba’t ibang kadahilanan tulad ng kasaysayang medikal ng pasyente, tindi ng sakit o kirot na nararanasan, at mga resulta ng dyagnostikong ginawa sa kanya.

 

Mga paghahanda bago ang operasyon

 

Sasabihin ng doktor ang mga  gagawin sa operasyon, ang mga posibleng masamang epekto nito, at ang mga inaasahang mararanasan matapos ang operasyon. Katulad ng kahit anong pagtitistis, ang pasyente ay papipirmahin ng isang kasulatan ng pagsang-ayon o pagpapahintulot (consent form). Bilang paghahanda sa operasyon, ang manggagamot ay maaring humiling ng mga pag-aaral ng dugo at ihi ng pasyente, ganun din ng iba’t ibang   x-ray at electrocardiograph (EKG). Maari ding mag-alok at magbahagi ang doktor o nars sa pasyente o mga kaanak nito ng mga katuruan patungkol sa pamamahala ng ostomy.

 

Upang maging malinis ang bituka bago ang operasyon, ang pasyente ay maaring hilingin ng doktor na huwag kumain o uminom ng kahit ano ilang oras bago ang pagtitistis. Maari ding painumin ng mga gamot na pampadumi o gumamit ng labatiba (enema). Maari ding painumin ng antibiotics upang kumaunti ang bakterya sa bituka upang maiwasan ang impeksiyon matapos ang operasyon.

 

Pangangalaga matapos ang operasyon

 

Matapos ang operasyon, imomonitor ang presyon ng dugo, pulso, paghinga, at temperatura ng pasyente hanggang ito ay bumalik sa normal.  Tuturuan ang pasyente kung papaano susuportahan inoperahang bahagi ng katawan habang humihinga nang malalim at umuubo, bahagi ng ehersisyo matapos ang operasyon. Maaari din siyang bigyan ng gamot  sa kirot kung nararapat.  Sinusukat din ang  lahat ng likidong (liquid) pumapasok at lumalabas sa kanyang katawan. Ang kulay at katas ng  sugat ay inoobserbahan.  Karaniwang pinapatayo na ang pasyente at pinapaupo sa silya kinagabihan ng operasyon. Karamihan ay nakakalabas na ng ospital makalipas ang dalawa o apat na araw.

 

 Mga panganib

 

Ang mga potensyal na panganib matapos ang operasyon ay madalas na nangyayari habang ang pasyente ay nasa ospital pa. Ang kanyang pangkalahatang kalagayan ng kalusugan bago ang pagtitistis ay nagpapahiwatig ng mga potensyal na panganib. Dapat bigyang tuon ang mga problema sa puso at mababang immune system ng pasyente.

 

Normal na resulta

 

Ang lubusang paggaling ng may sakit na walang anumang kumplikasyon ay inaasahan. Ang panahon ng  pagpapagaling ay iba-iba depende sa pangkalahatang kalagayan ng kanyang kalusugan bago ang operasyon. Ang mga pagbabago sa diyeta ay minimungkahi upang maiwasan muli ang pagkakasakit o upang mapangalagaan ang kasalukuyang kalagayan.

 

Ang mga payo patungkol sa mga pagbabago ng kasalukuyang  pangaraw-araw na pamumuhay ay ibinabahagi sa pasyente.

 

Matapos ang pagpapa-uwi

 

Ipaalam agad sa manggagamot kung maranasan ang matinding kirot, pamamaga, pamumula, pamamasa o pagdurugo ng sugat. Ipaalam din kung may pananakit ng ulo at kalamnan, pagkahilo, pagsusuka o pagduduwal, lagnat, pagtitibi o pangingitim ng dumi.

Ang impormasyong ito ay hindi pamalit sa mga payong medikal. Magtanong at sumangguni sa mga espesiyalista.

2nd Floor, Podium Building, The Medical City,

Ortigas Avenue, Pasig City, Metro Manila

Tel No. (632) 9881000 or (632) 6356789 ext. 7789

www.colonandrectalspecialists.com , www.crsi.com.ph

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.

Clinic Hours: Mondays to Saturdays – 8:00 AM to 5:00 PM except Wednesdays

Ang Mga Espesiyalista

Manuel Francisco T. Roxas, M.D.

Robert L. Chang, M.D.

Catherine S. Co, M.D.

Carlo C. Cajucom, M.D.

Marc Paul J. Lopez, M.D.

