Merry Christmas

Christmas Wishing from Nexus Surgical Associates.

Happy Holiday

Nexus Surgical Associates wishing all our doctors, nurses, paramedics, allied health, administrators and patients Merry Christmas and Happy New Year.

Dr Liau Kui Hin speaks on "The International Guidelines on the Prevention of Surgical Site Infections"

Our senior surgeon, Dr Liau Kui Hin, will be speaking on "The International Guidelines on the Prevention of Surgical Site Infection" at the Korean Surgical Society Conference on 25 Nov 2011 in Seoul, Korea.

Caring for Your Pancreas & Liver. Community Health Education Symposium

Dr Liau Kui Hin, our Senior Hepatobiliary & Pancreatic Surgeon, will be speaking at the Community Health Education Symposium on Saturday, 19 November 2011. He will lecture on " Pancreatic Cancer: Beating the Odds with Modern Day Treatments".

Publication By Nexus Surgical Surgeon Dr Liau Kui Hin

Moving towards the New International Study Group for Pancreatic Surgery (ISGPS) definitions in pancreaticoduodenectomy: a comparison between the old and new

1. Winson Jianhong Tan, 
2. Alfred Wei Chieh Kow, 
3. Kui Hin Liau

Article first published online: 22 JUN 2011

© 2011 International Hepato-Pancreato-Biliary Association

Issue

HPB

Volume 13, Issue 8, pages 566–572, August 2011

Dr Liau Kui Hin & Dr Ho Choon Kait Will Be Speaking at APHPBA 2011 Melbourne, Australia

Dr Liau Kui Hin & Dr Ho Choon Kait will be speaking at the 3rd APHPBA Congress 2011 Melbourne, Australia.

Dr Liau Kui Hin will speak on
1. Management of Hepatic Adenoma at 1400 -1600 hr on 29 Sep 2011
2. Management of Resectable liver metastases from periampullary carcinoma at 1030 - 1300 hr on 30 Sep 2011

Dr Ho Choon Kiat will speak on
1. Laparoscopic spleen preserving distal pancreatectomy at 1030 - 1300 hr on 29 Sep 2011
2. Debate: Local excision  is the preferred option to radical resection  for early tumours of the ampulla  at 1400 -1600 hr on 29 Sep 2011

Asian Pacific HPBA Congress Melbourne 2011
27 – 30 September 2011
Melbourne Convention and Exhibition Centre
Melbourne, Australia
The 2011 Congress will be focusing on "Making a difference with new technologies" and promises to be an exciting and innovative scientific program in a unique destination - Melbourne, Australia

Nexus Surgical Associates #11-02 Official Opening

Nexus Surgical is pleased to announce the official opening of the new clinic at Mt Elizabeth Medical Centre #11-02. You are welcome to join us at the new clinic for the official opening. Light refreshment will be served.

Medical Symposium in Indonesia, Speaker Dr Liau Kui Hin

Dr Liau Kui Hin, our Hepatobiliary & Pancreatic Surgeon will be speaking at the Medical Symposium at Immanuel Hospital in Bandung, Java, Indonesia on 15 September 2011. The lecture topic is "Organ Preserving Surgical Techniques in Cancer Surgery: How they impact on the outcome?" The symposium is tailored for healthcare professionals and medical students. Venue: Immaneul Hospital, Bandung, Indonesia. Time & Date: 1300 hr - 1500 hr, 15 Sep 2011. For more information, please contact Jainah at 65-6235 8633.

Opening of New Clinic at 11-02 Mt Elizabeth Medical Centre

Our new clinic at 11-02 Mt Elizabeth Medical Centre will start operation on 1 July 2011.
The direct line is 65-6235-8651. The main appointment line is 65-6235-8633.
Our team of surgeons are Dr Liau Kui Hin, Dr Lim Khong Hee, Dr Lee Chee Wei, Dr Ho Choon Kiat and Dr Jane Tan.

