Keep pace with moving technology and your eyes where world is standing-Adibul Hassan Rizvi



Surgical Week for Colorectal Diseases at JPMC

Keep pace with moving technology and your eyes
where world is standing-Adibul Hassan Rizvi

Every human being has a right to free healthcare with dignity

KARACHI: Prof. Adibul Hassan Rizvi Chief of Sindh Institute of Urology and Transplantation (SIUT) was the chief guest at the concluding session of the 12th Surgical Week for Colorectal Diseases at JPMC on 12th October 2017. Speaking at the occasion he urged the participants to keep pace with moving technology and eyes where world is standing. Every human being, he opined has a right to get free healthcare with dignity and it is doable, he remarked. The commended the Master Trainer Prof. Torbjorn Holm from Sweden and Course coordinator Prof. Michael Thompson from England for visiting Pakistan and sharing their knowledge and experience with Pakistani surgeons. You must have seen yourself that Pakistan is not as bad as it is projected by the world media. It is a safe place and Pakistanis are very hospitable people, he remarked.

He recalled that while he was doing house job here at JPMC many years ago we used to ask the patient’s attendants to arrange for drugs, disposables for surgery and he personally felt it was very irritating. When in hospital, the patient should not be required to pay anything and in UK I observed while working at National Health Service institutions that it was possible. When I returned to Pakistan, I was lucky that I had a few friends who agreed with my philosophy and we started working.

Dr. Seemin Jamali Director JPMC presenting a memento to Prof. Adibul Hasan Rizvi who
was the chief guest at the concluding session of Surgical Week for Colorectal
Diseases held at JPMC from October 9-12, 2017.

Speaking about why free healthcare in developing countries Prof. Adibul Hassan Rizvi said that the developing world was a victim of economic exploitation. Just 20% of the world population in the developed world has access to 80% of the world resources while the 80% population in the developing world has just 20% resources. This has given rise to inequality which has created lot of problems all over the world. People in the developing countries are still faced with malaria, diarrhea, and tuberculosis, Acute Respiratory Infections, HIV AIDs, HBV and HCV. Almost 85% of its population is denied modern medicine and surgery. Countries like Pakistan spend just 1.8% of its GDP on Health hence we have very poor health indicators. Health and Education always remain a low priority.

In the SIUT Model of Healthcare, we believe in public private partnership wherein the patient is at the center. We have gone to the community and it has not disappointed us. We at SIUT started as a Urology Ward. We added Nephrology and later Transplantation facilities and all this necessitated the development of the infrastructure to meet the patient’s needs. Now we have a 68-Bed emergency with 12 emergency dialysis stations, 45 OPDs weekly at six premises. We have a total of three hundred five dialysis machines at eight premises and account for 24% of the whole dialysis facility in Pakistan. So far we have done  5186 transplants and all these patients as well as their donors are being followed up regularly including provision of free drugs. We have also established a 100-Bed Oncology Centre. In SIUT at present we have sixty eight departments in different disciplines of medicine providing a comprehensive healthcare system. We have our routes in our soil and we are expecting that people of Pakistan will continue to support us, Prof. Adib Rizvi remarked.

Addressing the audience Prof. Mumtaz Maher Chairman of the organizing committee and who initiated this academic activity when he was on the faculty of JPMC over a decade ago appreciated the contributions made by both the guest speakers, master trainer Prof. Holm and the course coordinator Prof. Thompson. We have seen world class surgery. May God reward you for what you have done for our healthcare professionals in Pakistan. The participants have learnt lot of surgical maneuvers and tips and there were lot of take home messages during the presentations and during live surgery how to manage diseases like hemorrhoids, colon and bowl diseases. The talks were very enlightening and surgical skills superb.

Prof. Michael Thompson in his speech on the occasion said that he had enjoyed his visit to Pakistan and would like to come back again. I enjoyed the hospitality and visiting here was a great fun. Prof. Torbjorn Holm said that he also enjoyed his stay in Pakistan and was delighted to do surgeries. The equipment, instruments, facilities, trained staff of OT including the nurses, paramedics and anesthetists were well trained and very cooperative and heI enjoyed operating here. He too would like to come back and promote this meeting to his colleagues the world over.

Dr. Seemin Jamali Patron of the course and Executive Director of JPMC thanked the Master Trainer and the course coordinator for visiting Pakistan. Their visit to JPMC has provided the Pakistani surgeons an opportunity to listen to the world leaders in this field. Dr. Shamim Qureshi Secretary of the course thanked all those who extended their valuable help and assistance to make the course successful. As usual there was a free registration and CME Credits was available for the registered participants. The total number of registered participants was four hundred eighty who had come from all over the country. Later the chief guest presented the mementoes to the overseas guest speakers, master trainer and organizers. Dr. Seemin Jamali presented a mementoes to Prof. Adib Rizvi while certificates were presented to all the OT staff and organizers.

On first day of the course Prof. Torbjolm Holm from Sweden who was the master trainer at the course made a presentation on “An overview of Restorative Proctocolectomy”. He discussed its indications, resection techniques, options for reconstruction, early and late compilations in detail. Speaking about indications he mentioned Ulcerative colitis, Crohn’s disease, Indeterminate colitis, Lynch syndrome, Familial adenomatous polyposis besides Multiple synchronous or metachronous cancers. In ulcerative colitis surgery may be required in 15-35% of the patients.

Speaking about the principles of resection in ulcerative colitis Prof. Holms said that it is to save ileocolic vessels, to save inferior mesenteric artery and superior rectal artery, to protect autonomic nerves, remove omentum, if the dissection is close to rectal wall or TME. One should always include rectal mucosa down to dentate line. One can opt for one, two or three stage procedure in elective setting. However, in emergency setting it is a three stage procedure.

Dr. Seemin Jamali Director JPMC presenting mementoes to Master Trainer Prof. Torbjorn Holm from
Sweden and Course coordinator Prof. Michael Thompson from England, Prof. Mumtaz Maher and
Dr. Shameem Qureshi Chairman and Secretary of the course respectively in the concluding
session of Surgical Week for Colorectal Diseases held at JPMC from October 9-12, 2017.

A systematic review of quality of life after total proctocolectomy with ileostomy or IPAA which included thirteen studies reporting a total of 1604 patients showed that neither procedure was found to be superior with regard to health-related quality of life. Their conclusions were that both total proctocolectomy with ileostomy and IPAA appear equivalent in terms of overall health related quality of life. Most patients are satisfied with their choice regardless of procedure. Most of the improvements in quality of life after surgery are related to the control of disease-related symptoms.

However, there are some controversies regarding the approach open or laparoscopic with or without TA-TME, one two or three stage procedure, removal of the omentum, TME or close dissection besides construction type i.e. Hand-sewn or stapled IPAA. Prof. Holm concluded his presentation by stating that collectomy or proctocolectomy improves quality of life in patients with colitis. Ileostomy, IRA or IPAA are the surgical options after resection.  IPAA probably is the best choice for patients with ulcerative colitis and very selectively in Crohn’s disease.  IRA is less complicated and can be used as a temporary solution in ulcerative colitis and as a permanent solution in Crohn’s without proctitis.  Permanent ileostomy is a good permanent solution in many patients.

Prof. Thompson talked about How to prevent and manage Pouch complications. His second presentation was on Pitfalls in colorectal anastomotic techniques, Management of anastomotic leakage while Prof Holm showed live demonstration of Hemorrhoidectomy.