Scientific Program

Day 1

KEYNOTE SPEAKERS
  • Which is the most common site of metastasis after curative resection with neoadjuvant radiotherapy for rectal cancer :the liver or the lungs?

    Peking University Cancer Hospital
    China
    Biography

    Professor Gu Jin is an eminent surgeon and is currently Professor of colorectal Surgery Department of Beijing Cancer Hospital, Peking University Cancer Hospital. He is also Chairman of the Chinese Society of Oncology (Chinese Medical Association). He graduated with a medical degree from Beijing Medical University, after which he went on to complete further training as a Visiting Scholar at Les Hôpitaux Universitaires de Strasbourg, France and then at the Columbia School of Physicians and Surgeons, US. Prior to assuming his present appointment, he held the position of Attending Physician before being promoted to Professor and Deputy Director of the Department of Surgery, Beijing Medical University, China. He has published more than 71 papers in reputed journals.

    Abstract

    BACKGROUND: The liver and the lung are generally known as the most common sites of metastasis in rectal cancer. OBJECTIVE: To investigate the incidence, timing and predictive factors of metachronous hepatic and pulmonary metastases after curative resection with neoadjuvant radiotherapy. DESIGN: This study is a retrospective analysis of prospectively collected data. SETTING: This study was conducted at a tertiary referral cancer hospital. PATIENTS: A total of 382 consecutive patients with locally advanced rectal cancer (LARC) who received curative resection with neoadjuvant radiotherapy from 2002 to 2011 were enrolled in this study. MAIN OUTCOME MEASURES: The primary outcomes measured were the incidence and timing of pulmonary and hepatic metastases and associated risk factors. RESULTS: Seventy-six patients with LARC followed by curative resction (19.9%) developed distant metastases. The 5-year disease-free survival for the entire cohort was 77.5%. The most common site of metastases was the lung (57.9%, n=44), followed by liver 38.2% (n=29), bone 18.4% (n=12), extra-regional lymph nodes 9.2% (n=7), peritoneum 7.9% (n=6), and brain 2.6% (n=2). Median interval from rectal surgery to identification of pulmonary metastases was much longer than that of hepatic metastases (20.2 months vs 10.1 months, p=0.022). In multivariate analysis, pulmonary recurrence was significantly associated with pathologic T stage (HR=3.820, 95% CI: 1.444-10.105; P=0.007), and pathologic N stage (HR=3.432, 95% CI: 1.681-7.006; P=0.001). As for liver metastases, only the pathologic T stage (HR = 3.659, 95% CI: 1.395-9.601; p = 0.008) retained its significance in logistic regression multivariate analysis. LIMITATIONS: The study is limited by its retrospective and single institutional nature. In addition, only one third of the metastasis were histologically or cytologically confirmed, the proportion is way lower than other studies CONCLUSION: Our study emphasizes that the lung was the most common site of recurrence in a cohort with LARC who underwent neoadjuvant radiotherapy and curative surgery. As differences in patterns of pulmonary and hepatic metastases are observed, tailor-made and organ-targeted surveillance strategies leading to early detection of metastatic disease is strongly needed.

  • Spinal Cord Fusion in Acute Spinal Cord Injury of Dog

    Harbin Medical University
    China
    Biography

    Dr. Xiaoping Ren received his M.D in Harbin Medical University in 1984. He performed his Clinical and Research Hand Fellowship training in University of Louisville in Kentucky (1996-2000). Currently, he has professor position in Harbin Medical University in China and adjunct faculty in Loyola University Chicago in US. Dr. Ren has had over 60 publications in peer-reviewed journals and he is holding active Memberships of the American Association for Hand Surgery, Orthopedics and Neurological of American Academy and the American Heart Association. As well as practice as a Hand and Microsurgeon in clinic, his research interesting on protective strategies against ischemia/reperfusion of CNS and SCI functional recovery.

    Abstract

    Employing an acute dog model of spinal cord injury (SCI) using a diamond knife to generate a clean cut with little crush injury, we show that application of PEG preparations on the severed ends effects considerable neuroprotection and repair. Our results show that electrical continuity starts to be detected one hour after injury, and that BBB scores reach approximately 50% of the sham levels after three to four weeks. This level of restoration of function continues out to 6 month, which is the longest we assessed the dog. Neurophysiological and DTI MR Data confirm electrophysiological and anatomical continuity. This study suggests that a form of spinal cord injury can effectively be treated and points out a way to treat spinal cord injury patients by removing the injured segment and, along with vertebral shortening, reapproximating and fusing the two stumps.