New Clinic at 11-02 Mt Elizabeth Medical Centre

Nexus would like to announce the opening of Nexus Surgical Associates' New Clinic at 11-02 Mt Elizabeth Medical Centre in early July 2011.
The clinic contact number is 65-6235-8651. The main appointment line is 65-6235-8633.
You can also email us at enquiry@nexussurgical.sg

Nexus Surgical Associates Nurse Manager

Nurse Leong Li Kar will be the Nurse Manager of Nexus Surgical Associates with effect from 1 July 2011.
Congratulation Nurse Leong.

Welcome Our New Enrolled Nurse

Nexus Surgical Associates would like to welcome our Enrolled Nurse Catherine Seah to our team. 

Nexus Surgical Specialists

With effect from 1 July 2011, our list of surgeons at Nexus Surgical Associates
1. Dr Liau Kui Hin
    Hepatobiliary & Pancreatic Surgery, Surgical Oncology
2. Dr Ho Choon Kiat
    Hepatobilairy & Pancreatic Surgery
3. Dr Lim Khong Hee
    Upper Gastrointestinal Surgery & Bariatric Surgery
4. Dr Jane Tan
    Colorectal Surgery
5. Dr Lee Chee Wei
    Vascular & Vein Surgery
Our appointment line is 65-6235-8633. Our Clinic is located at 3 Mt Elizabeth, #08-06 Mt Elizabeth Medical Centre, Singapore 228510.

Surgeons Joining Nexus Surgical Associates

Dr Jane Tan and Dr Lee Chee Wei will be starting their practice at Nexus Surgical Associates Clinic on 1 July 2011. Together with Dr Liau Kui Hin, Dr Ho CK and Dr Lim KH, the group focuses in providing comprehensive surgical services which include upper gastrointestinal surgery, hepatobiliary surgery & pancreatic surgery, colorectal surgery, bariatric surgery, endocrine surgery, trauma surgery, vascular surgery, laparoscopic surgery, surgical oncology, hernia surgery, diagnostic and therapeutic endoscopy. For appointment, contact us at 65-6235-8633.

Free Chromogranin A Blood Test for Diagnosis of Neuroendocrine Cancers

In the month of June, Nexus Surgical continues to offer free CgA test for patients who are suspected to have carcinoids / neuroendocrine tumours (NET) or on follow-up for NET. $40.00 administrative & transportation charges apply. For enquiry, please contact Nurse Li Kar at 65-6235 8633 or email us at enquiry@nexussurgical.sg

New Nexus Surgical Associates Clinic at 11-02 Mt Elizabeth Medical Centre in July 2011

Our new clinic at 3 Mt Elizabeth, 11-02 Mt Elizabeth Medical Centre will be opened in early July 2011. For consultation, patients now have the choice of #08-06 & #11-02 Mt Elizabeth Medical Centre, #05-01 Parkway East Hospital and #09-12 Novena Medical Centre. Nexus Surgical Associates provide a comprehensive range of surgical services which include upper gastrointestinal, hepatobiliary & pancreatic surgery and colorectal surgery, bariatric surgery, surgical oncology, laparoscopic surgery, endocrine surgery, vascular surgery, trauma surgery, hernia surgery, diagnostic and therapeutic endoscopy.

Dr Liau Kui Hin speaks on "Prevention of Unplanned Potsoperative Hypothermia in Elective Major Operations" at Healthcare Quality Improvement Forum

Dr Liau Kui Hin, our senior consultant surgeon, will be sharing his Healthcare Quality Improvement Project on the prevention of unplanned postoperative hypothermia in elective major operations at the Ministry of Health, bi-annual HQIF Forum. The forum is Date: 27 July 2011, Wed Time: 1.30-5.30pm Venue: Ministry of Health, Singapore

Dr Liau Kui Hin debates on "One Stage Laparoscopic Common Bile Duct Exploration is Better Than ERCP + Laparoscopic Cholecystectomy" in the Management of Biliary Stones Disease.

