Colorectal Surgery training set up should be established at various medical institutions


7th annual Colorectal Surgical Week concludes at JPMC
Colorectal Surgery training set up should
be established at various medical institutions

Dedicated surgical units and opportunities for
juniors to have Hands on Training is essential
improve patient care and overall results

KARACHI: The 7th annual surgical week for colorectal diseases which consisted of presentations, live demonstration of various surgical procedures and consultation corner concluded here on October 4th 2012. Prof. Evaghelos Xynos MD, PhD, FACS Prof. of Surgery at Creta Interclinic of Heraklin, Agia, Olya Hospital Athens Greece was the master trainer. As usual it attracted a large number of surgeons from all over the country. Prof. Irshad Waheed former Professor of Surgery who also served as Director of JPMC was the chief guest in the concluding session. He commended the organizers for such a well attended surgical session on colorectal surgery. Apart from providing patient, teaching and training, this premier postgraduate medical institution, he opined, should also contribute to medical literature. In the past Annals of JPMC was started but only a few issues could be published, He advised the JPMC faculty to look into the possibilities of restarting its publication.

Prof. Irshad Waheed presenting a mementoe to Prof. Evaghelos Xynos during
the concluding session of Surgical Week for Colorectal Diseases at JPMC. Also
seen in the picture from (L to R) are Prof. Tariq Mahmood, Prof. Mumtaz Maher
and  Dr. Shamim Qureshi.

Prof. Xynos in his brief speech thanked his hosts and said that people of Pakistan are very friendly. I have enjoyed my visit to Pakistan and it has been a pleasure to participate in this academic activity. On first day of the course Prof. Xynos gave an overview of restorative proctocolectomy followed by live demonstration of haemorrhoidectomy. On the second day he discussed Total Mesorectal Excision which was followed by live demonstration of abdomino perineal resection. Recent advances in surgery for rectal prolapse were discussed on the third day which was followed by abdominal rectopexy while on the last day he discussed complex anal pathology and then showed sphincter repair. 
Earlier on a suggestion from Dr. Shamim Qureshi Secretary of the course there was an open discussion on how to improve this course in the days to come as the organizers have already invited the speaker for the next three years. Prof. Mumtaz Maher former Professor of Surgery and a noted colorectal surgeon who initiated this colorectal surgery week at JPMC many years ago opined that we should be demonstrating haemorrhoids, fistulae and fissures which are the common conditions in Pakistan rather than testing the competence of the invited guest trainers by giving them difficult complex cases. It is in the interest of the participants of the course to discuss diseases which are common here rather than those which are very rare. He further stated that we must have dedicated surgical units in different institutions different people doing different surgical procedures. They should then concentrate in those areas and others should refer the relevant cases to them. It will not only improve the patient care but the results will be much better because of expertise. We must have colorectal set up in various institutions where colorectal work is done. In the past we decided to have some laparoscopic surgery sessions at another institution during the course but it did not work due to politics. May be in future we should have two surgeons so that we do not waste any time though it will increase the cost. But we need to take this course a step further, he remarked.
Laparoscopic surgery Prof. Mumtaz Maher further stated is here to stay. We must organize hands on workshops in teaching institutions and start training people instead of people trying to learn on patients by just watching. They must be fully trained before they can operate upon patients. We should identify and have a few surgeons and few training centers and learning at different centers can be organized. We get the feed back that seniors are not happy because the juniors take too much time doing these procedures. Juniors, he said, will take time as speed was not under discussion. Learning will take time, let juniors work and do proper surgery. It is important that we create opportunities for the juniors to learn and do not discourage them.
Dr. Shamim Qureshi said that may be in future we do have some presentations on surgical anatomy and physiology. Some MRI, ultrasound and endoscopic experts can also be invited to participate in the programme and update the participants on various issues. Prof. Mumtaz Maher said that last time we saw the guest surgeon struggling in one of the case. If the surgeon is struggling, he won’t be keen and interested to teach and train and the whole objective of this course will be lost. I myself learn while coming here every year. In our institutions, unfortunately the senior seldom teach. We all were taught by the Registrars, junior faculty members and seniors seldom bothered to take interest in teaching and training. It is time we change this practice. We must teach the juniors how to do hernias, haemorrhoids and the proper way of doing these things. We must make a team of people who are capable and interested in teaching and training for which appropriate arrangements should be made.
Mr. Shuakat Ali Jawaid Chief Editor of Pulse International was also invited to give his observations. He pointed out that one would have loved to see more senior surgeons from other city hospitals come and join this academic activity. Some are keen to learn and go even overseas for that but there are others who are least interested and won’t even attend such sessions being held in their own city within the country. In the past there used to be dedicated moderators drawn from various city hospital and they would comment on each and every step the operating surgeon was taking so that the participants can follow. In Pakistan we have lot of inhibitions’ and even if we do not know, we are shy of asking questions. Hence, proper moderation of the live demonstration could be organized, it will be much better. There is always room for improvement and the organizers should look into minute details for which one needs a team which works. Detailed proceedings of the presentations and live demonstration of various surgical procedures will be covered in the forthcoming issues.

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