General Surgery and its specialties
Chair
Co-Chair
Advisor
Speaker
  • The Iranian model of living renal transplantation
    Speaker
    Mitra Mahdavi-Mazdeh
    Tehran University of Medical Sciences
    Iran
    Biography

    Mitra Mahdavi-Mazdeh, Iranian Tissue Bank Research & Preparation Center, Tehran University of Medical Sciences, Tehran, Iran

    Abstract

    Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the ‘Achilles heel of the model’. Living unrelated renal donation (LURD) is still a hot topic in professional debates around organ shortage for transplantation. The still increasing demand for renal transplantation brings the subject of LURD to the core of medical caregivers’ attention confronting them with a number of controversial aspects of this entity topic, requiring ethical consideration. Transplantation societies and the World Health Organization try to prevent unethical practices by formulating guidelines for the organ distribution and donation of unrelated living kidneys. The declaration of Istanbul on Organ Trafficking and Transplant Tourism 2008 is among the latest common global efforts to convince different countries to agree on a common approach to stop commercial exploitation and stimulation of deceased donation. Socioeconomic differences, as well as differences in cultural values, religious beliefs, legislative barriers, and lack of the required infrastructure between countries, may prevent setting standard international guidelines. In this short review, the positive and negative aspects of the Iranian LURD are discussed.

  • The results of 29 years of use Low Level Laser Therapy (LLLT) (890nm) in the treatment of various oncologic diseases (clinical and experimental investigations).
    Speaker
    Mikhaylov Vladimir
    Eternity Medicine Institute
    United Arab Emirates
    Biography

    Mikhaylov Vladimir was born on March 21, 1959 in Uglich, Yaroslavl province, Russia Professional experience: 1976- 1982- has finished the Ryazan medical institute named after I.P. Pavlov. 1982-1983- Emergency Hospital Ryazan medical interns surgical department 1983-1985 - Regional Hospital of Kozmodemyansk, Mari ASSR -surgical oncologist 1985-1989- Regional Cancer Hospital, Ryazan – surgical oncologist 1989-1987 - State Research Center of Laser Medicine, Moscow, Senior Research Fellow, Department of Surgery of the biliary tract and parenchymal organs, 1994 - is nominated as the conducting scientific employer, Department of Surgery of the esophagus and stomach. 1997 – 2000 - Head of Moscow Scientific-Practical Center of laser Medicine. 2000 – 2006 -General director of Scientific medical laser Center, Moscow. Since 2006 - private practices on family medicine in Moscow. 2013- Physician Contract with Eternity Medicine Institute, Dubai

    Abstract

    We became used LLLT for the treatment of cancer diseases since 1988. The experimental studies were conducted in three areas: 1.Study the effect of different doses LLLT on the growth of experimental tumors. Implanted - Walker's carcinosarcoma n256 (from the U.S.A. bank)- (26 rats) and cancer of the mammary gland RMK-1 (75 rats). Spontaneous –mice with cancer of mammary glands type B -(188 animals), 2.Evaluation of the effectiveness of use LLLT in combination with various chemotherapeutic agents (vincristin,5-Fu,ciclophosphan) -Walker's (31 animals), , RMK-1 (63 animals). 3.The effect LLLT on the accumulation of hematoporphyrine derivatives -Walker's (188 animals). Clinical study: Breast cancer: Before surgery – 41 patients (II-III st.). In postoperative period- 38 patients (III-IV st.). Only LLLT- 57 patients (IV st.) Cancer of esophagus- (LLLT) + external radial therapy under the radical program - 20 patients, only LLLT-15 patients (T3NoMx). Only LLLT- 63 patients (IV st.). Cancer of stomach: LLLT before surgery -112 patients (IV st.). Only LLLT- 173 patients (IV st.). Cancer of colon: LLLT before surgery -61 patients ( IV st).). Only LLLT- 24 patients (IV st.). Cancer of rectum: LLLT before surgery -44 patients (IV st) Only LLLT- 17 patients (IV st.). Patients with other localizations of tumor (IV st.) – 139 patients.

  • Comparison Between Mitral Valve and Concomitant Mitral with Tricuspid Valve Operations: A Retrospective Analysis
    Speaker
    Steven T. Leung
    Wake Forest University School of Medicine
    USA
    Biography

    Steven T. Leung graduated with the M.B.B.S. degree in 2013 from the University of Queensland, Australia. Since then, he has completed his internship in general surgery at the Mayo Clinic, and his PGY-2 year at the University of Florida. He is currently a Research Fellow with the Department of Surgery at Wake Forest Baptist Health. He plans to complete his residency in general surgery, and pursue a fellowship in cardiothoracic surgery.