Dr Liau Kui Hin, our senior heaptobiliary laparoscopic surgeon, will be speaking at the upcoming 10th Asia Pacific Congress of Endoscopic Surgery (ELSA 2011). The congress will be held from 11 - 13 August 2011 at the Suntec Singapore Convention and Exhibition Centre in Singapore. The theme of this congress is "So Radical Today, So Obvious Tomorrow". Dr Liau Kui Hin will debates in a symposium session on "One Stage Laparoscopic Common Bile Duct Exploration (CBDE) is Better Than Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with Laparoscopic Cholecystectomy" in the management of gallstones and bile duct stones. For more information, visit the website at http://www.elsa2011singapore.com

Emergency surgery for jejunal diverticulosis: our experience and review of literature

An article written by Drs Tan Ker Kan and Jody Liu, and supervised by Dr Ho Choon Kiat has been published in the May issue of the ANZ Journal of Surgery (2011 May;81(5):358-61), the official scientific publication of the Royal Australasian College of Surgeons.

Abstract:
Background:  Jejunal diverticulosis is a rare entity and is often asymptomatic. However, some of its complications may require acute surgical intervention. This study was performed to evaluate the presentation and outcome of patients who underwent urgent surgery for complicated jejunal diverticulosis. Methods:  A retrospective review of all patients who underwent emergency surgery for complicated jejunal diverticulosis from November 2005 to December 2008 was performed. Results:  Six cases of complicated jejunal diverticulosis required urgent surgery during the study period. Three patients presented with acute abdomen from perforated jejunal diverticulum. Preoperative computed tomographic (CT) scans were useful in localizing the source of sepsis. One patient died from the subsequent complications. The other three patients presented with massive lower gastrointestinal haemorrhage for which CT angiography was able to localize the source of haemorrhage in two of them. Small bowel resection was then performed and all three were discharged well eventually. Conclusion:  Though rare, jejunal diverticulosis can present with several life-threatening complications that mandates immediate surgery. While the surgical procedure may be technically simple, achieving the accurate preoperative diagnosis is often fraught with challenges. CT scan could prove invaluable in the management if the situation permits.

Surgical Lecture: Paradigm Shifts in the Management of Colorectal Liver Metastases

Speaker: Dr Ho Choon Kiat, MBBS, FRCS (Edin), FRCS (Glasg), M.Med (Surg), FRCSEd (Gen), FAMS. 
Chairman: Dr Wong Seng Weng
Time: 1230 hr to 1400 hr 19th May 2011 Venue: Parkway East Hospital Conference Room Level 3. 

Synopsis: When a cancer has spread outside of its origin to a distant site, it is very often considered a terminal disease. However, this is not the case for colorectal cancer. Even if it has spread to distant sites like the liver and lungs, with treatment, 5 years, and even 10 years, survival is now possible. This is due to advancements made in many fronts, including better anaesthetic care, better diagnostic tests, better chemotherapy agents and better surgical techniques. Dr Ho, a liver surgeon by training, will describe some of these advancements and some of the strategies that have brought hope to even the most dismal of cases.

Dr Liau Kui Hin on Conference Leave from 19-22 May 2011

Dr Liau Kui Hin will be attending the Annual Scientific Meeting of the College of Surgeons, Academy of Medicine of Malaysia (CSAMM) at Pullman Kuching, Sarawak, Malaysia from 19-22 May 2011. During his absence, Dr Ho Choon Kiat and Dr Lim Khong Hee will be covering his duty.

Lecture on "Laparoscopic Liver Surgery for Benign & Malignant Conditions" by Dr Liau Kui Hin

Dr Liau Kui Hin will be speaking at the 5th International Congress of the Society of Laparoscopic Surgeons of Bangladesh (SLSB) on 11-12th June, 2011. The lecture is on "Laparoscopic Liver Surgery for Benign & Malignant Conditions". The scientific conference is held in Dhaka, Bangladesh.

