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January 24-30, 2016 marked another SPSA surgical mission to Calbayog City, Samar. Despite it being the third time the group conducted the mission to this progressive city of Western Samar, Secretary Mel Senen Sarmiento, Mayor Ronald Aquino andthe whole of  Calbayog and the volunteers who opened their town to the SPSA missionaries again with their welcoming hospitality like the two previous forays in 2006 and 2009.

The mission was coordinated by Dr. Helen Gomez and her husband Atty. Ed Gomez who are residents of the Calbayog and are no strangers to SPSA, having participated in previous SPSA missions.  Mission started with screening patients at the City gymnasium followed by scheduled surgeries at three hospital venues: Camillus, Saniatarium and Our Lady of Porziuncula hospitals. A total of 248 cases both major and minor surgeries were performed during the 4 – day operative days.

SPSA missionaries were billeted at the Ciriaco hotel and were bussed to their respective hospital assignments.  The yearly undertaking of the Society was sponsored by numerous charitable organizations including the office of the Representative, now the Secretary of the Department of Interior and Local Government Mel Senen Sarmiento, the City Mayor, Ronald Aquino,  Henry Sy’s Foundation who donates the IV fluids used every year, Americares, Society of Philippines Surgeons in America its doct


The Society of Philippine Surgeon in America will conduct its yearly surgical mission to Calbayog , Samar on January 24-30 2016. More than fifty volunteers of surgeons, anesthesiologists and anesthetists, ancillary support personnel from different parts of the United States, Canada, and Europe , comprise the team that will be in Calbayog for the third time . The mission is under the auspices  Mel Sarmiento, who represented the city as a Mayor and Congressman and recently was appointed as Secretary of the Department of the Interior and Local Government by the President.  The present Mayor of Calbayog, Ronald Aquino  as well as some of the NGOs of the City are also involved in having the SPSA missionaries return to Calbayog for this mission.

Dr. Helen Gomez and her husband Atty. Ed Gomez have been coordinating the mission logistics with the SPSA Mission Co-Chairs Dr. Ed Barcelona and Dr. Ed Quiros who took over the SPSA committee with the demise of Dr. Manny Cacdac a year ago, and from Dr. Pacifico Dorado who has remained an avid and active supporter of the mission.  Benefactors of the surgical mission include many of the volunteers who have sent surgical supplies to the office of the then Congressman Sarmiento,  many medical companies, and Americares. 

It will be the Society’s 4th surgical mission to the province of Samar.

SPSA Holds Annual Seminar In Surgery

The Society of Philippine Surgeons in America held its 41st Continuing Medical Education Seminar in Surgery, July 17-24 2015 aboard the Oceania Cruise Line Ship Riviera. The theme of the conference which was put together by SPSA’s CME Chairman Dr. Benjamin Zamora was “Standards of Surgical Practice 2015”. The seminar which was interactive with the didactic lectures and panel discussions had well-known members of the SPSA Faculty as speakers.

During the cruise, the SPSA’s Annual Board of Governors meeting was held where past and pending business of the Society was discussed and acted upon. During this annual event, Sarie Laserna, MD, president of the Society handed over the chain in absentia to the incoming president of the Society, Carl Calica, MD, a general and robotic surgeon from New York who unfortunately could not attend the ceremony. During her farewell address, Dr. Laserna enumerated SPSA’s accomplishments under her leadership including fostering better relationships with the appropriate government agencies in the Philippines as well as leaders of organized medicine relative to foreign medical and surgical missions. She vowed to continue and be active in what she calls the unfinished business that she has started under her term and vowed to help the new SPSA president in the initiatives Dr. Calica would undertake.

SPSA is fully accredited by ACCME and this educational activity was designated for maximum of 16 hours of Category 1 CME credit. Dr. Zamora also delivered the Manuel Cacdac Professorial Lecture on the subject matter of Ebola Virus.

Change Of Venue For 2016 Surgical Mission

Months after unproductive arrangements of possible SPSA surgical mission to Camarines Sur upon the invitation of the governor, Migz Villafuerte, SPSA officially ended its efforts at working on the proposed mission to the province. This was a necessary move because of the time element involved in the details and the logistics the activity requires for both the missionaries and the host, the latter apparently not fully engaged at this time in pursuing the engagement.

The Society of Philippine Surgeons in America which has been conducting surgical missions in the Philippines for approximately 30 years is now actively pursuing an arrangement with another city in the Visayas. It would be the third time the SPSA would be going to this city and the fourth time the Society has been to this province in a few years. The proposed date of the mission would be January 24-30 2016.

SPSA President Confers With RP Health Officials

Dr. Rosario Laserna, current Society of Philippine Surgeons in America president, met recently with various Philippine government health officials to discuss several issues affecting Filipino-American physicians and organizations conducting surgical and medical missions to the Philippines.

Dr. Laserna, an Obstetrician- Gynecologist from Fredericksburg, Virginia, called on Dr. Janette Garin, the Secretary of Health and discussed with her the need for a Health Attache in the Philippine Embassy in Washington, to assist and expedite many of the requirements imposed by the Philippine government on Filipino- Americans and foreign organizations wanting to undertake charitable medical and surgical missions to the country. Among the functions of an attaché suggested include ccordinating activities related to processing STPs or special temporary permits or medical license applications by the Philippine Regulatory Commission, and assisting with Bureau of Customs declarations of medical and surgical supplies essential to mission activities . The Secretary of Health assured Dr. Laserna that she and her staff will work on the t request with feasibility and cost studies within the next 3-6 months.

Prior to the courtesy call on the new Secretary of Health, Dr. Laserna also met with the new Philippine Regulatory Commission Chairman, Dr. Florentino Doble who was most helpful in advising how graduates of Philippine medical schools practicing abroad, can re-apply and renew their medical license in the Philippines personally or by e-mail. A ‘Summit’ meeting with the President and leadership of the Philippine College of Surgeons and the Philippine Medical Association, arranged in advance at the offices of the PCS in Quezon City, and attended by many of the fellows of SPSA was held jointly to discuss how best to resolve the problems of foreign surgical and medical missions in the country.

SPSA Holds Surgical Annual Surgical Mission

The Society of Philippine Surgeons in America, in conjunction with the World Surgical Foundation , conducted its yearly surgical mission in Talavera, Nueva Ecija, January 24-31, 2015. It was held under the sponsorship and auspices of Representative Violago, of the second district of Nueva Ecija at the Dr. Paulino Garcia Memorial Extension Hospital.

The SPSA joined the mission at the invitation of Dr. Domingo Alvear, president and founder of the World Surgical Foundation. Dr. Alvear, a pediatric surgeon an SPSA fellow and a former president of the Society , had been arranging the mission with the staff of the congressman and WSF advance logistical team of Drs. Lester Suntay and Beda Espineda, both pediatric surgeons in the Philippines.

The SPSA contingent included general surgeons, obstetrics and gynecology, and anesthesiologists. WSF consisted of pediatric surgeons, anesthesiologists, urology, surgical residents. Auxiliary personnel from both organizations assisted during the event. Two hundred nine major and minor operations were performed. There was one mortality and three complications which were subsequently attended to.