    Abstract

    Background: Differences in opinion to treatment of tricuspid regurgitation secondary to mitral regurgitation exist. This study compares the mortality and morbidity of concomitant mitral and tricuspid valve operations to mitral valve operations alone. Methods: Between 2004 to 2012, 153 mitral valve operations were performed. In this group, 130 patients (age, 58.2 +- 13.6) underwent mitral valve repair only, and 23 patients (age, 70.6 +- 7.7) underwent joint mitral and tricuspid valve repairs. The results between these two groups were compared using Pearson’s chi-square and propensity score analyses. Results: Patients undergoing combined valve operations were more elderly (ages 58.2 vs. 70.6 , p<0.001), and more commonly female (73.9% vs. 44.6%, p=0.010). When performing Pearson chi-squared test, the combined valvular operation group had a similar operative mortality (0.0% vs. 1.5%, higher incidence of prolonged ventilation (30.4% vs. 11.5%, p = 0.017), and higher postoperative length of stay (9.7 days vs. 6.4 days, p = 0.039). On the contrary, there were no statistically significant differences in major complications rate (43.5% vs. 16.2%, p = 0.103) or aortic cross-clamp time (114.9 min vs. 119.7 min, p = 0.566) between the two groups. However, due to the disparity between our two groups, propensity score analyses were also performed, which did not demonstrate any differences between outcomes measured in this study. Conclusions: The postoperative mortality and morbidity is similar between patients undergoing mitral valve repair only and patients undergoing mitral and tricuspid valve repairs. Given the decreased quality of life from progressing tricuspid regurgitation and similar postoperative mortality and morbidity rates, a concomitant valvular procedure is a reasonable approach for selected patients with severe tricuspid regurgitation secondary to mitral valve pathology.

  • Design of “H” joystick for reduction of fractures and its application in femoral shaft fracture.
    Speaker
    Xinjia Hu
    Shenzhen People’s Hospital
    China
    Biography

    Xinjia Hu, Orthopaedics Surgeon Department of Shenzhen People’s Hospital, Guang dong Provience, China

    Abstract

    Purpose: In the treatment of femoral shaft fractures by closed reduction and fixation of interlocking intramedullary nail, through the orthopaedics traction table, displacement of overlap or rotation could be corrected, but displacement of lateral or angulation does often exist still. So we have designed an “H” joystick, it can be used in close reduction of fracture, correct the displacement of lateral or angulation, and it has the function of reduction with multi-direction. Method: This design includes two parallel interval of rail, one vertical joystick, four assistant rods. Using Peek materials, can be sterilized by high temperature, penetrated by X-ray. Press “H” joystick, it can adjust the displacement of angulation and lateralaccording to the principle of leverage. Moreover,the horizontal spacing bar has arranged up and down through the hole, the manipulation of the main stem more groove structure, according to the position of fracture and patients’ fat or thin to adjust between two rail and the spacing between each pair of rod, so it can adapt to the needs of different patients and has good applicability. Result: We apply the design in femoral shaft fracture, 51cases. All the displacement were reducted without incision at fracture site. We feel that the femoral shaft fracture reduction and intramedullary nail fixation becomes simple, fast,we also make a further play in minimally invasive technique. The technique has applied for a patent for invention. Conclusion: This design have advancement, can be applied in clinical femoral fractures of the reset, and gradually extended to other fracture reduction.

  • Robotic surgery and patient positioning: Ergonomics, clinical pearls and review of literature
    Speaker
    Dr Shagun Bhatia Shah
    Rajiv Gandhi Cancer Institute and Research Centre
    India
    Biography

    Dr. Shagun Bhatia Shah is a motivated and dedicated anaesthesiologist with sixteen years of experience in the field of anaesthesia. Her interest in oncoanaesthesia drove her to practice as a consultant at RGCI&RC. She is especially interested in recent advances in anaesthesia like USG guided lines, nerve blocks, epidurals and anaesthesia for robotic surgery. She is certified in TEE (Trans esophageal echocardiography) use and utilizes it for managing cardiac patients undergoing noncardiac oncosurgery. She has successfully conducted clinical trials like “Optic Nerve Sheath Diameter guided noninvasive ICP measurement in patients undergoing robotic surgery in steep Trendelenberg position” and is presently conducting the trial “ TEE for intraoperative goal directed fluid therapy in cardiac patients undergoing non cardiac oncosurgery and robotic surgery in ST position” among others. She is ready to walk that extra mile with post- operative and terminally ill cancer patients to alleviate their pain and suffering.

    Abstract

    Statement of the problem: Robotic surgery has revolutionised patient management and opened newer doors for the anaesthesiologists regarding patient safety. Patient positioning and operation theatre (OT) configuration assumes unique importance for robotic surgery due to multiple factors. First and fore-most, the position cannot be changed once the robot is docked. Further, adequate surgical exposure requires extreme positioning and revamping of the existing positioning devices. In addition, there is restricted access to the patient and its antecedent problems. Last, but not the least, space restriction and protection of patient from the clashing robotic arms requires special devices and several unfavourable position modifications. Position related nerve palsies, pressure ulcers, port site necrosis, venous thrombosis and other injuries are on the rise in the recent years and appropriate measures may make it largely preventable. Methodology: Our experience of providing perioperative and anaesthetic care for more than 2500 robotic surgeries (various surgical disciplines) has helped us highlight the major positioning associated deficiencies and problems during robotic surgeries. We have also attempted to find practical solutions for the same, and to define the best practices for robotic positioning using a thorough review of literature.

  • Assessment of Quality of Life after Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis
    Speaker
    Sadaf Qadeer
    Sir Syed College of Medical Sciences for Girls
    Pakistan
    Biography

    Dr. Sadaf Qadeer is an ENT specialist with special interest in Rhinology . She is apt in Endoscopic surgery with emphasis on immunology and allergy. This study is first of its kind in Pakistani population. This study sheds light on the main subtypes of chronic rhinosinusitiis and post-operative quality of life after FESS in such patients.