Liver Surgery Lecture by Dr Liau Kui Hin on 11 May 2011

Changing Concept in Liver Surgery for Liver Cancer. Speaker: Dr Liau Kui Hin, FRCS, FAMS. Time: 1230 hr to 1400 hr 11 May 2011 Venue: Gleneagles Hospital Lecture Hall. With technological advancement and better understanding in oncology, the concept of liver surgery in the treatment of liver cancer is changing rapidly. The surgical techniques and instrumentation for liver operations have improved tremendously over the last decade. Better anaesthetic and nursing care in the operation theaters, intensive care units and post-operation ward also contributed significant to the better operative outcome. From segment-oriented liver resection and orthotopic liver transplantation to laparoscopic liver surgery and radiofrequency (RFA) or microwave tumor ablation, progress was evident. In this lecture, Dr Liau will discuss the impacts of the recent changes on the practice of liver surgery for liver cancer and the short and long term outcomes of laparoscopic liver operations.

Nexus Surgical Clinic Closed on Polling Day 7 May 2011

The clinic is closed on polling day 7 May 2011. For urgent clinical matters, please contact our 24 hours answering service at 65-6333-5550.

Free Chromogranin (Cg A) Test for Patients on Follow-up or Suspected to have Neuroendocrine Tumours.

In the month of May, Nexus Surgical continues to offer free CgA test for patients suspected to have carcinoids / neuroendocrine tumours (NET) or patients on follow-up for NET. $40.00 administrative & transportation charges apply. For enquiry, please contact Nurse Li Kar at 65-6235 8633 or email us at enquiryFree @nexussurgical.sg

Diagnostic & Therapeutic Endoscopy by Nexus Surgical Associates

Screening and therapeutic gastroscopy and colonoscopy are available at Mt Elizabeth Hospital, Parkway East Hospital, Gleneagles Hospital, Mt Alvernia Hospital, Novena Medical Centre and Thomson Medical Centre. For appointment and scheduling of Endoscopy Services, please contact Nexus Surgical Associates at (65)-6235-8633 or email us at enquiry@nexussurgical.sg or visit our website http://www.nexussurgical.sg/ and fax the downloaded request form to (65)-6235-5675.

Continuing Medical Education Talk by Dr Liau Kui Hin

Our Nexus Surgical Associates Liver Surgeon, Dr Liau Kui Hin will be speaking on The Changing Concept in Liver Surgery for Cancer Treatment on Wednesday 11 May 2011 at Lecture Theatre in Gleneagles Hospital.

Is Whipple Operation Justified in Elderly Patients?

Publication in the journal SURGEON, by Dr Liau Kui Hin & Dr Ho Choon Kiat. Abstract: Although mortality & morbidity for Whipple operation / pancreaticoduodenectomy (PD) have improved significantly over the last two decades, the concern for elderly undergoing PD remains. This study examines the outcome of the elderly patients who had PD. A prospective database comprising 69 patients who underwent pancreaticoduodenectomy between 2001 and May 2008 was analyzed. Using WHO definition, elderly patient is defined as age 65 and above in this study. Two groups of patients were compared [Group 1: Age ≤65 & Group 2: Age >65]. The mean age of our patients was 62 ± 11 years. There were 37 (54%) patients in Group 1 and 32 (46%) patients in Group 2. There was no statistical difference between the two groups in terms of gender and race. However, there were more patients in the Group 2 with >2 comorbidities (p = 0.03). The median duration of operation was significantly longer in Group 2 (550 min vs 471 min, p = 0.04). Morbidity rate in Group 2 was higher (56% vs 44%, p = 0.04). There was higher proportion of post-operative pancreatic fistula (POPF) in the elderly group (37.5% vs 16.7%, p = 0.05). Majority of them are Grade A POPF according to the ISG definition. The median post-operative length-of-stay (LOS) in hospital was 9 days longer in Group 2 (p = 0.01). Mortality rate between the 2 groups of patients was comparable (0% vs 3%, p = 0.28). In conclusion, elderly patients are at increased risk of morbidity in pancreatocoduodenectomy, in particular POPF. However, morbidity and mortality rates are acceptable. It is therefore justified to offer PD to elderly patients who do not have significant cardiopulmonary comorbidities.