SPSA Gears for Spring Meeting

The Society of Philippine Surgeons in America will hold its 2015 Annual Spring meeting this coming May 24 to June 5, 2015. The meeting will include a customized tour of Ireland and Scotland which will start in Edinburgh and ends in Dublin. Several tourist and historical landmarks are included in the itinerary for the members and friends of the Society that are attending the yearly spring event.

The SPSA Board of Directors will discuss several agenda items during the meeting. The results and the recommendations will then be presented to the presented to the membership during the Society’s Annual CME meeting in July.

Category 2 continuing medical education activities , will also be held during the tour. Dr. Benjamin Zamora, SPSA CME Chairman, has lined up topics and speakers for the ACCME-accredited activity of the Society.

SPSA Joins WSF for the January 2015 Surgical Mission

The Society of Philippine Surgeon in America is partnering with the World surgical Foundation for the next surgical mission to the Philippines, January 24-31, 2015, in Talaveras, Nueva Ecija. The mission was arranged initially by Dr. Domingo Alvear, founder and president of the World Surgical Foundation. He then invited the Society of Philippine Surgeons in America to join the group. The invitation was accepted by the SPSA Board and the logistics of joining the mission was worked on by Dr. Ed Barcelona, co-chair of the Surgical Mission Committee of SPSA. He and Dr. Ed Quiros were appointed to chair the Committee by the SPSA President, Dr. Rosario Laserna and the SPSA Board after Dr. Manny Cacdac resigned the post after many years of chairmanship because of his illness.

The Nueva Ecija mission at the new Paulino Garcia Hospital in Talaveras, was a culmination of discussions and negotiations resulting in"exemptions" from the requirements imposed by the Philippine Regulatory Commission, the Department of Health and organized medicine in the Philippines, for foreign medical missions from abroad. Both the World surgical Foundation and the Society of Philippine Surgeons in America have been conducting surgical missions to the underserved areas in the Philippines, taking care of the imporished and indigent patients there that it did not take much for the Philippine government to acquiesce to the "exemptions"

The group includes several specialists in their field and are expected to perform operative procedures with some of their Filipino counterparts joint in the effort.

SPSA Turnover Ambulance to Ormoc City

The Society of Philippine Surgeons in America, Inc,. after a successful fund-raising campaign initiated and headed by Dr. Hernan Reyes for the relief efforts towards typhoon Yolanda victims in Leyte, turned over a brand new ambulance to Representative Lucy Torres-Gomez . The ambulance was delivered to OSPA Hospital which was one of the venues during the 2 past surgical missions of SPSA. The campaign to help the Ormocanos was started at the beginning of the year and was quickly responded to by many SPSA fellows and friends. Dr. Hernan Reyes, founder of the Society and Dr. Rosario Laserna expressed their appreciation to all those who contributed to the fund.

The turnover ceremonies were held on September 15, 2014 in Ormoc City. The Society of Philippine Surgeons in America was represented by Dr. Mel Simon and his wife Lydia, and Dr. Ed and Bing Quiros who were with the 2 previous surgical missions to the city. Representative Lucy Torres-Gomez pulled all the stops for the ceremony which was attended by the dignitaries of the City.

The remaining monies of the Ormoc City Campaign Fund presently held by the Philippine Surgeon’s Charities will be used to purchase or equip medical needs of the hospitals as specified by the SPSA. The amount will be disbursed to the office of Representative Lucy Torres-Gomez.

SPSA Stalwart Passes Away

Dr. Manny Cacdac , a neurosurgeon from Terre Haute Indiana, passed away last November 2 at his home in Florida. Doc Manny as he is known to every one, was for a long time the Convention Chair and Co-Chair of the Society of Philippine Surgeons in America until he resigned this year because of lingering illness. He was also a past president of the Society.

Doctor Cacdac  was the founder of the Hydrocephalus Foundation of the Philippines, a foundation that treats and operates on hydrocephalic children in the Philippines. For his humanitarian work in the United States and in his home country, Dr. Cacdac had been the recipient of numerous awards and recognition including the SagamoreWabash Award given by the governor of Indiana and the Linkapil Award given and presented by the President of the Philippines.  He was also a recipient of a humanitarian award by his class during their 50th class reunion in Las Vegas Nevada.  He was a leader and President of many medical and social organizations in his home state of Indiana and in the United States.

A retired Lieutenant Colonel in the US Navy, Manny was an avid sportsman, a hunter, and a fisherman.  His many friends and acquaintances here and abroad, those he has worked with and those whose lives he  had touched, are truly touched by his passing.

He is survived by this family, his wife Fe who is an internist, his three children, Maricel, Manuel Jr. Michele and four grandchildren.

SPSA’s 40th Annual CME Surgery Ends With Several Events

L-R: Dr. Hernan Reyes, Dr. Velchek, Cora Ignacio, Mrs. Lorie Reyes, Dr. Iggy Ignacio

The Society of Philippine Surgeons in America’s 40th CME in Surgery and the Society’s 42nd year of existence was marked with a three-day surgical seminar with SPSA’s own roster of faculty participating and the three Canadian academic surgeons delivering State of the Art Lectures and the Annual Professorial Lecture. The latter was delivered by Dr. William G. Pollett, Professor of Surgery at Memorial University of Newfoundland, St. John’s whose topic, “TheTraining of a General Surgeon: A Work in Progress” detailed steps Canada is taking to match skill sets of surgeons needed in specific practice environment in their country. Several aspects of surgery were covered during the three-day surgical symposia planned by Dr. Ben Zamora, SPSA’s CME Chair. This included disciplines in Pediatric, Neurosurgery, Colorectal, Head and Neck, Cardiovascular surgery as well as Oncology and miscellaneous subjects such as Healthcare in 2014 and Global Burden of Surgical Diseases in Children.

The last day was for the gala dinner and induction of the new set of officers of the Society and the the Board of Governors. Dr. Edgardo Navarro from Germany, handed the Presidential Medallion to the new President of the Society, Dr. Rosario Laserna, an obstetrician-gynecologist from Fredericksburg, Viirginia who outlined an ambitious and pragmatic agenda during her term of office. She is an indomitable and relentless fund-raisers for her causes and for several organizations which she had headed, and promised to do the same for the Society. her husband was a former president of the Society himself.

During the event, The Society, accepted the resignation of Dr. Manuel Cacdac as the Convention chair and appointed Dr. Ben Zamora to the post. The Society also appointed Dr. Ed Barcelona and Dr. Ed Quiros to co-chair the Surgical Missions as Dr. Cacdac remains indisposed to carry on the activities of the Chair although he promised to help the mission any which way he can.

To many, the lobster feast at Dr. Jimmy Belen and his very gracious wife Neri at their Inverrary residence, and that at the Sports Award Dinner at Dr. Iggy Ignacio and his lovely wife Cora at their cabin in NS, added some more memorable memories for the SPSA fellows and their guests.

Philippine Surgeons Charities To Close its Books

During the last meeting of the Philippine Surgeons Charities Board of Directors held in Nova Scotia Canada during the SPSA’s 40th Annual Continuing Medical Education Seminar in Surgery, Dr. Pacifico Dorado’s letter of resignation was accepted. Dr. Hernan Reyes, the founding father of the Society of Philippine Surgeons in America was elected to transact the business of the 501-c3 organization which was established as a financial arm of SPSA many years ago, providing the necessary funds for the Society’s surgical mission activities, the CME and its ACCME activities, and at one time until it was placed on a moratorium, funding related to the Traveling Fellow Program.