    Abstract

    Introduction: Chronic Rhinosinusitis (CRS) is a group of disorders characterized by the inflammation of mucosa of the nasal passages and paranasal sinuses.It includes chronic rhinosinusitis with polyps, CRS without polyps and Allergic Fungal Sinusitis(AFS). This debilitating disease causes negative impact on quality of life (QOL) of patients.Functional endoscopic sinus surgery(FESS) is the mainstay of surgical treatment for patients and improves QOL of patients.This subjective assessement of QOL can be measured by disease specific questionnaires. SNOT-22 questionnaire is widely used and validated questionnaire for this purpose.Objective: To compare the quality of life after functional endoscopic sinus surgery in patients with subtypes of chronic rhinosinusitis. Material and Methods: Prospective study was done on 54 patients. Data was collected using SNOT-22 questionnaire and filled in pre-operative period then in post-operative follow-up visits on 1st,3rd,6th and 12th months. Paired sample t-test was used to compare pre-operative and post-operative SNOT scores and multivariate generalized linear model was used to estimate regression parameters for SNOT scores in CRS with polyp and AFS in comparison of CRS without polyps. Results: Out of 54 patients,59.3% were males,mean age was 35.98,29.6% were in CRS without polyp group,44.4% and 25.9% were in CRS with polyps and AFS group. Recurrence occurred in 7.4%,revision surgery required in 3.7% while 22.2% had history of asthma. Paired sampe t-test showed statistical significant reduction in post-operative SNOT scores. Linear model results showed SNOT scores in CRS with polyp group was significantly reduced. Conclusion: FESS provides significant improvement in QOL of patients in chronic rhinosinusitis. Publications: 1. Ehnhage et al. One year after endoscopic sinus surgery in polyposis: Asthma, olfaction and quality of life outcomes. Otolaryngol head and neck surg. Dec 2011. 2. Bezerra T et al. Assessment of quality of life after endoscopic sinus surgery for chronic rhinosinusitis. Braz J Otorhinolaryngol. 2012;78(2):96-102 3. Marambaia PP, Lima MG, Santos KP, et al. Evaluation of quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire.Braz JOtorhinolaryngol.2013;79(1):54-8. 4. Hopkins C, Gillett S et al. Psychometric validity of the 22-item sinonasal outcome test.Clinical Otolaryngology.2009:34:447-454. 5. Mascarenhas JG, Fonseca VMG, Chen VG, et al.Long term outcomes of endoscopic sinus surgery for chronic rhinosinusitis with and without polyps. Braz J Otorhinolaryngol.2013;79(3):306-11.

  • Insertion of cochlear implant electrodes through round window membranes: Its accessibility in paedriatic population
    Speaker
    Montasir Junaid
    Armed forces hospital southern region
    Saudi Arabia
    Biography

    Dr. Montasir Junaid, is an ENT specialist with special interest in otology and head and neck surgery. He has worked as Assistant professor in Pakistan and currently is a visiting faculty in Armed forces Hospital southern region, Saudia Arabia. Dr. Junaid has more than 25 publications and two books published as author and co-author. He is also an active member of Pakistan Cochlear implant Program where cochlear implants are being done free of charge on financially challenged pediatric patients with complete hearing loss.

    Abstract

    Introduction: For infants and children with severe to profound hearing impairment,cochlear implantation is the widely accepted surgery of choice. There has been a recent shift of electrode array insertion from bony cochleostomy to round window membrane(RWM) insertion. Round window membrane is strategically placed which could be accessed after an optimal post tympanotomy . St.Thomas hospital (STH) classification is used to evaluate the accessibility of RWM insertion of electrode array and can be classified as Types I ,IIa , IIb and III. In type I RWM is 100% visible and insertion is straight forward while in type III RWM is not visualized at all and a bony cochleostomy is under taken. Material & Methods: A total of 190 pts were included with minimum age of 1.5 years and maximum of 4.1 with mean of 2.76, There were 48.2 % males and 50.3 % females in the group. Children with diagnosed syndromes or age more than 4.5 were not included in study. Results: The Cause of hearing loss in majority of cases was unknown (53.7% ) followed by low birth weight (14.7%), maternal infections(12.6%) , meningitis (6.3%), birth asphaxia & jaundice (5.3%) and non-inherited congenital (2.1%) All the type III pts underwent bony cochleostomies (2.1 %) while simple round window insertions were 65.3 % (32.2% in Type I, 54.8% in type II a and 12.9% in Type II b) and 32.6 % underwent extended round window insertion. (33.8% in type II a and 66.1% in Type II b ) Conclusion: STH classification is an easy way to assess the accessibility of RWM insertion in patients planned for cochlear implantation provided that a proper posterior tympanotomy has been undertaken.