 

Thursday, 01 August 2013 13:45

ACS International Scholarship

Written by
Hello everyone!

This year I was privileged to be awarded an International Scholarship to the American College of Surgeons National Surgery Quality Improvement Program.

It's actually my second such award from the ACS. The first one was in 2002, where I focused primarily on refining my own clinical and surgical skills.

This present scholarship is different in the sense that it focuses on programs and policies to improve the quality of surgical care within institutions and organizations. (Quite appropriate I suppose for my age).

I look to this award as also a responsibility for me to share my experiences with other Filipino surgeons and surgical societies. 

I have decided therefore to blog about the program, sharing my learning experiences and insights.

Let me begin by posting below the original essay I submitted as part of the application process for the international scholarship, as a way for you to understad where I am starting from. 

The convention starts in a few hours and ends on July 16. I will then visit the University of California San Diego Medical Center to have a first-hand view of how the NSQIP is implemented. Hopefully I will able to give a daily blog of my experiences.

Sincerely,

Dr. Ramy Roxas

ESSAY

I am Dr. Manuel Francisco T Roxas , a clinical associate professor and colorectal surgeon from the University of the Philippines College of Medicine. In 2002 I was fortunate to have been awarded the ACS International Guest Scholarships, gaining first-hand experience of how such a prestigious award broadens one's outlook on surgical practice, as well as opens new opportunities for leadership roles. Since then my career focused on sharpening my skills as a colorectal surgeon, particularly in the areas of minimally invasive and robotic surgery; as well as in establishing programs for improving rectal cancer outcomes through multidisciplinary pre-treatment planning, neo-adjuvant chemoradiotherapy, total mesorectal excision and pathologic audit. I was given the privilege to serve in 3 concurrent positions: as President of the Philippine Society of Colorectal Surgeons; Chief of the Division of Colorectal Surgery at the Philippine General Hospital; and Director of the Medical City Cancer Center (a tertiary, JCI-accredited, private hospital). Now that my terms in these three positions are coming to an end, new areas of personal development are opening up for me. I am specifically interested in 3 programs of quality improvement in the ACS to guide my next endeavors, namely the NSQIP, the Cancer Accreditation Program, and Simulation-based Training.
As the newly appointed Consultant Director of the Colorectal Clinic in The Medical City, it is my responsibility to improve quality of colorectal surgical care beyond present JCI requirements. I am interested in witnessing first-hand how enhanced recovery after surgery (ERAS), infection control, and other colorectal surgery quality programs are implemented in an ACS collaborative hospital so that I can adopt similar programs for our colorectal patients.
Another pressing concern for me is the lack of standardized quality of care measures for cancer treatment in my country, even in the Philippine College of Surgeons. I have come to understand that satisfactory compliance with patient safety programs/policies do not necessarily translate to better oncologic surgery (although high quality oncologic surgery includes strict compliance with basic patient safety and surgical quality standards). I am therefore interested in learning how the ACS, through its Committee on Cancer, accredits cancer programs, and implements policies to improve the quality of cancer care nationwide.
Furthermore, I have recently been involved in the strategic planning and creation of clinical simulation training programs in both private and government sectors. We envision programs to train medical and paramedical personnel on newer invasive/surgical techniques and technology, while constantly assuring patient safety. I am therefore very interested in the ACS accreditation and standardization process for simulation-based training.
Finally, I am in line for nomination to the Board of Regents of the Philippine College of Surgeons this December. As a potential Regent, it will be my advocacy to set in place the quality assurance programs that I will hopefully learn in the ACS, should I be fortunate enough to receive the scholarship. I hope to visit two accredited hospitals in California where NSQIP programs are institutionalized. I also want to visit the main headquarters of the ACS so I can gain a better understanding of how it implements and monitors such quality improvement programs.




Briefly describe your clinical practice

My clinical practice is 98% focused on colorectal surgery. While I receive a small allowance from the govenment for the part-time work I do in the Philippine General Hospital - mainly for training residents in surgery and research - my main source of income is from my clinical work in the Medical City, the second largest hospital network in the country, where I am currently the Director of the Colorectal Clinic, as well as the Stoma and Wound Care Clinic.


Briefly describe your teaching contributions

1. As a teacher:

I am a clinical associate professor of the Department of Surgery, University of the Philippines College of Medicine and Philippine General Hospital. Part of my responsibilities has been to lecture to medical students, my assignment being specifically on gastrointestinal bleeding, as well as hold preceptorships with them in the clinics.