At the meeting, Dr. Al Lopez, PSC’s treasurer, presented the financial status of the PSC and suggested that it be closed with the monies after being liquidated, transferred to designated funds of the SPSA. Specifically, the funds be transferred to a separate SPSA account for Surgical missions which would be opened by the mission co-chairs, Ed Barcelona and Ed Quiros. It was also decided that the funds raised for the Ormoc City ambulance donation be disbursed from the PSC funds.

Dr.Lopez would contact an accountant and a lawyer to close the books on the PSC and suggested henceforth that all charitable donations be made to the Society of Philippine Surgeons in America, Inc specific and designated funds. SPSA in also a 501c-3 organization registered in the state of Maryland.

Recommendations made during the meeting were accepted by the Board.

Ormoc City Fund Raising Campaign: Up to Date Tabs


Dr. Hernan Reyes
Dr. Manuel Cacdac
Dr. Ed Quiros
Dr. Mel Simon
$ 1000.00

Donations Received

Dr. Ben Zamora
$ 100.00
Dr. Phillip Chua
$ 100.00
Dr. Ed Barcelona
$ 500.00
Donations Through SPSA
$ 850.00

Typhoon Yolanda Fund Raising
Lecanto, FL (Al Lopez)
$ 6000.00
Dr. Lopez donated
$1696.00  to this fund
Additional Donation, Dr. Lopez
$ 150.00
John and Michelle Cunningham $ 1000.00
Dr. Manuel Cacdac
$  2000.00

Total Donations to Date: 
$ 10,700.00
Donations Plus Pledges: 
$ 20,700.00


Traveling up north in the reaches of the Mountain Province, the Society of Philippine Surgeons in America, Inc. conducted its annual surgical mission in Apayao province, the second poorest province in the Philippines. Mission date was March 1-9, 2014. The mission was several months in planning, sponsored by Governor Elias Bulut, Jr, his sister, Representative Eleanor Bulut-Begtang and Ms. Naida Praugh of AIM. Dr. Manuel C. Cacdac, SPSA’s Mission Chair who worked diligently to have the mission happen, was not able to join the group for health reasons. Despite the logistical difficulties that the missionaries and the hosts had to overcome, the surgical mission ended on a very positive note. There were 21 plastic surgery cases done, general and gynecological cases 120, ophthalmology 53, minor surgical cases 166 and dental cases involving 497 patients resulted in 894 tooth extractions. The mission hosts were extremely hospitable during the whole mission week. The Governor invited back the SPSA for another mission in the very near future.

SPSA Founder Appeals For Ormoc Typhoon Victims

Dear Members, Colleagues and Friends of SPSA and PSC:
It has been over three months since the most powerful cyclone, Typhoon Haiyan, known as Typhoon Yolanda, in the Philippines devastated this country. A Category 5 super typhoon, the deadliest recorded typhoon in the country affected 7 provinces with the major focus of devastation in the east coast of Samar and Leyte province with loss of thousands of lives, destruction of homes, livelihood and infrastructure of the various communities and severe economic losses estimated to be close to 1 billion US dollars. Although the wind speeds were extreme, the major cause of damage and loss of life appears to have been the storm surge which flooded heavily populated low lying areas particularly in the City of Tacloban. On the west coast of Leyte, Ormoc City, though not as hard hit, 90 percent of the city was damaged or destroyed. Hospitals in the city were either shut down or working at partial capacity, leaving many of the nearly 2,000 injured in the city without assistance.

The Society of Philippine Surgeons in America and the Philippine Surgeons Charity have been conducting annual surgical missions to the Philippines for over 2 decades and Ormoc City, Leyte has been the destination of this mission on two occasions during which the generosity and assistance to the group by Congresswoman Lucy Torres-Gomez was instrumental to the success of the mission. In response to her appeal on behalf of the people of Ormoc City, the Governing Board of SPSA and PSC approved to raise funds to support the relief and reconstruction efforts for the City. A fund raising drive with a goal of raising the amount of $100,000.00 (USD) on or before December 31, 2014 was approved to cover the purchase of a basic medical ambulance for the city. Additionally, funds will be used to assist the various medical facilities with building reconstruction, medical supplies and equipment.
This relief effort is made to honor the volunteerism efforts of past and present members of the SPSA surgical mission to the Philippines led by Drs. Manuel Cacdac, Pacifico Dorado, Daniel Fabito and Mel Simon (Founding Chair).

SPSA President Ed Navarro, together with the SPSA/PSC Ad Hoc Committee for Ormoc City Relief Project request your kind and generous assistance to the people of Ormoc City, Leyte. To quote a martyred German theologian during WW II: “ If human beings have passed on to loved ones and to many the blessings they have themselves received, then they have surely fulfilled the most important thing in life; then they have surely themselves become persons happy in God and have made others happy in God.” Bonhoeffer: Pastor, Martyr, Prophet, Spy by Eric Metaxas.

Please help us reach our fund raising goal on behalf of the people of Ormoc City, Leyte, Philippines. onor/pledge sheet is enclosed for your convenience. THANK YOU.

Ed Navarro, President, SPSA SPSA/PSC
Ad Hoc Committee for Ormoc City Relief Project
Honorary Chair: Manuel Cacdac
Chair: Hernan M. Reyes
Co-Chairs: Pacifico Dorado & Mel P. Simon
Fund Raising Co-Chairs: Sari Laserna& Bing Quiros


Hernan Reyes, MD FACS

Ohio SPSA Couple Raises Typhoon Relief Funds

Dr. Pacifico Dorado and Dr. Ludy Dorado, both SPSA fellows from Ironton, Ohio, through their fund-raising efforts, sent $6000. to the American Red Cross and the AmeriCares specifically earmarked for the disaster relief victims of the recent typhoon Haiyan that ravaged the provinces of Leyte and Samar. The donation was raised from the couple’s civic clubs, personal donation and a matching grant from the couple’s hospital in Kentucky.

From all across the US, SPSA fellows have and still are working for delivery of relief goods and medical and surgical reconstruction of hospital facilities  damaged and wiped out by the recent calamity that swept the country. Dr. Juan Montero and Dr. Domingo Alvear, both past presidents of the SPSA, are continuing in their efforts through their respective organizations in channeling medical and surgical supplies to the Philippines affected by Haiyan. Dr. Hernan Reyes, SPSA founder has volunteered to head as well further SPSA relief efforts.

Dr. Dorado is a general surgeon and is co-Chair of SPSA’s Surgical Mission together with Dr. Manuel Cacdac, a neurosurgeon from Indiana and founder of the Hydrocephalus Foundation of the Philippines.

SPSA Joins Typhoon Yolanda Relief Efforts

The Society of Philippine Surgeons in America has joined the many international, national and local groups and organizations in calling for continued relief efforts for the people and areas severely devastated by the recent typhoon Haiyan (Yolanda) in the Philippines. 

Several friends of the Society have inquired about how to help those that have been severely affected by the typhoon. Most of these friends have joined and been to the SPSA surgical missions especially hit by Yolanda. Dr. Ed Navarro, SPSA president and Dr. Manny Cacdac, surgical mission chair, have suggested that donations be sent by those who want to help to the Philippine Surgeon Charities, c/o Pacifico Dorado, MD FACS, 1403 Shawnee Trail, Ironton, OH 45638. PSC is a 501-c3 corporation and all contributions are tax-deductible.