  • Failure to demonstrate the role of high risk human papilloma virus in epithelial ovarian cancer
    Speaker
    Bibi Ghodsied Seyyedi Alavi
    Mashad University of Medical Sciences
    Iran
    Biography

    Dr. Ghodsieh Alavi has obtained her doctorate degree in Medical Sciences in Mashhad University of Medical Sciences in 1979. With encouragements from her mother for promoting women’s health, Dr. Alavi continued her education in Gynecology and Obstetrics specialty from 1980 to 1984 and from 1984 to 2011, she was a Faculty Member of Ghaem Hospital, Mashhad, Iran. Since 1984 Dr. Alavi has been a manager in Alavi Medical Clinic/Women’s Cancer Clinic and Since 2001 to present, She is manager of the Gynecology Ward and hospital board consultant in Bent Al-Hoda General Hospital, Mashhad, Iran.

    Abstract

    Background and Aims: Ovarian cancer is one of most common causes of cancer related women's mortalities. Human papilloma virus is a known factor concerning cervical cancer but its role in causing ovarian cancer is not yet verified. A few studies also identified HPV DNA in ovarian carcinoma tissues. However, some studies did not detect HPV DNA in ovarian carcinoma tissues. In this article, we investigated the potential role of high risk HPVs in the ovarian epithelial carcinoma. Methods: Fifty archived epithelial ovarian cancer paraffin blocks were collected. Then, 30 non-malignant ovarian blocks used as control. These samples were histopathologically were confirmed by a pathologist and the proper blocks for DNA extraction and PCR were sorted. PCR was conducted deploying highly specific primers for high-risk types of HPV (18 and 16) according to the instructions of manufacturer company. Results: High-risk oncogenic sequences were identified in 4 (5%) of the 80 studied samples. Of the 4 HPV positive cases, there was 1 case with normal tissue, 1 case of mucinous cyst adenocarcinoma, and 2 cases of serous cyst adenocarcinoma Conclusion: Surprisingly, our findings could not support any association between high-risk oncogenic human papilloma virus (18 and 16) and malignant ovarian epithelial cancer. Therefore, that HPV is highly unlikely to play any causal role in the pathogenesis of epithelial ovarian neoplasia.

  • Albendazole therapy in human lung and liver hydatid cysts: A 13-year experience.
    Speaker
    Sayyed Hossein Fattahi Massoom
    Mashad University of Medical Sciences
    Iran
    Biography

    Dr. Hossein Fattahi has obtained his specialty in General Surgery in Mashhad University of Medical Sciences, Iran, in July 1985. Passionate about Thoracic surgery, he continued his Sub-Specialty in it from May 1996 to June 1998. Dr. Fattahi has attended a Thoracic Surgery specialty program in Massachusetts General Hospital, Harvard University, USA, for 6 months in 2006. To this day, Dr. Fattahi has been a member of Iranian Medical Council since 1979 and Academic Board Member of Ghaem Hospital as a Professor, since 1985, where he operates and visits patients in Thorax Surgery Ward and Thorax Walk-In Clinic.

    Abstract

    BACKGROUND: Cystic echinococcosis (CE) is an endemic disease in Iran. This study has aimed to report the efficacy of Albendazole therapy in patients with CE. METHOD: Among 164 patients with echinococcosis who were referred to the surgery clinic, Ghaem hospital, Mashhad University of Medical Sciences between 2001 and 2013, two were diagnosed with alveolar echinococcosis (AE) and 162 with CE; 43 of whom underwent surgery. The rest 119 patients received medical therapy by Albendazole 15 mg/kg/day for three phases. Each phase included 6 weeks of Albendazole therapy followed by 2 weeks of no medication. The patients were classified according to radiologic evaluations into four groups: (1) cured, (2) improved, (3) unchanged, and (4) worsened or relapsed. RESULTS: Patients who completed more phases had significantly greater chances of better response. Of the 56 patients who completed all three phases, 37 (66.1%) were cured, 15 (26.8%) improved, 4 (7.1%) remained unchanged, and none worsened or relapsed. [Odds ratio (OR):4.78, 95% confidence interval (CI): 2.95-7.74, P < .0001]. CONCLUSION: Albendazole can be beneficial for inoperable, multiple cysts, and multiple organs CE patients.

  • Adult intussusception: An eight year institutional review
    Speaker
    Uduma Felix Uduma
    University of Uyo teaching Hospital
    Nigeria
    Abstract