Much of my teaching load has been on the training of general surgery residents and colorectal surgery fellows. I initiated the training of Total Mesorectal Excision and Laparoscopic Colorectal Surgery in the Philippine General Hospital, particularly when I became Chief of the Division of Colorectal Surgery in 2007.

I am a frequent lecturer in the Philippine College of Surgeons on topics such as endorectal ultrasonography, intestinal staplers, laparoscopic colorectal surgery, total mesorectal excision (TME), extralevator abdominoperineal resection, and robotic rectal cancer.

2. As a course/program leader or developer:

As a two-term chief of the Division of Colorectal Surgery at the Philippine General Hospital, I initiated the Colorectal Polyp and Cancer Study Group funded by the National Institute of Health; the Rectal Cancer TME Program; and the Multidisciplinary Team Approach. I also expanded the Colorectal Fellowship Program from one year to two years, specifically to improve training in laparoscopic colorectal surgery. I also improved the financial status of the Division, making it now self-sufficient.

During my two terms as President of the Philippine Society of Colon and Rectal Surgeons, we expanded the colorectal surgery curriculum to a two-year program, incorporating laparoscopic colorectal surgery in the training. We also started a fellowship training program in Davao City, only the third such program in the country, and the first outside of Manila.

Under my leadership as the first Director of the Cancer Center, The Medical City, we established highly specialized cancer units for Breast, Head and Neck, Liver, Bone, Prostate, and Colorectum, moving the hospital away from the more generalist approach of its past.
Briefly describe your professional leadership contributions:

1. Society or College

As a two-term president of the Philippine Society of Colon and Rectal Surgeons (PSCRS), I initiated the Rectal Cancer TME Certifying Course held during the Philippine College of Surgeons (PCS) Annual Conventions. I also started the Annual and Midyear Conventions of the PSCRS, attracting surgeons from all over the country. By the end of my term, this March, 2013, I increased the funds of the PSCRS ten-fold (from P 200,000 to P 2,000,000).


2. Committee leadership

As Chair of the Committee on Research of the Philippine College of Surgeons, from 2005 and 2006, I organized several courses on research methodology and evidence-based medicine for residents and consultants. I also initiated recognition awards for researches by members/fellows that were published internationally.


Provide a brief description of your research work:

My research work initially focused on the development of clinical practice guidelines for the Philippine College of Surgeons. My participation included being one of the main authors of the Guidelines on Pre-operative Cardiac Clearance, as well as on Curable Rectal Cancer. I also participated as a consultant on methodology in Guidelines for Breast Cancer, Colonic trauma and Surgical Critical Care.

I am the main author of two internationally published randomized controlled trials on local anesthesia for hemorrhoidectomy, both of which were done to try to facilitate faster turn-over time for our out-patient hemorrhoid surgery at the Philippine General Hospital. I am also a co-author on an internationally published randomized controlled trial evaluating the role of antibiotics for hernia surgery. All three are cited in Medline and Cochrane.

At present, my clinical research has focused more on colorectal surgey concepts that are relatively new in our country, such as laparoscopic surgery, Total Mesorectal Excision, the multidisciplinary team approach for colorectal cancer, and extralevator abdominoperineal resection.


Awards, Prizes:

A. International

1. International Guest Scholar, American College of Surgeons, 2002

2. Lions for Stoma Care International Scholar, Modena, Italy, June 7 - 11, 2007

3. 2nd Prize, Research Poster Presentation, 10th Congress of the Asian Federation of Coloproctology, Singapore, March 24-26, 2005


B. National

1. International Research Award, Philippine College of Surgeons, December 7, 2004

3. 1st Prize , Teodoro P Nuguid Research Award, Philippine Society of Colorectal Surgeons, February 28, 2002


C. Local/Regional

1. Academic Citation, Leadership and Management Development Program, Ateneo De Manila University Graduate School of Business, March 2012

2. Outstanding Faculty Research Paper, 21st Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 2007

3. Outstanding Faculty Research Paper, 19th Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 2005

4. Outstanding Faculty Research Paper, 14th Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 1999

5. De La Salle University College of Medicine, Class 1988 Graduation Awards:
- Valedictorian
- Dean's Special Award
- Leadership Award
- Outstanding Clinical Clerk
- Outstanding Clinical Clerk in Pediatrics
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Thursday, 01 August 2013 13:45

ACS International Scholarship

Written by
Hello everyone!