While relief efforts are already underway, it would  take asometime to bring some sense of normalcy to those areas that have been hard hit by the typhoon which up to now had been the fiercest and strongest known to man. In the words of Dr. Navarro, in the Philippines “the fight for survival begins”.

Two SPSA officers launch Fund for Hope for Haiyan

In response to the massive disaster from monster typhoon Haiyan in the Philippines, two officers of the SPSA led the launching of the Fund for Hope Drive of the Filipino United Network – USA, which has so far raised and sent One Million Pesos to the Linkapil disaster relief arm of the Commission on Filipinos Overseas in Manila.

Philip S. Chua, MD, FACS, FPCS, past (7th) president of the SPSA, is Chairman of FUN-USA, a 501(c)3 humanitarian Foundation in the United States, and Sarie Laserna, MD, FACOG, SPSA incoming president, is its Vice- Chairperson. Treasurer is Aleflor Ragaza, MD. of Milford, Connecticut. The website of this non-profit advocacy entity which was founded in 2007, is “

There is no sunshine in the Philippines today…as the death toll reaches6,000 and more than 2 million suffering victims…Let’s not wait for surgery to open our heart,” appeals the FUN-USA chairman. The link below shows where the donations are coursed through for security and accountability: usa-fund-for-hope-for-the-victims-of-yolanda&catid=173:newsupdates-on- typhoon-yolanda&Itemid=859

Donations to this international humanitarian campaign are tax-deductible to the extent allowed by law and may be made visiting


Plans for the Society of Philippine Surgeons in America’s 40th Annual CME in Nova Scotia, Canada is underway. The venue which will be at Cape Breton’s Inverary Resort is being arranged by the hosts, Dr. Bayani Ignacio, past SPSA president and his wife, Cora Ignacio, RN. The CME will start with the Board of Governors meeting followed by a reception on July 16. CME Seminar dates will be on July 17-19 2014. Dr. Benjamin Zamora, SPSA’s CME chair is busy preparing the topics and the list of speakers for the ACCME-accredited surgical conference. Additional logistics for the seminar is being handled and coordinated by Dr. Manny Cacdac, the Society’s convention Chair.

Inverary Resort is Nova Scotia’s most beautiful vacation resort. It is located on the waterfront of Baddeck Bay and is one of National Geographic’s 20 “must see places. Dr. Ignacio , anticipating a well-attended conference has made arrangements with the resort for the best available rates for the attendees of the surgical seminar.

Laserna Elected In-coming SPSA President

Sarie Laserna, MD, FACOG was recently elected as the in-coming President of the Society of Philippine Surgeons in America, Inc during the last Annual 39th CME Seminar aboard the luxury ship Regatta, August of this year. Dr. Laserna, an Obstetrician-Gynecologist from Fredericksburg, Virginia, will be the second female president since the Society was founded in 1972. Dr. Francisca Velchek was the first female president elected in 1993.

Dr. Laserna has been on the Board of Governors of the Society since 2009 and was at one time the Chairperson of the Membership Committee. She has been very active at several medical societies in Virginia. She was a founding president of an organization that helps and supports women,on health issues particularly affecting younger women. She is presently involved with a number of “nation building” organizations , among them the Gawad Kalinga movement in the Philippines. She is an indomitable fund-raiser for all the organizations she is involved in.

Dr. Laserna is married to Oscar Laserna, MD FACOG, FACS, also an obstetrician-gynecologist and 2006 President of SPSA. They have three children and four grandchildren.

SPSA HOLDS 39TH Annual Seminar

The Society of Philippine Surgeons in America ,Inc will be holding its 39th Annual CME Seminar in surgery. The theme of the meeting will be “Standards of Surgical Practice 2013: Diagnosis, Complications and New Techniques”. For the first time, the Society will be holding its seminar on a cruise ship, aboard Oceania’s Regatta. The meeting will be held on July 29 to August 5 2013. Attendees will board the ship in Vancouver, Canada and will dock at the end of the eight-day cruise in Seattle, Washington. State of the Art Lecture will be delivered by Domingo Alvear,MDFACS, chief of Pediatric Surgery at Polyclinic Hospital, Harrisburg, Pennsylvania and former president of the Society. The Professorial Lecture will be given by Francisca Velchek, MD FACS, professor of Pediatric Surgery, State University of New York Downstate Medical Center and chief of Pediatric Surgery Long Island College Hospital in Brooklyn, New York. Dr. Velchek was also a past president of the SPSA. Dr. Benjamin Zamora, MD FACS, the CME Chair, has assembled well-known speakers during the surgicalivity which has been designated for 16 hours of Category 1 of the AMA Physicians Recognition Award. The SPSA is accredited with commendation by the American Council for Continuing Medical Education for physicians. During the seminar,a new set of officers of SPSA will be installed.


Edgardo Navarro,MD, an anesthesiologist and critical care specialist from Germany will be installed as the 38th President of the Society of Philippine Surgeons in America, Inc. during the Society’s 39th Annual CME Seminar in Surgery in Alaska. While Dr. Navarro resides and practices in Germany, he is of Filipino descent, graduated from the Faculty of Medicine and Surgery of the University of Santo Tomas in 1971. Prior to being elected as President-Elect last July in Orlando, Florida, Dr. Navarro has served on the Board of Governors and is presently the Executive Secretary of the Society.

Dr. Navarro runs a charitable medical and surgical foundation based in Germany that benefits medically third-world countries. He has been active in SPSA’s surgical missions in the Philippines. He has also joined the Rotary Club International missions to his native country. Dr. Navarro is married to his wife Regine, a nurse at a hospital in their city of Germany. They have one daughter, Jackie, who is presently a medical student in the Netherlands.
Having been trained in Germany where he has resided continuously since his postgraduate studies, Dr. Navarro is fluent in the German language but has remained conversant in his native tongue, Tagalog, and his native dialect of Pampanga.


The Society of Philippine Surgeons in America held its annual spring board meeting aboard S.S. Isabel during a scheduled cruise along the Duororiver in Portugal. The Board decided among other things to hold the next CME meeting in Nova Scotia, Canada next July 2014 at a hotel/resort area not too far away from former SPSA president Bayani Ignacio, MD and his wife, Cora Ignacio’s residence. The couple have agreed to host the meeting. The venue was chosen over the city in Germany which was initially proposed by incoming SPSA President, Ed Navarro, MD who lives in Germany.

Aboard the ship which never sailed off the port of Porto because of the swollen Duoro River caused by continuous rain, the Society also held a CME meeting which qualified for an ACCME category 2 credits. Speakers during the symposium included Mel Simon, MD, Celia Ona, MD, FerdieOna,MD, Edward Quiros,MD, Ed Navarro,MD and Ralph Zaragoza, MD. The program was planned and moderated by SPSA’s CME chairman, Dr. Ben Zamora.

Meanwhile, the Board also discussed the coming CME annual meeting in Alaska, the next surgical mission venue in the Philippines presently being arranged by Manny Cacdac, MD, the financial status of the Society, and the next spring meeting in 2014.

The group were bussed to the places in Portugal and Spain which the cruise was supposed to have traveled and meandered through but for the strong river currents and the locks which were closed because of the rains. Six couples took and extended land tour in Spain after the river cruise ended.