    BACKGROUND: Intussusception is a rare cause of intestinal obstruction in adults. Its diagnosis could be elusive based solely on clinical features because of protean presentations. Supplementary imaging allow for pre-operative diagnosis, early institution of definitive management, and a better clinical course. PATIENTS AND METHODS: Records of adults managed for intestinal obstruction by laparotomy in a surgical unit of a tertiary health facility were retrospectively examined. The subgroup having an intra-operative diagnosis of intussusception was extracted and analyzed. Data obtained included age, sex, and primary symptoms at presentation. Presence of intestinal perforation , the histology of the lead point of resected tissues and the final disposition of the patients were documented. RESULTS: Four hundred and three patients underwent surgical management of intestinal obstruction. Eight patients (2%) had an intra-operative diagnosis of intussusceptions at laparotomy , four males and four females.(male: female ratio 1:1). Abdominal pain was the presentation in 7 (87.5%) and anal protrusion in 1 (12.5%). Four patients (50%)had bowel perforation with peritonitis. Seven of the resected intestine had lead points which were benign. Two patients (25%) died from sepsis. Resection and anastomosis were done for all the patients. CONCLUSION: Intussusception in adults is uncommon but carries a high morbidity and mortality which can be reduced with a good clinical assessment , appropriate imaging and early laparotomy

Otorhinolaryngology Surgery
Ophthalmic Surgery
Oral & Maxillofacial surgery (OMS)
Endocrine Surgery
Cardiothoracic Surgery
Transplantation Surgery
Obstetrics and Gynaecological Surgery
Urology Surgery
Perioperative Care and Anaesthesiology
Acute Care Surgery
Neurosurgery
Plastic Surgery
Orthopaedic Surgery
Advancements in Surgery

Day 2

KEYNOTE SPEAKERS
  • Should considerations in patient dignity affect our surgical decisions?

    Peking University Cancer Hospital
    China
    Biography

    Professor Gu Jin is an eminent surgeon and is currently Professor of colorectal Surgery Department of Beijing Cancer Hospital, Peking University Cancer Hospital. He is also Chairman of the Chinese Society of Oncology (Chinese Medical Association). He graduated with a medical degree from Beijing Medical University, after which he went on to complete further training as a Visiting Scholar at Les Hôpitaux Universitaires de Strasbourg, France and then at the Columbia School of Physicians and Surgeons, US. Prior to assuming his present appointment, he held the position of Attending Physician before being promoted to Professor and Deputy Director of the Department of Surgery, Beijing Medical University, China. He has published more than 71 papers in reputed journals.

