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ICCP Chair Dr. Graham Newstead (second from left), ASCRS International Committee Chair Dr. Michael Spencer (fourth from left), and ASCRS Research Foundation Assistant Director Karen Oster (center) honor ASCRS Traveling Scholarship winners Drs. Tashi Dendup (left) and Tihomir Hristov (right) and International Scholarship winner Dr. Samser Nahid (second from right).
International Scholar Report:
Scholarship introduced modern techniques, enriching knowledge for colorectal treatment in Bangladesh
Dr. Terry HicksBy Dr. Sayed Md. Samser Nahid, MBBS, FCPS

I would like to express my gratitude to the International Council of Coloproctology (ICCP) and ASCRS for the scholarship that gave me the opportunity to participate in the 2014 ASCRS Annual Meeting and visit the clinics of my dream.

As a part of my scholarship, I attended this year’s ASCRS Annual Meeting in Hollywood, FL. At the first day symposium on advanced endoscopy and endoluminal surgery, I learned about new, advanced endoscopy techniques, imaging, how to overcome with a difficult endoscopy, modern pressure regulated endoscopy, stenting for colonic malignancy, endoscopic clipping for bleeding control, and colonic perforation.

In the afternoon, I made a presentation before the ICCP, in which I gave a brief summary of the health care infrastructure and colorectal surgery in Bangladesh. During the meeting, I met Drs. Graham L. Newstead, Sydney, Australia, Stanley M. Goldberg and Michael P. Spencer, Minneapolis, MN. I also enjoyed the presentation of Dr. Tashi Dendup from Bhutan.

On the third day, I attended the sessions on ligation of intersphincteric fistula tract, in which I was particularly interested. I learned different aspects of the procedures. I also attended sessions on laparoscopic proctectomy and low stapled anastomosis. I really enjoyed the “Past Presidents’ Panel: Controversies and Cases,” especially the sessions with Drs. David Beck, New Orleans, LA, and Stanley Goldberg, Minneapolis, MN. Then, I joined the sessions on rectal prolapse and obstructed defecation syndrome. I gained a lot of understanding on the pathophysiology, investigation options, and better management options for the disorders.

On the fourth day, I joined the sessions on treatment of anal fistula, before leaving early to prepare my podium presentation for the next morning. I was a little bit nervous on the morning of my presentation. IT professionals in the speaker ready room helped me a lot. I made my presentation on transanal hemorrhoidal artery dearterialization with mucopexy without Doppler. This was my first international podium presentation. After that, I watched video sessions on transanal total mesorectal excision, closure of fistula in ano with laser, and robotic surgery.

Cleveland Clinic, Cleveland, OH (May 26-June 6)
My clinic visits started at the Cleveland Clinic, Cleveland, OH, where I spent most of my time in the OR, observing various operations for inflammatory bowel diseases. I think the Cleveland Clinic is the best place for IBD and was amazed by the world class facilities available there. I met with Drs. James Church, David Dietz, Tracy Hull, Hermann Kessler, Feza Remzi, and Luca Stocchi. My observations included several laparoscopic total proctocolectomies with ileal pouch and pouch anal anastomosis and laparoscopic hemicolectomies. They always secure the anastomosis with hand sewn suture, even after successful use of stapler devices. Watching TEMS there for the first time was exciting.

In Bangladesh, we have used a good number of operation procedures for intestinal obstruction due to strictures. Some techniques used at the Cleveland Clinic are different from the ones we have been using. I discussed technique with all the surgeons during the procedures and even after the procedures. They were so helpful, and I learned much from them about different procedures. All doctors in Cleveland listened to my queries patiently and answered them. I am really grateful to them for teaching me and upgrading my knowledge. I feel proud to have trained in such a large and top-ranked institution.

Mayo Clinic, Rochester, MN (June 9-20)
My next destination was the Mayo Clinic, Rochester, MN, where I was assigned to Dr. Heidi K. Chua for the next two weeks. I went to the OR with Dr. Chua and observed different procedures. I watched a sphincteroplasty operation for the first time here and also saw artificial sphincter placement procedure for incontinence. For the first time, I watched robotic abdominoperineal excision. I went to clinics and rounds with Dr. Chua. She always introduced me to others and to the patients.

My experience with Dr. Chua was very enjoyable, as she taught me how to do endoscopy with interventions and gave many good tips. For the first time, I learned about the importance of abdominal pressure during colonoscopy. I appreciated how Dr. Chua and others took time to listen to the patient’s complaints and explain every detail of the treatment options. I was pleased to see that patients wanted to go home within 24 hours of surgery, due to their enhanced recovery protocol. I would like to thank the Mayo Clinic for excellent education booklets for patients, which I have taken for translation to Bangla.

MD Anderson Cancer Center, Houston, TX (June 23-27)
My last destination was MD Anderson Cancer Center in Houston, Texas. I feel lucky to have had an opportunity to visit this excellent center—one of the top centers for treating cancer in the world. I was assigned to Dr. George J. Chang and observed his robotic abdominoperineal excision (APE). He briefly described the procedure and I observed a couple of APE operations, laparoscopic colon resection, and surgery for recurrent colon cancer over the next three days.

The most interesting thing I saw in this clinic was reconstruction of a different kind after APE. I was amazed to see a patient talking and wanting to sit up after 18 long hours of surgery, due to an enhanced recovery system. Dr. John M. Skibber showed me techniques of total mesorectal excision.

During my last day with Dr. Chang in the clinic, I learned how to break bad news and counsel a patient regarding his or her disease and treatment options. If there were no time constraints, I would have liked to spend more time with Dr. Chang, who is a very good teacher and a great surgeon to watch. I would like to thank Dr. Chang and his team members for what they have done for me. Though my duration was short in MD Anderson Cancer Center, I learned a lot and hope to return in the future.

Conclusions
My tour was very fruitful. Observation of the most modern techniques enriched my knowledge. I met learned and experienced surgeons all over the U.S., who taught me many things. I am sure this knowledge will help me provide better service to our patients and improve the current condition of colorectal care in my country. Thank you.

Dr. Sayed Md Samser Nahid is Assistant Professor of Surgery, Cox’s Bazar Medical College, Bangladesh.

The purpose of the ASCRS International Scholarship Award is to provide a surgeon residing outside of the U.S. and Canada, who has demonstrated a strong interest in colon and rectal disease and who demonstrates potential for achieving a leadership position in colon and rectal surgery in his or her home country, with an opportunity to visit clinical, teaching, and research activities in North America and to attend and participate in the Annual Meeting of the ASCRS.

The award carries a stipend of $8,000. Details of the application process and an application form may be found on the Society’s website, www.fascrs.org.