SPSA Gears for Its Apayao Mission
Surgical Mission March 1-9 2014

Apayao, Mountain Province, up in northern Philippines will be the next site of the Society of Philippine Surgeon in America’s next surgical mission March 1-9 2014.  Hosts of the undertaking are Congresswoman Eleanor Bulut-Begtang and Governor Elias Bulut, Jr. who extended the invitation to the Society’s Mission co-Chair, Dr. Manuel Cacdac sometime last year. Tentatively, there are are at least 76 volunteers from the US, Canada, UK, Germany, and the Philippines. The medical and surgical teams are represented by general surgeons, obstetricians-gynecologists, plastic surgeons, opthalmologists, anesthesiologists, urologist, neurosurgeons,  dentists, internist and nephrologist. Making up the rest of the contingent are nurses and other support personnel.

Three hospital venues have been made available for the surgical procedures to be performed during the week-long mission. The group will fly in to Laoag airport and will be bused for the three-hour drive to Luna, Apayao. Some of the team members from the Philippines are planning to drive the ten-hour trek to the site.

It will be the first SPSA surgical mission to Apayao, although other groups reportedly have had similar medical mission trips to this northern part of the country.

Cacdac and Velchek receives Phil. Presidential Award This is a historic day for the Society of Philippine Surgeons in America. Two members, both Past Presidents of the Society were given the Presidential award for Filipino individuals or organizations overseas. This biennial award is given to deserving individuals and or organizations to recognize their contribution to Phil. development and progress and promote the interest of Filipinos in the Philippines and abroad.

Dr. Manuel A. Cacdac was awarded the LINKAPIL (Lingkod sa Kapwa Pilipino), award for his humanitarian endeavors with bringing surgical missions to different parts of the Philippines once or twice a year and for founding the Hydrocephalus Foundation of the Philippines. President Benigno Aquino recognizes the significance of his professional contribution that has resulted in an increase awareness of hydrocephalus and thereby improving the lives of afflicted Filipino babies, giving them a chance to be normal human beings. Dr. Cacdac was also a BPinoy awardee in 2010, The Most outstanding Indiana Filipino Physician of the Year in 2011, The Most Outstanding Alumnus for Community Service Award, USTMAAA in 2012. He was nominated for CNN Heroes and the Ramon Magsaysay Award in 2012.

Dr. Francisca Tolete-Velchek, was awarded the Pamana Ng Pilipino Award which is conferred to Filipinos overseas who, in exemplifying the talent and industry of the Filipino, have brought the country honor and recognition through excellence and distinction in the pursuit of their work or profession. She was one of eleven awardees. in this category. Dr. Velchek is a Professor of Surgery at The Downstate Medical Center and Chief of Pediatric Surgery at the Long Island College Hospital, Attending Pediatric Surgeon at the Lenox Hill Hospital, and visiting professor of surgery at the Univ. of the Phil., where she graduated from. She has many accomplishments, written books and medical articles, and many awards. In conferring this ward , the President recognizes her outstanding achievement as a doctor of medicine and academician in the field of Pediatric Surgery in the United States....SPSA BOARD MEETS, CANADA NEXT CME SITE

The Society of Philippine Surgeons in America held its annual spring board meeting aboard S.S. Isabel during a scheduled cruise along the Duororiver in Portugal. The Board decided among other things to hold the next CME meeting in Nova Scotia, Canada next July 2014 at a hotel/resort area not too far away from former SPSA president Bayani Ignacio, MD and his wife, Cora Ignacio’s residence. The couple have agreed to host the meeting. The venue was chosen over the city in Germany which was initially proposed by incoming SPSA President, Ed Navarro, MD who lives in Germany.

Aboard the ship which never sailed off the port of Porto because of the swollen Duoro River caused by continuous rain, the Society also held a CME meeting which qualified for an ACCME category 2 credits. Speakers during the symposium included Mel Simon, MD, Celia Ona, MD, FerdieOna,MD, Edward Quiros,MD, Ed Navarro,MD and Ralph Zaragoza, MD. The program was planned and moderated by SPSA’s CME chairman, Dr. Ben Zamora.

Meanwhile, the Board also discussed the coming CME annual meeting in Alaska, the next surgical mission venue in the Philippines presently being arranged by Manny Cacdac, MD, the financial status of the Society, and the next spring meeting in 2014.

The group were bussed to the places in Portugal and Spain which the cruise was supposed to have traveled and meandered through but for the strong river currents and the locks which were closed because of the rains. Six couples took and extended land tour in Spain after the river cruise ended.

SPSA Officer Passes Away

Hector Soto, MD FACS, a member of the SPSA Board of Governors, passed away last week. He was 72 years old and has practiced Orthopedic surgery for more than 48 years in Portsmouth, Ohio.

Dr. Soto was a 1964 graduate of University of Santo Tomas Faculty of Medicine and Surgery. He did his postgraduate training at Elizabeth General Hospital and his residency in Stamford Hospital in Connecticut and Worcester City Hospital in Massachussetts. He was board certified in Orthopedic surgery.

Dr. Soto was very active fellow of the Society of Philippine Surgeons in America. The Society will surely miss him in the many activities he had involved himself in the Society. He is survived by his wife, Lourdes.

SPSA Hosts Confab on its 40th Anniversary

The Society of Philippine Surgeons in America celebrated its 40th anniversary by hosting a symposium on medical and surgical missions to the Philippines, September 30 at the Chicago Marriott Hotel. The event was held during the American College of Surgeons’ annual Congress in Chicago September 29-October 4 2012. The meeting was organized by Hernan Reyes, MD FACS, the Society’s founder and was arranged by Dr. Manny Cacdac, SPSA’s convention chairman. Past presidents of the Society which included Danny Fabito, MD FACS, Pacifico Dorado, MD FACS, Mel Simon, MD FACS, Bayani Ignacio, MD FACS and Johnny Montero, MD FACS, and Frances Velchek, MD FACS were invited to speak on surgical missions to the Philippines and the recent impact of the Philippine Regulatory Commission’s directives on foreign medical and surgical missions to the country.

Dr. Reyes and CME chair Dr. Zamora moderated the panel. The meeting was attended by invited dignitaries from the Philippines which included Dr. Enrique Ona, Secretary of Health, Dr. Rey Melchor Santos, past PCS and PMA president, current Philippine College of Surgeons’president Dr. Maximino Simbulan, former ACS Governor, Philippine chapter Dr. Ben Gaddi. Dr. Enrique Ona, MD FACS and a transplant surgeon was honored with Honorary Fellowship Award, by the American College of Surgeons, the first Filipino surgeon bestowed this prestigious honor. A guest of honor at this symposium, he gave a talk on the state of health care in the Philippines and what his department has done and plans for the future of health care in the Philippines. He also assured that he would look into the recent PRC directives and work on making foreign surgical and medical missions in the country continue. Dr. Rey Santos discussed the problems associated with the foreign surgical and medical missions in the Philippines as it relates to the local physicians and surgeons. The symposium was preceded by the SPSA Board of Governors meeting during which the upcoming Ormoc City surgical mission on January 20-26 2013, the Portugal/Spain spring cruise and the Annual CME meeting, among other agenda were discussed.