    Abstract

    A surgeon makes a decision primarily based on whether a patient has indications or contraindications for surgery, which at the core, questions whether the patient benefits from surgery [1]. However, a surgeon often encounters a number of non-biomedical factors that affect the decision-making. The following case involves the dignity of a patient and the dilemma that a surgeon faces when the dignity contradicts surgical principles, as well as clinical guidelines and norms. The patient was a 32-year-old male. Two years ago, he had abdominal perineal resection (APR) and sigmoid colostomy for rectal cancer in another hospital, as well as physician recommended adjuvant chemotherapy. One year after surgery, a prominent lesion appeared at the stoma. When he came to our hospital in April 2016, the tumor had already invaded most of the lower abdomen wall, which had an ulcerated and infected surface, and the colostomy bag could not be fitted properly. It was suspected that the patient had metastatic lesions in the lungs as well, but this could not be confirmed. The patient was otherwise in good physical condition and strongly requested surgery. The patient explained that the lesion had prevented him from contact with people, even his family, which made him feel that he had no dignity, and this caused him immense pain (Figure 1). However, based on principles of oncological surgery, extensive local resection is not beneficial to the patient if there are suspicions of distant metastases. It was the patient’s last words that helped me make my decision: “I can’t even hug my daughter. What’s the point of living? Doctor, only you can restore my dignity!” I had repeated communication with the patient and his family, clearly explaining to them the indications, complications, and risks of the surgery. There were also differing opinions in the discussions within our department. In the end, I decided to proceed with the surgery for the sake of his dignity. The surgery was a success, and the patient recovered well (Figure 1). The patient returned home two weeks after surgery. He hugged his 4-year-old daughter, who had until then, refused to be affectionate with him. However, liver metastases appeared 4 months after the surgery and he received further treatment. This was the first time in the 30 years since I became a surgeon that I performed surgery for the dignity of the patient, even if it meant going against the current clinical guidelines. Cancers at stoma sites are rare, and only 20 cases have been reported in the literature to date. Even among these 20 reports, most are only case reports [2] [3]. Primarily from the perspective of surgical technology, there is no problem with tumor resection in this case. It is also possible to complete reconstructive surgery. Our surgery would have a huge physical impact on the patient, not to mention the suspected distant metastases. Given these reasons, should this surgery be performed. This is a new issue that surgeons may encounter: It is incontrovertible for a surgeon to base the decision of surgery on the surgical principles and clinical guidelines. However, what should the surgeon do when faced with non-biomedical factors, involving medical ethics, patient’s dignity, and social factors? Firstly, from an ethical and humanistic perspective, the patient in this case felt, through his relationship with his family and especially his daughter, that the disease debased his dignity as a human being. In particular, it was difficult for him to fulfill his role as a father, because he was unable to express his love for his daughter. A hug from a daughter was a very precious thing for this father at the current stage in his life. Especially in a country such as China with ancient roots, family values are very different from that of the West. The feelings Chinese parents have towards their children, especially regarding the care of the only child, are singularly inimitable. Therefore, the surgeon, in the role as a caretaker, should help the patient regain his dignity. It is in line with human rationale and sentiment for a surgeon to consider the patient’s main needs, in combination with his quality of life and clinical condition, as well as having an extensive discussion with the patient and the family, then coming to the conclusion of “surgery for the sake of the patient’s dignity,” in order to help him regain courage and confidence in life. Secondly, for a surgeon, the decision to perform surgery for the sake of the patient’s dignity is not included in the usual surgical principles. Strictly speaking, for patients with colon cancer, who are suspected of having distant metastases, oncologists may also question extensive resection of locally recurrent tumors and extensive reconstruction. Currently, there are no clinical guidelines or related regulations to recommend surgery with the patient’s dignity as consideration. Moreover, the definition of “dignity” is, in fact, relatively difficult to define. Third, a surgery for the sake of patient dignity will be questioned by the healthcare system. In China’s healthcare system, any surgery outside the scope of healthcare regulation is considered as an “off-label” surgery, and there is a risk of payment denial by the healthcare system. Therefore, surgeons should decide with caution to perform such controversial surgery for the sake of patient dignity, which is outside current regulations in the healthcare system. Before deciding to perform an “off-label” surgery for the sake of patient dignity, the surgeon should first consider the patient’s subjective needs and should have thorough communication with the patient and the family, as well as perform a multidisciplinary comprehensive assessment and have an effective communication with the health insurance agencies preoperatively. Given the current social context of China, a developing country where the healthcare system is far from perfect, it is necessary and more appropriate for the patients, the family, the attending surgeon, and health insurance agencies to negotiate for a good solution. A surgical decision-making mechanism incorporating multiple social factors such as patient dignity still has a long way to go. Classic surgical decision-making literatures and textbooks all have inarguably and clearly described the procedures, steps, basis, and even evidences for surgical decision- making [4] [5]. However, if we take a closer look, we will find that those decision-making processes seldom consider non-biomedical humanity factors such as sociology, ethics, or dignity. Humanistic qualities of surgeons directly affect psychological feelings of treated patients and even the therapeutic effects [6]. Enhancing the education and cultivation of surgeons for humanistic qualities is also an important part in our surgical decision-making. In addition to rigorously following clinical norms and guidelines in surgical decision-making, a surgeon should also consider many other patient factors, including their social psychology, dignity, ethnics, religions, and laws. Putting all of these together truly reflect the people-oriented character of modern medicine and the connotation of saving people’s lives. 1. Sacks GD, Dawes AJ, Ettner SL, et al. Surgeon perception of risk and benefit in the decision to operate. Ann Surg 2016; 264(6): 896-903. 2. Maeda C, Hidaka E, Shimada M, et al. Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report. World Journal of Surgical Oncology 2015; 13(6):171. 3. Shibuya T, Uchiyama K, Kokuma M, et al. Metachronous adenocarcinoma occurring at a colostomy site after abdominoperineal resection for rectal carcinoma. J Gastroenterol 2002; 37:387–390. 4. Clive RG, Quick JBR, Simon JF, et al. Problems, diagnosis and management 5th Edition 2013; 10-16. 5. Courtney M, Townsend Jr, Mark E. Sabiston textbook of surgery: the biological basis of modern surgical practice, 19th edition 2012: 211-239. 6. Welling RE, Boberg JT. Professionalism: lifelong commitment for surgeons. Arch Surg 2003; 138(3): 262- 264.

General Surgery and its specialties
Chair
Co-Chair
Advisor
  • Allied Academies surgery 2017 Advisor Speaker Jin Gu photo
    Jin Gu
    Peking University Cancer Hospital
    China
Speaker
  • Newly discovered way of the function of cardio-vascular System and the latest theory of the development of cardio-vascular diseases.
    Speaker
    Mikhaylov Vladimir
    Eternity Medicine Institute
    United Arab Emirates
    Biography

    Mikhaylov Vladimir was born on March 21, 1959 in Uglich, Yaroslavl province, Russia Professional experience: 1976- 1982- has finished the Ryazan medical institute named after I.P. Pavlov. 1982-1983- Emergency Hospital Ryazan medical interns surgical department 1983-1985 - Regional Hospital of Kozmodemyansk, Mari ASSR -surgical oncologist 1985-1989- Regional Cancer Hospital, Ryazan – surgical oncologist 1989-1987 - State Research Center of Laser Medicine, Moscow, Senior Research Fellow, Department of Surgery of the biliary tract and parenchymal organs, 1994 - is nominated as the conducting scientific employer, Department of Surgery of the esophagus and stomach. 1997 – 2000 - Head of Moscow Scientific-Practical Center of laser Medicine. 2000 – 2006 -General director of Scientific medical laser Center, Moscow. Since 2006 - private practices on family medicine in Moscow. 2013- Physician Contract with Eternity Medicine Institute, Dubai

    Abstract

    The main role in transportation of blood to the capillary bed is played by the artery, the power of the heart is only 0,49 -0,027 % of the power needed to transport blood to the capillary bed. The vascular pump is regulated by the frequency of contractions of the heart muscle and is tightly synchronized with the work of the heart. The rapid spread of the pulse wave causes a suction effect. Following the reduction of the vessel wall, the blood is just drawn from the aorta and large arteries to the smaller vessels down to the capillary bed. Systematic irregularities in the vascular pump are the starting point in the development of diseases of the cardiovascular system. These illnesses may be both local and systemic, depending on the size and the location of pathological changes in the vascular wall.