Publication by Dr Lim Khong Hee in Journal of Gastrointestinal Oncology

Emergency surgery for perforated gastric malignancy: An institution’s experience and review of the literature J Gastrointest Oncol 2011; 2: 13-18. The aim was to evaluate the outcome of patients who underwent surgery for perforated gastric malignancies. A review of all patients who underwent surgery for perforated gastric malignancy was performed. Twelve patients (nine gastric adenocarcinoma and three B-cell lymphoma) formed the study group. Ten (83.3%) had subtotal gastrectomy performed, while two (16.7%) underwent total gastrectomy. All eight patients with adenocarcinoma who survived the initial operation fared poorly. The two patients with lymphoma who survived the surgery underwent subsequent chemotherapy has no disease recurrence currently. In conclusion, surgery in perforated gastric malignancy is fraught with numerous challenges.

General Surgery Journal Club

Journal Club will be held on Monday 4 April 2011 (time: 1230 hr to 1400 hr) at conference room level 2, Mt Elizabeth Medical Centre.

ASEAN OR/OT Nurses Forum 2011, Hanoi, Vietnam

Dr Liau Kui Hin will be speaking on Evidence-Based Practices in Management of Surgical Site Infection & Nutrition Management at the ASEAN OR/OT Nurses Forum 2011 on 31 March in Hanoi, Vietnam.

Free Chromogranin A (CgA) Test at Nexus Surgical Clinic

Nexus Surgical will continue to provide free CgA test for patients suspected to have carcinoids / neuroendocrine tumours (NET) in March and April 2011. Patients who are diagnosed or on follow up for NET also qualify. $40.00 administrative & transportation charges apply. For enquiry, please contact Nurse Li Kar at 65-6235 8633 or email us at enquiry@nexussurgical.sg

Reducing Surgical Site Infection in Singapore

Reducing Surgical Site Infection in a Hospital in Singapore.

Liau Kui-Hin, Aung KT, Wounds International, 2011 Feb, Volume 2, Issue 1

Surgical site infection (SSI) is preventable and achieving zero SSI rates for every clean operation should be the goal of all surgeons. This paper describes one hospital’s strategy for reducing SSIs, enhancing the care of patients and promoting a culture of patient safety. All clean and clean-contaminated elective gastrointestinal and hernia operations were managed using four specific interventions. SSI rates were compared to historical data.

Publication by Dr Liau Kui Hin and Dr Ho Choon Kiat

Using Percutaneous Transhepatic Cholangioscopic Lithotripsy for Intrahepatic Calculus in Hostile Abdomen.

Kow A W C; Wang B; Wong D; Sundeep P J; Chan C Y; Ho C K; Liau K H

The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 2011 Apr;9(2):88-94

Hepatolithiasis is a challenging condition to treat especially in patients with previous hepatobiliary surgery. Percutaneous Transhepatic Cholangioscopic Lithotripsy (PTCSL) is an attractive salvage option for the treatment of recurrent hepatolithiasis. We reviewed 4 patients, with previous complex abdominal surgery, who underwent PTCSL. This was performed using 3 mm cholangioscope & Holmium Laser through a Percutaneous Transhepatic Cholangio-catheter inserted by interventional radiologists. The median age was 50 (43-69) years and median duration of the condition prior to PTCSL was 102 (60-156) months. Three patients had recurrent pyogenic cholangitis (RPC) with recurrent intrahepatic stone. They all had prior complex hepatobiliary operations. The median duration of procedure was 130 (125-180) min. The number of stones ranged from one to three with the largest size of stone comparable to the size of bile duct. The median follow up was 18 (10-24) months. All patients were symptom free with neither stone recurrence or cholangitis at the last follow up. In summary, PTCSL is a feasible and an effective treatment method for patients with recurrent biliary stone following complex abdominal surgery as the success rates from open surgery and endoscopic procedures are limited. Excellent results can be expected with this minimally invasive technique.