Cacdac USTMAA Awardee

Manuel Cacdac, MD, a neurosurgeon from Terre Haute, Indiana was recently awarded the Most Outstanding Alumnus for Community Service during the last USTMAAA Annual Meeting at Caesar’s Palace in Las Vegas, Nevada, August 18-21, 2012.

Dr. Cacdac, a past president of SPSA and presently a co-chair of the Society’s surgical mission, is also the founder of the Hydrocephalus Foundation of the Philippines. Dr. Cacdac has been involved in surgical missions to the underserved areas and continues to work on hydrocephalic babies  in the Philippines .

He has been a recipent of numerous awards for his charitable work including Indiana’s Physician of the Year and the prestigious BPinoy Award given in the Philippines to Filipinos who have distinguished themselves in their chosen profession.

Michigan Surgeon SPSA's 37th President

Leo M. Madarang, MD, a Michign surgeon was installed as SPSA's 37th President during the Society's Annual CME Meeting Seminar in Surgery, July 11-15 2012 in Orlando, Florida.

Leo graduated from the University of Santo Tomas in 1971. He did his internship at St, Joseph Hospital and then his residency in General Surgery and Trauma at Hurley Medical Center. He served as Chief of Surgery at Genesee Memorial Hospital in Flint, Michigan and Wheelock Memorial Hospital in Goodrich, Michigan. He is in practice as a general surgeon and as a wound care specialist and hyperbarist at McLaren Regional Medical Center in Flint, Michigan. He is married to his wife of 40 years, Maria Teresa. They have 4 children-- Angela Joyce, a paralegal, Candice, a Director of Restaurants and Marriott, Michelle, a registered nurse, and Leo, Jr., a lawyer. The new SPSA president plays golf, collects classic comic books and enjoys traveling. The group is scheduled to have another surgical mission, tentatively set on the third or the last week of January 2013.

Past Presidents’ Special Program
Sunday, September 30, 2012
5:00 p.m. – 10:00 p.m.

40th Anniversary Celebration
Chicago Marriott Downtown Magnificent Mile

The Society of Philippine Surgeons in America will host a Past Presidents’ Special Program on the occasion of the Society’s 40th anniversary  during the American College of Surgeons’ 96th Annual Congress in Chicago. The meeting will be held on September 30, 2012 at the Chicago Marriott Downtown Magnificent Mile at 5-10 PM.

Hernan Reyes, MD FACS, the Founder of the the Society, has prepared a program that includes past presidents of the Society, together with special guests from the Philippines which include Dr. Enrique Ona, the Secretary of Health of the Philippines, Dr. Rey Melchor Santos, former Philippine College of Surgeons and Philippine Medical Association president, and Dr. Ben Gaddi, Past President and Governor, ACS Philippine Chapter.


Dr. Michael Nussbaum SPSA’s 38th Annual CME Education Seminar in Surgery Professorial Lecturer

Michael S. Nussbaum, MD FACS, Professor and Chair of the Department of Surgery, University of Florida College of Medicine, Jacksonville will the Professorial Lecturer July 13, 2012 during the SPSA’s 38th Annual Continuing Medical Education in Seminar in Surgery in Orlando, Florida. He will be speaking on “Laparoscopic Management of Common Bile Duct Stones”. Dr. Nussbaum who is also the Surgeon-in-Chief at Shands Jacksonville Hospital and Program Director of the Surgery Residency Program at UFCM, Jacksonville has been named one of the Best Doctors in America since 2009.

He will be joined during by a number of distinguished guests and SPSA faculty during the Society’s 3- day seminar the theme of which is “Standards of Surgical Practice 2012, Diagnosis, Management and New Techniques”.

Benjamin Zamora, MD FACS, SPSA’s CME Committee Chairman says that all the speakers are known experts in their respective specialties. The educational activity has been designated by the Accreditation Council for Continuing Medical Education (ACCME) to provide 16 credits in Category One of the AMA Physicians Recognition Award. For registration and inquiries, call 843. 243.0369

Calbayog Mission Ends on a Positive Note

SPSA’s surgical mission to Calbayog last November 28 to December 5 2011 ended on a strongly positive note despite the fewer number of missionaries compared to the two previous missions there in 2006. Working at three different venues, most of  which were done at St. Camillus Hospital, the team performed 111 major surgeries, 128 minors and 665 dental procedures over five and half days.

The mission was sponsored by Congressman Mel Sarmiento and Calbayog City Mayor Aquino.
For the new members of the surgical team as well as the ‘veteran’ missionaries led by Dr. Manny Cacdac, it was a moving and overwhelming experience.

The group is scheduled to have another surgical mission, tentatively set on the third or the last week of January 2013.

SPSA CME Re-Accredited

The Society of Philippine Surgeons in America now belongs to a select few, out of several hundreds of providers of continuing medical education in the country, having received the highest rating on its 2011 re-accreditation application. Dr. Benjamin Zamora, the Society’s CME chairman proudly announced that SPSA was given a 6-year full accreditation  to expire on November 30, 2017 by the Accreditation Council on Continuing Medical Education. Dr. Zamora stated that  “In our 38 years of accreditation with ACCME, we have always achieved the standard 4-year accreditation which means compliance to all required elements”

Dr. Zamora and his wife Mary Zamora, RN, the Society’s Coordinator who worked hard on the re-application process for several months, received the notification letter and the certificate from Murray Kopelow, MD, MS, the ACCME Chief Executive Officer.

The Society of Philippine Surgeons in America conducts a yearly annual surgical symposium and continuing medical education in July and during its spring Board meeting.

Click here to view [ Accreditation Council Continuing Medical Education ]

Former SPSA President Out With New Book

Philip Chua, MD FACS FPCS long-awaited book  came out of publication recently. “Let’s Stop Killing Our Children” is a collection of the author’s articles and commentaries on our environment and social issues which were published in numerous websites and newspapers here in the United States and abroad.  The book, according to the author is meant to encourage  “the fundamental value of starting a healthy lifestyle and prevention of diseases from crib, or even before the conception of the child”.  The articles  are “aimed to educate, challenge, and inspire the public on health issues and offer preemptive strategies in dealing with diseases in general”.

Dr. Chua, a cardiac surgeon, is a former president of the Society of Philippine Surgeons in America, editor emeritus of the Philippine Surgeon and presently the Chairman of the Filipino United Network USA. He writes a weekly column  on health related issues for four newspapers in the United States. The foreword to the book was written by Dr. Denton Cooley with whom the author trained under during his cardiac fellowship at Texas Heart Institute.

Dr. Chua who is married to his wife Farida, a pediatrician, and has five children who are all physicians, has promised to donate royalties from  books purchased by and through the Society of Philippine Surgeons in America in the Philippines towards the charitable  activities of the Society. The book can be purchased through  Xlibris, the publisher of the book or through the internet, and Barnes and Noble.

SPSA Fellow UST Quadricentennial Awardee

Zorayda Lee-LIacer, MD from Maryland member of the SPSA Faculty and SPSA Board of Governors was recently honored with the Thomasian Leadership Award during the University of Santo Tomas Quadricentennial Celebration last December 2010 in recognition of her humanitarian services to her patients, her colleagues and to organized medicine.

An anesthesiologist and critical care specialist, she is considered a trailblazer for championing antidiscrimination against women and foreign medical graduates as chairman of the Anti-Discrimination Committee of the Maryland State Medical Society. She lobbied many times during the legislative sessions of the Maryland Legislature in support of physician issues.  For her advocacy of patient and physician issues, she was recognized and presented with citation awards by the Governor, Senate President and the Speaker of the House of the State of Maryland.

