Colorectal surgery offers bright future for the young surgeons

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Interview: Prof. Adam Dziki Colorectal Surgeon from Poland

Colorectal surgery offers bright future
for the young surgeons

With increased awareness these diseases will be seen
more and people will look for trained surgeons’ in this specialty

KARACHI: Prof. Adam Dziki MD, PhD, FRCS, FACS, Professor of Surgery at Medial University, Lodz, Poland a renowned colorectal surgeon from Europe who is also Chief Editor of Polish Journal of Surgery was the invited guest speaker and Master Trainer at the 8th Colorectal Surgery Course held at JPMC from September 30th to October 1st 2013. Apart from making oral presentations on surgical management of Ulcerative Colitis, Rectal Cancer and Rectal Prolapse, he also demonstrated live various surgical procedures like lateral sphincterotomy for anal fissures, Haemarrhoidectomy, abdominal rectopexy, pilonidal sinus, recto vaginal fistulae and sphincter repair. During the course on October 2nd, Prof. Adam took out some time to talk to Pulse International Chief Editor. Given below are the excerpts from the conversation:


Adam Dziki

Would you like to share some details about your academic career?
I did my MD in 1975 and then earned PhD in 1978. I became Associate Professor in 1992 and was then promoted as Professor of Surgery in 1997. I was honoured by Royal College of Surgeons from England in 2005 with its fellowship and became fellow of American College of Surgeons in 2006.

How and when did your professional love affair started with colorectal surgery?
I got a scholarship in 1982 to go to Netherland where I saw some surgeons doing colorectal surgery which I could not see in Poland. It was in 80s that I had learnt that a few doctors were dealing with colorectal diseases. I established the first OPD for colorectal diseases at the hospital and I got interested in this specialty. Then I went to many other places and learnt more about colorectal surgery. I got Fulbright Scholarship in 1991 to go to United States so I went to Washington where I had an opportunity to work with an eminent surgeon Lee Smeth. Then I had training at Cleveland Clinic in USA and at St. Mark’s hospitals in England

What are the pre-requisites to set up a colorectal surgical training department?
You need to have a good department well equipped and adequately staffed. The unit must have at least two to three trained and experienced colorectal surgeons. One must follow the guidelines for the treatment of colorectal disease. This will also mean that these certified colorectal surgeons will guarantee that the trainees will work under their supervision. The trainees must have and properly maintain their log books. Record all the operations which they perform like laparoscopic cholecestectomy and other proctologic procedures. All these must be audited by an outside agency and it must be ensured that all the records maintained was OK and they are doing well. These trainees must spend at least two years in a busy practice before they can perform these procedures independently.

Colorectal is a very difficult area to operate and how important is the knowledge of anatomy for the surgeons doing these procedures?
Yes. Of course it is a very difficult area to operate and the surgeon must have adequate knowledge of anatomy and physiology. The first important thing is that one should do no harm to the patient. Even if the results are not as expected, they surgery should not do any harm. Make sure there are no injury and no incontinence. The surgeon should know what he/she is doing. As a physician they should know that quality of life is extremely important after surgery. Hence one must be careful and mindful of what is going to happen later on.

Is it possible to prevent rectal prolapse?
You cannot avoid it, it comes with age. However, one should ensure that the patient does not suffer from constipation, uses healthy diet, does not spend long time in the toilet and put strains on the bowl and all this can be avoided.

Don’t you think that if the causes of inflammatory bowl diseases become known, the surgery will be reduced?
At present many things are not so well known. There could be some genetic causes and some environmental. Any one who discovers this will get a prize as it will go a long way in reducing the burden of colorectal diseases.

You looked quite relaxed while operating. Is it a part of your personality or how does it comes?
It is the experience which makes you relaxed. You should know what you are doing, how to prevent complications? If you get into problems, how to get out of such a situation.

You were showing live demonstration of various surgical procedures. Did you find out if the patients were asked to given their informed consent for live demonstration?
The surgical team at JPMC had talked to the patient and I was told they have given their consent.

Operating at home ground offers lot of benefits and advantages. One knows the assistants, equipment and the surgical team. Did you find some difficulty while operating here at JPMC in Pakistan?
Of course it was a bit difficult and stressful. If one knows the assistants, you know what you can expect from them. If you know members f the surgical team, you can rely on them and one is aware as to what is happening day to day in the department. All this makes things quite easy. On the other hand while you are going to operate and show live at a new institution overseas, you do not know what sort of equipment will be available, what quality of support services are available, what is the level and experience of the other members of the surgical team but one has to mentally prepared for all this. One should be open mind how to get out of a situation in which you find yourself.

What about the cases which were selected for surgery?
Most of them were very difficult cases and it required lot of surgical effort to manage them well.

It was fascinating to see you handle the tissues very gently, what advantages such an approach offers?
This is my way of gentle dissection. It helps you get better results. Healing is also quick and better. Pain is less and the patient appreciates all this.

What is the future for young surgeons going for specialization in colorectal surgery?
They all will have a bright future. Colorectal diseases will be seen more and more as people become aware due to increased awareness about these diseases. People will be looking for surgeons trained in this field and thus colorectal surgeons will be extremely busy.

Is it possible to do something for early screening for colorectal cancer?
It is the duty of print and electronic media to educate the people that every bleeding cannot be from hemorrhoids. It could be ulcer and very severe. Hence they must consult the doctor and go for proper diagnosis.

How much time do you give to your second love i.e. medical journalism as Chief Editor of Polish Journal of Surgery?
I do some work daily. Look at some papers, review some, accept few and reject others. It is a monthly publication and hundred years old. Previously it was taken out of Medline but I brought it back in the Medline. If you have good reviewers, the quality of manuscripts accepted is good, it results in improving the quality and standard of the journal.

How serious is the problem of plagiarism in your experience?
Now it is not a major problem though about fifteen years ago, it was a major problem in our experience. We used to come across one or two papers which were plagiarized but now because of public interest, the authors are afraid of indulging in scientific misconduct like plagiarism.

How well developed is the surgical sub-specialties in Poland?
Surgical sub-specialties are not well developed. We are going to make some changes to improve the situation. Previously it used to be six years in general surgery and then people will do two years specialty training like vascular surgery, plastic surgery, orthopedics surgery and thoracic surgery and so on with the result that not many people were coming for specialization in the sub-specialties. Now we are making some changes whereby they will serve for two years in general surgery and then spend three to four years in sub-specialty for specialization.

What about the quality of cases discussed in the consultant corner?
I must appreciate most of these cases were very interesting and very well worked up. They generated lot of useful discussion and overall it was good, informative and useful.

The specialized surgery needs lot of sophisticated equipment and instruments which needs to be properly maintained and all this increase the cost of treatment for the patients?
Actually if one has the basic equipment and instruments which are essential, it is good but new equipment with some minor modification does not offer any major advantage though the cost is very high. Hence, one can get almost the same results with the basic and essential equipment and instruments.