This year I was privileged to be awarded an International Scholarship to the American College of Surgeons National Surgery Quality Improvement Program.

It's actually my second such award from the ACS. The first one was in 2002, where I focused primarily on refining my own clinical and surgical skills.

This present scholarship is different in the sense that it focuses on programs and policies to improve the quality of surgical care within institutions and organizations. (Quite appropriate I suppose for my age).

I look to this award as also a responsibility for me to share my experiences with other Filipino surgeons and surgical societies. 

I have decided therefore to blog about the program, sharing my learning experiences and insights.

Let me begin by posting below the original essay I submitted as part of the application process for the international scholarship, as a way for you to understad where I am starting from. 

The convention starts in a few hours and ends on July 16. I will then visit the University of California San Diego Medical Center to have a first-hand view of how the NSQIP is implemented. Hopefully I will able to give a daily blog of my experiences.

Sincerely,

Dr. Ramy Roxas

ESSAY

I am Dr. Manuel Francisco T Roxas , a clinical associate professor and colorectal surgeon from the University of the Philippines College of Medicine. In 2002 I was fortunate to have been awarded the ACS International Guest Scholarships, gaining first-hand experience of how such a prestigious award broadens one's outlook on surgical practice, as well as opens new opportunities for leadership roles. Since then my career focused on sharpening my skills as a colorectal surgeon, particularly in the areas of minimally invasive and robotic surgery; as well as in establishing programs for improving rectal cancer outcomes through multidisciplinary pre-treatment planning, neo-adjuvant chemoradiotherapy, total mesorectal excision and pathologic audit. I was given the privilege to serve in 3 concurrent positions: as President of the Philippine Society of Colorectal Surgeons; Chief of the Division of Colorectal Surgery at the Philippine General Hospital; and Director of the Medical City Cancer Center (a tertiary, JCI-accredited, private hospital). Now that my terms in these three positions are coming to an end, new areas of personal development are opening up for me. I am specifically interested in 3 programs of quality improvement in the ACS to guide my next endeavors, namely the NSQIP, the Cancer Accreditation Program, and Simulation-based Training.
As the newly appointed Consultant Director of the Colorectal Clinic in The Medical City, it is my responsibility to improve quality of colorectal surgical care beyond present JCI requirements. I am interested in witnessing first-hand how enhanced recovery after surgery (ERAS), infection control, and other colorectal surgery quality programs are implemented in an ACS collaborative hospital so that I can adopt similar programs for our colorectal patients.
Another pressing concern for me is the lack of standardized quality of care measures for cancer treatment in my country, even in the Philippine College of Surgeons. I have come to understand that satisfactory compliance with patient safety programs/policies do not necessarily translate to better oncologic surgery (although high quality oncologic surgery includes strict compliance with basic patient safety and surgical quality standards). I am therefore interested in learning how the ACS, through its Committee on Cancer, accredits cancer programs, and implements policies to improve the quality of cancer care nationwide.
Furthermore, I have recently been involved in the strategic planning and creation of clinical simulation training programs in both private and government sectors. We envision programs to train medical and paramedical personnel on newer invasive/surgical techniques and technology, while constantly assuring patient safety. I am therefore very interested in the ACS accreditation and standardization process for simulation-based training.
Finally, I am in line for nomination to the Board of Regents of the Philippine College of Surgeons this December. As a potential Regent, it will be my advocacy to set in place the quality assurance programs that I will hopefully learn in the ACS, should I be fortunate enough to receive the scholarship. I hope to visit two accredited hospitals in California where NSQIP programs are institutionalized. I also want to visit the main headquarters of the ACS so I can gain a better understanding of how it implements and monitors such quality improvement programs.




Briefly describe your clinical practice

My clinical practice is 98% focused on colorectal surgery. While I receive a small allowance from the govenment for the part-time work I do in the Philippine General Hospital - mainly for training residents in surgery and research - my main source of income is from my clinical work in the Medical City, the second largest hospital network in the country, where I am currently the Director of the Colorectal Clinic, as well as the Stoma and Wound Care Clinic.


Briefly describe your teaching contributions

1. As a teacher:

I am a clinical associate professor of the Department of Surgery, University of the Philippines College of Medicine and Philippine General Hospital. Part of my responsibilities has been to lecture to medical students, my assignment being specifically on gastrointestinal bleeding, as well as hold preceptorships with them in the clinics.