She was the first female president of the Georges County Medical Society and for eight years, a member of the Maryland Board of Physician Quality Assurance and was for twenty-five years, a member of the state’s Medical Society’s House of Delegates.  Formerly, she was also an assistant professor in the Department of Anesthesia at Georgetown University Medical Center. Since 1988, Dr. Lee-LIacer has been joining the surgical mission to Sorsogon. 

She has also been with the SPSA surgical mission for the last five years. Dr. Zorayda is married to Dr. Reynaldo Lee-LIacer, a surgeon from Maryland and a former president of the Society of Philippine Surgeons n America.  Currently, she is Medical Director of a 22-bed critical care unit at Laurel Regional Hospital in Laurel, Maryland.

Church Donates to SPSA Surgical Mission

The First Presbyterian Church of Borger recently donated $5303.60 to Philippine Surgeon Charities for the SPSA's surgical mission to the Philippines. Pictured above is Dr. Ed Quiros receiving the donation from Mr. Jerry Pool and Ms. Julia Kasch, both representing the Church.

Cacdac Indiana PMA Physician of the Year

The Philippine Medical Association of Indiana awarded the Indiana PMA Physician of the Year to Manuel Cacdac, a neurosurgeon during the PMA Inaugural Ball September 17, 2011. Dr. Cacdac, a past president of SPSA, its current Convention Chairman and co-chair of SPSA’s surgical missions, has been a recipient of numerous local and national awards for his humanitarian activities. He is the founder and chairman of the Hydrocephalus Foundation of the Philippines which undertakes surgical treatment hydrocephalic indigent babies and children through ventriculo-peritoneal shunt program.

Rep. Mel Sarmiento, in the middle, at Tacloban Airport with Dr. Cacdac. Alice Barcelona, RN and Rep. Torres staff last January.


SPSA’s next surgical mission will be in Calbayog, Samar. This is scheduled for November 28 – December 4 2011.  This would be the Society’s third surgical mission to Calbayog.  Two previous missions to the city were held in January and December 2006 under the auspices then of the late Congressman Reynaldo Uy and Mayor Mel Senen Sarmiento and Congressman Catalino Figueroa who had patients from his Catbalogan district come to Calbayog for needed surgery.  

Previously, the Society also held a mission in Catbalogan, sponsored by Congressman Figueroa. This next mission is upon the invitation of Congressman Sarmiento who now represents the first district of Samar in the 15th Congress.  The congressman has sent a letter to SPSA President Dr. Gualberto requesting the Society to return to the city. Dr. Manny Cacdac, co-chair of SPSA’s surgical mission committee is coordinating the activity with the congressman’s office.

During the 2006 missions to Calbayog,  close to a thousand surgical procedures were performed by the missionaries, “SPSA’s efforts changing the lives of  many Samarenos”, as Congressman Sarmiento acknowledged in his letter.

Dr. Cacdac as started fund-raising activities to subsidize the Society’s missionary activities and has asked fellows of the Society and volunteers to sign up early if they are joining the post Thanksgiving, pre-Christmas trip to Samar.

The Society of Philippine Surgeon in America’s surgical mission to Ormoc City last January 30 to February 5, 2011 ended with 836 surgical procedures performed by different specialists represented in the surgical team. The operative procedures include 212 minor surgeries, 119 majors including cleft lips and palates, 421 dental, 72 eye cases that included 52 cataracts/lens implant, and 12 ventriculo-peritoneal shunts in conjunction with the Hydrocephalus Foundation of the Philippines.

The procedures were carried out in three different hospitals: Ormoc sugar Plantation Farmers Hospital where majority of the major and minor procedures were done, Gatchalian Hospital, and the Ormoc City District Hospital.

The surgical mission was sponsored by Congresswoman Lucy Torres-Gomez of the 4th Congressional District of Leyte. The congresswoman, her husband chief-of staff Richard Gomez, her staff and all the civic organizations who undertook the sponsorship of the mission in so short a period of time, went all-out to make the mission end on a successful note.

 Dr. Antonio Alfonso delivered the Annual Professorial Lecture

Dr. Antonio Alfonso delivered the Annual Professorial Lecture at the recent 37th Annual Surgical CME Seminar of the Society of Philippine Surgeons in America. His talk was "Surgical Approaches to Thyroid Disorders-Evolution of Treatment in 30 Years".

Dr. Alfonso, a Fellow of SPSA is the Distinguished Teaching Professor and Clarence and Mary Dennis Chair, Department of Surgery, State University of New York-Downstate Medical Center. He is also the concurrent Chair, Department of Surgery, Long Island College Hospital in Brooklyn, New York.

Cacdac BPinoy Awardee
Indiana neurosurgeon Manuel Cacdac, MD, a former president of the Society of Philippine Surgeons in America and co-chair of the Society's. Surgical Mission and its Convention Chair was unanimously selected to receive this year's BPinoy Awards by the Selection Committee of the Bank of Philippine Islands. The award is in recognition of Dr. Cacdac's "exceptional talent and outstanding achievement in the field of medicine". The BPinoy Awards, now in its fifth year, is given to Filipinos who excel in their chosen fields of discipline at home or internationally.

Physicians for Peace Honors Past SPSA President

Physicians for Peace, an international non-profit organization, presented Dr. Juan Montero with its first Excellence in Service Award for his longtime support of the organization's mission, at home and abroad, as well as his humanitarian efforts in the Philippines.

The award ceremony took place at the 2010 Physician for peace Celebrate the Nations  gala reception in Virginia Beach, Virginia last October 2. "It is fitting that our first Excellence in Service Award honors Dr. Montero, who has been the consummate volunteer, leader and advocate for our organization for 15 years and counting", said Brig. Gen. Ron Sconyers (USAF, Ret), president and chief executive  officer of Physicians for Peace.  For his numerous work, Montero who retired from general and thoracic surgery private practice in 2007, and a past president of the Society of Philippine Surgeons in America, has received numerous honors including the Philippine Presidential Award in 2000, the Association of Medical College's Humanism in Medicine Award in 2002, and the American College of Surgeons' Surgical Volun-teerism Award in 2003.

Progress in the Care of the Coronary
Artery Disease Patient

P SPSA 34 th Annual C.M.E.
Seminar in Surgery
July 16-20, 2008
The Great Wolf Lodge
Traverse City , Michigan

Progress in the Care of the Coronary Artery Disease Patient

Manuel R. Estioko, M.D.
Saint John’s Health Center
Santa Monica , CA 

Coronary artery disease (CAD) remains the number one killer for both men and women in the United States. It is a progressive disease and there are clinical events that require treatment interventions either medical and or surgical. Ruptured atherosclerotic plaque often initiates platelet aggregation, thrombus generation, acute coronary occlusion and myocardial infarction (MI). Much has been accomplished in the medical treatment of the patient especially with the use of beta-blockers and statins. Better control of co-existing disease conditions like hypertension and diabetes further contribute to improved results.