ParkwayHealth CME Programme

Dr Lim Khong Hee from Nexus Surgical will be speaking on Current Concepts in Laparoscopic Surgery on 1 April 2011 at Mt Elizabeth Medical Centre. Time 1-2 pm Venue: Seminar Room, Level 2  Mt Elizabeth Medical Centre. For enquiry, please contact Nexus Surgical at 6235-8633.

Alliance Healthcare PL's Specialist Panel Provider Network

Nexus Surgical Associates is part of Alliance Healthcare PL's Specialist Panel Provider Network. (T&C apply) For more information, please contact us at 65-6235-8633 or email us at enquiry@nexussurgical.sg

Specialist Panel: Alliance Medinet Great Eastern Programme

Nexus Surgical Associates is part of Alliance Medinet Great Eastern Programme's Specialist Provider Panel. (T&C apply) For more information, please call us at 65-6235-8633 or email us at enquiry@nexussurgical.sg

Nexus Direct Access Endoscopy (DAE) Service

Family Physicians and other specialists can download the DAE referral form at http://www.nexussurgical.sg/panel/Direct-Access-Endoscopy-Form.pdf.
Fax the form to 6235-5675 and we will schedule the appoint as per request.
For enquiry, please contact us at 6235-8633

Specialist Panel

Nexus Surgical is pleased to announce that we are on the specialist panel of Shenton Insurance, iXchange (which also covers members of NTUC Income) and MHC-Aviva.

Members whose health plans are covered by these companies can visit Nexus Surgical for a surgical consult  (individual health insurance plans T&C apply).

National Symposium in Jakarta

Our surgeon Dr Liau Kui Hin will be speaking at the National Symposium on Surgical Site Infection Risk Reduction, Prevention & Management in General Surgery. Venue & date: Siloam Hospital, Jakarta, Indonesia on 19 March 2011.

Surgeon on Conference

Dr Liau Kui Hin will be on medical conference leave from 8 to 13 of March 2011.

Public Talk in Malaysia

Our surgeon Dr Lim Khong Hee will be talking on "Gastric Pain - What Should We Do?" in Kota Kinabalu and Labuan, Sabah, East Malaysia on Saturday 3 March 2011. For details, please contact Nexus at 62358633 or email us enquiry@nexussurgical.sg

Nexus Surgical Consult Referral Letter

Family physician can download and print the referral letter for surgical consult from Nexus website or blog: www.nexussurgical.sg/panel/Surgical-Consult-Referral-Form.pdf

Endoscopy Services by Nexus Surgical

Nexus Surgical Endoscopists are accredited to provide Endoscopy Services at the following sites: Mt Elizabeth Hospital, Mt Alvernia Hospital, Parkway East Hospital, Gleneagle Hospital, Thomson Medical Centre, Paragon Medical Centre. For Direct Access Endoscopy Scheduling, please contact our staff at 6235 8633 or fax us at 6235 5675.

Free Chromogranin A (CgA) Test at Nexus

In Feb and Mar 2011, Nexus Surgical provides free CgA for patients suspected to have neuroendocrine tumours (NET). Patients pay $40.00 for administrative charges only. For enquiry, please contact Nurse Li Kar at 6235 8633.

Nexus Surgical @ Parkway East

Our surgeons from Nexus Surgical Associates provide consultation, endoscopy services and surgery in Parkway East Hospital. Dr Liau Kui Hin and Dr Ho Choon Kiat are accredited surgeons with expertise in liver, gallbladder and pancreatic surgery. They are also skilled in laparoscopic and endoscopic surgery. For appointment, please contact us at 6235 8633 or email us at enquiry@nexussurgical.sg

Direct Access Endoscopy Services

In Feb 2011, Nexus Surgical Associates initiated the Direct Access Endoscopy Services for our family physicians. This is a hassle free scheduling service for endoscopy. Physicians can download the request form from Nexus website www.nexussurgical.sg. Alternatively, you can contact us at 6235 8633, our staff will be pleased to assist you in the scheduling. NSA