Much of my teaching load has been on the training of general surgery residents and colorectal surgery fellows. I initiated the training of Total Mesorectal Excision and Laparoscopic Colorectal Surgery in the Philippine General Hospital, particularly when I became Chief of the Division of Colorectal Surgery in 2007.

I am a frequent lecturer in the Philippine College of Surgeons on topics such as endorectal ultrasonography, intestinal staplers, laparoscopic colorectal surgery, total mesorectal excision (TME), extralevator abdominoperineal resection, and robotic rectal cancer.

2. As a course/program leader or developer:

As a two-term chief of the Division of Colorectal Surgery at the Philippine General Hospital, I initiated the Colorectal Polyp and Cancer Study Group funded by the National Institute of Health; the Rectal Cancer TME Program; and the Multidisciplinary Team Approach. I also expanded the Colorectal Fellowship Program from one year to two years, specifically to improve training in laparoscopic colorectal surgery. I also improved the financial status of the Division, making it now self-sufficient.

During my two terms as President of the Philippine Society of Colon and Rectal Surgeons, we expanded the colorectal surgery curriculum to a two-year program, incorporating laparoscopic colorectal surgery in the training. We also started a fellowship training program in Davao City, only the third such program in the country, and the first outside of Manila.

Under my leadership as the first Director of the Cancer Center, The Medical City, we established highly specialized cancer units for Breast, Head and Neck, Liver, Bone, Prostate, and Colorectum, moving the hospital away from the more generalist approach of its past.
Briefly describe your professional leadership contributions:

1. Society or College

As a two-term president of the Philippine Society of Colon and Rectal Surgeons (PSCRS), I initiated the Rectal Cancer TME Certifying Course held during the Philippine College of Surgeons (PCS) Annual Conventions. I also started the Annual and Midyear Conventions of the PSCRS, attracting surgeons from all over the country. By the end of my term, this March, 2013, I increased the funds of the PSCRS ten-fold (from P 200,000 to P 2,000,000).


2. Committee leadership

As Chair of the Committee on Research of the Philippine College of Surgeons, from 2005 and 2006, I organized several courses on research methodology and evidence-based medicine for residents and consultants. I also initiated recognition awards for researches by members/fellows that were published internationally.


Provide a brief description of your research work:

My research work initially focused on the development of clinical practice guidelines for the Philippine College of Surgeons. My participation included being one of the main authors of the Guidelines on Pre-operative Cardiac Clearance, as well as on Curable Rectal Cancer. I also participated as a consultant on methodology in Guidelines for Breast Cancer, Colonic trauma and Surgical Critical Care.

I am the main author of two internationally published randomized controlled trials on local anesthesia for hemorrhoidectomy, both of which were done to try to facilitate faster turn-over time for our out-patient hemorrhoid surgery at the Philippine General Hospital. I am also a co-author on an internationally published randomized controlled trial evaluating the role of antibiotics for hernia surgery. All three are cited in Medline and Cochrane.

At present, my clinical research has focused more on colorectal surgey concepts that are relatively new in our country, such as laparoscopic surgery, Total Mesorectal Excision, the multidisciplinary team approach for colorectal cancer, and extralevator abdominoperineal resection.


Awards, Prizes:

A. International

1. International Guest Scholar, American College of Surgeons, 2002

2. Lions for Stoma Care International Scholar, Modena, Italy, June 7 - 11, 2007

3. 2nd Prize, Research Poster Presentation, 10th Congress of the Asian Federation of Coloproctology, Singapore, March 24-26, 2005


B. National

1. International Research Award, Philippine College of Surgeons, December 7, 2004

3. 1st Prize , Teodoro P Nuguid Research Award, Philippine Society of Colorectal Surgeons, February 28, 2002


C. Local/Regional

1. Academic Citation, Leadership and Management Development Program, Ateneo De Manila University Graduate School of Business, March 2012

2. Outstanding Faculty Research Paper, 21st Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 2007

3. Outstanding Faculty Research Paper, 19th Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 2005

4. Outstanding Faculty Research Paper, 14th Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 1999

5. De La Salle University College of Medicine, Class 1988 Graduation Awards:
- Valedictorian
- Dean's Special Award
- Leadership Award
- Outstanding Clinical Clerk
- Outstanding Clinical Clerk in Pediatrics
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