In the event of admission for acute MI, cardiac catheterization and coronary angiogram is recommended to be done as soon as possible. The culprit vessel is identified; angioplasty and stenting are done to limit infarct injury. There is a trend towards multi-vessel stenting as well as repeat stenting. These are some reasons why patients are referred later for surgery and many are older and sicker. However, there are complications of stenting. Bare metal stent (BMS) has significant restenosis problem of about 25 to 40%. Drug eluting stent (DES) was introduced and decreased the incidence of restenosis by about one half but recently, there is observed acute stent thrombosis with the DES and patients have to take Clopidogrel for extended period to avoid this complication. So what is the next advance in technology?

Emergency coronary bypass is indicated in unstable patients in spite of or failed percutaneous coronary interventions (PCI). Some of these patients have tight left main coronary stenosis. The complications of PCI such as coronary dissection, occlusion, perforation and tamponade are low. Other serious conditions requiring emergency surgery are post-MI ruptured ventricular septum and ruptured papillary muscle of the mitral valve with severe regurgitation and pulmonary edema.

Coronary artery bypass graft (CABG) operation has consistently good long term results with low mortality and morbidity. CABG operation volume in most institutions in the US has decreased because of the progress in non-surgical treatments. The indications, graft conduits and present surgical techniques will be discussed in the presentation. The results of On pump and Off pump CABG will be compared. MidCab and Heartport are off the radar but Robotic surgery and minimally invasive procedures are emerging.

The high incidence cardiovascular disease in women and death from it was not well appreciated in the past. Women present their cardiac condition differently. Women’s health is the next frontier which is getting more recent attention. The treatment of CAD remains a major challenge for many years to come.


P SPSA 34 th Annual C.M.E.
Seminar in Surgery
July 16-20, 2008
The Great Wolf Lodge
Traverse City , Michigan


Opportunities in Blood Conservation in Major Surgery

Manuel R. Estioko, M.D.
Saint John’s Health Center
Santa Monica , CA

For so long physicians adhered to traditional transfusion practices without solid scientific evidence. An example of this is the use of arbitrary transfusion trigger and following the 10/30 hemoglobin/hematocrit rule. There were no accurate data supporting the different transfusion guidelines. Transfusion was left at the discretion of the individual physician resulting in tremendous variability in the use of blood and its components.

Over the past two decades, many studies emerged in the literature that has captured the attention of the medical community. These reports covered many aspects related to blood transfusion including: the hazards of blood-borne diseases; the deleterious effects of blood to vital organs like lung injury; immunosuppresion effect of blood transfusion and the increased risk of infection and poorer survival outcomes of transfused patients. At the same time, major, complex operations and even reoperations in cardiovascular, orthopedic and other specialties were successfully performed with less blood or no blood transfusions. Other factors became evident: the high cost of blood and its management; the dwindling volunteer blood donors and crises of blood supply. All these developments lead to the focus on blood conservation in most medical centers in the country. Blood management became important in medical practice that can no longer be ignored or considered an inconsequential issue.

Blood transfusion can be avoided in surgery in the following ways:

  1. Increase red cell mass before surgery.
  2. Minimize blood loss during surgery.
  3. Avoid bleeding problems.
  4. Accept lower levels of hemoglobin and hematocrit postoperatively.
  5. Optimize patient's recovery.

There are many opportunities in blood conservation that include strategies before surgery, intraoperative techniques and postoperative care. Erythropoiesis stimulating agents (ESA) and iron therapy are utilized to increase red cell mass in preparation for major surgery. Sound surgical principles that have to be followed with great details will be discussed in the presentation. The main goals are to minimize blood loss and employ techniques that avoid bleeding. Meticulous hemostasis is performed in every step of the operation. Excessive intravenous fluid administration is to be avoided since it can lead to dilutional coagulopathy. The principles in blood conservation are applicable in any surgical procedure. Fewer problems are encountered in general surgical operations and non-cardiac procedures because there is no burden of large dose Heparin anticoagulation and risk of bleeding. Open heart surgery is more involved, but successful operations can be performed (including complex operations and reoperations), without the use of blood. To illustrate this, we are presenting our experience in the surgical treatment of thoracic aortic dissection and aneurysm. Usually, this group of patients have large blood loss and are always transfused. To perform these procedures without blood transfusion is indeed the ultimate surgical challenge.

The emphasis on optimum blood management is here and is gathering more attention. There are principles and strategies that are applicable in surgery to decrease blood transfusion or avoid transfusion completely. It is incumbent upon the physicians and surgeons to re-evaluate their practice to approach the state of the art. It is no longer acceptable to be using so much blood.

G. Michael Deeb, M.D.

G. Michael Deeb, M.D.
Herbert Sloan Collegiate Professor of Surgery
Director Multidisciplinary Aortic Clinic
Section of Cardiac Surgery
University of Michigan
Cardiovascular Center
Ann Arbor, Michigan

The purpose of this lecture is to discuss the surgical treatment for thoracic aortic disease. We will discuss the various sites and locations of thoracic pathology in relationship to its specific needs for repair. We will talk about the indications for intervention for each type of pathology depending on their location and the underlying etiology of the disease.

We will look at the aortic root, the ascending aorta, the aortic arch and the descending thoracic aorta separately. We will discuss the indications for operation and the various types of operations at each site. We will go into explicit detail as to the various interventional techniques which are available for each site. We will then discuss results which include both short-term and long-term data.

We first begin with the aortic root and ascending aorta and discuss the various indications for intervention. We will then divide intervention into valve sparing roots versus root conduit replacement with a valve.

We will then discuss aortic arch surgery and the evolution of aortic arch surgery as well as the techniques of hyperthermic circulatory arrest with both retrograde and antigrade cerebral perfusion. We will talk about the progression and present status of this type of surgery.

We will then end the lecture discussing descending thoracic aortic and thoracoabdominal aortic aneurysms and discuss the differences between invasive interventional and less invasive intervention with percutaneous stents.

At the end of this lecture you should have a broad idea of the various types of pathology for thoracic aortic disease as well as the particular sites and each of their specific nuances for repair. You will be familiar with the major invasive techniques as well as the new endovascular techniques.

"Asanguinous" Open-Heart Surgery

Philip S. Chua, MD, FACS, FPCS, Victor K. O' Yek , MD, FACS, FRCS, Cris J. Carlos, MD, Felix R. Gozo, MD, Cardiovascular Surgery Associates, 8684 Connecticut Street, Merrillville, Indiana 46410

"Asanguinous" open-heart surgery was initially performed by our team at our institution in January 1982 for mitral valve replacement in a Jehovah's Witness, whose religious beliefs precluded blood transfusion. Since then, we have applied this principle to all of our open-heart cases, with excellent results. Using an IBM 2991 blood cell processor and Sorensen Autologous Transfusion System, our institution has salvaged an average of 92.1 units of blood per month, from January 1982 to December of 1983, with a total of 650 units for 1982 and 1105 units for 1983. From January to August of 1984, a total of 645 units were saved, with an average of 80 units per month. This protocol involved 1121 patients with coronary bypass surgery, 32 of which had concommitant repair of LV aneurysm, and 27 with unilateral carotid endarterectomy. One hundred and sixty-eight underwent cardiac valve replacement, 109 mitral, 57 aortic, and 2 combined MVR-AYR. Eighty-six percent of our entire series did not require homologous, transfusion, other than their own, individual salvaged packed cells. "Asanguinous" open-heart surgery is not only possible and safe, but also a medically prudent technique that is cost-efficient and devoid of the usual hazards associated with homologous transfusion.

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