  • Inguinal hernia repair; tension free mesh repair, a new technique
    Speaker
    Adel Goda Hussein
    Cairo University
    Egypt
    Abstract

    Abdominal wall hernias represent a common issue in general surgical practice. The definitive treatment of all hernias, regardless of their origin or type, is surgical repair. There is an ongoing debate about whether to repair primary, unilateral inguinal hernias by the laparoscopic or the open method. Many agree that laparoscopic repair is better for bilateral or recurrent hernias, but its use for primary, unilateral hernias is controversial. So, still the open method has the upper hand in unilateral inguinal hernia repair. There are different methods for repair, nowadays; the most popular method is the mesh repair. In this study, we worked on 200 cases of inguinal hernias, through the period of January 2013, to January 2016. Age groups ranging from 29 – 60 years old, all are males, with mean follow up 1.5 years. The aim of this work is to represents the best method for inguinal hernia repair with the least complications especially recurrence and neuralgia. We modified the technique of tension free mesh repair, and we found that by this method we had no recurrence in all cases ( recurrence rate 0 %), we had only 4 cases of post-operative superficial wound infection (2 %) & 2 cases mesh infection (1%) and 6 cases (3%)

  • Post burn ectropion correction of upper eyelid with full thickness skin graft and 40% overcorrection – A prospective study
    Speaker
    Taslima Sultana
    Dhaka Medical College Hospital
    Bangladesh
    Biography

    Dr. Taslima Sultana is a Consultant in Burn and Plastic Surgery Department, Dhaka Medical College Hospital, Dhaka, Bangladesh. She has Completed her post-graduation ;MS in Plastic surgery from Dhaka Medical College in July,2016. She is now dealing mainly Burn patients and doing a lot of reconstructive plastic surgery but she is passionate about aesthetic plastic surgery also. During her residency she has done research on upper eyelid ectropion correction technique and create an innovative technique on post burn ectropion correction. Her article accepted for international presentation in 11th Asia Pacific Burn Congress ,Taiwan,2017 , 18th ASEAN Congress of Plastic Surgery 2017 , Bangkok Riverside, Bangkok , Thailand and 17th European Burns Association Congress , Barcelona, Spain. Her research interest is in Aesthetic surgery and Post Burn Scar Contracture Reconstruction.

    Abstract

    Background: This study describes the procedure of 40% over correction needed in case of upper eyelid post burn cicatricial ectropion release and coverage with FTSG as FTSG have more primary contraction potential. Methods: This was a prospective observational study done in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, from January 2015 to December 2015. 40% over correction with FTSG was used in the treatment of 21 upper eyelid ectropion of 20 patient. Vertical distance between lower eyelid margin to malar fold was divided into 3 equal portions with 2 imaginary line when 1 portion equals to 33% (approx.). Release of ectropion was such extent that upper lid margin should touch the mid point of middle portion of the defined area or goes beyond the mid point. Then it assumed that adequate 40% over correction is achieved. Post-operative complete eyelid closure and graft take were used as outcome measures. Result: A total of 14 eyelids of male and 7 eyelids of female made up the study groups. After release and overcorrection wound dimension was mean horizontal length 40.86 ± 5.50 mm. Minimum HL is 30 mm and maximum is 60 mm. Mean vertical length is 29.86 ± 4.28 mm. Minimum VL is 21 mm and maximum is 36 mm. In 19 (90.48%) cases complete graft was obtained, 10% graft loss in 1(4.76%) case and 20% graft loss in 1 (4.76%) case survival. Palpebral fissure measurements were compared preoperative and post-operatively and p value was <0.001 in closed state, which was highly significant. Outcome were excellent in 12 (57.1%), satisfactory 7 (33.3%) and poor outcome in 2 (9.52%) cases. Conclusion: 40% over correction with full thickness skin graft may be used as a reasonable reconstructive option for post burn cicatricial upper eyelid ectropion. Keywords : Ectropion , Post Burn , Full Thickness Skin Graft , Overcorrection

  • The effects of cement distribution index on refracture of adjacent segments after percutaneous vertebroplasty
    Speaker
    Zhaozong Fu
    Jiangmen Central Hospital
    China
    Biography

    Zhaozong Fu, born in 1984, medical doctor, spine surgeon, worked on osteoporosis, fracture and spinal degenerative diseases. The author’s research is supported by Guangdong Natural Science Foundation

    Abstract

    Objective: To investigate the effects of cement distribution index on refracture of adjacent segments after percutaneous vertebroplasty. Methods: A retrospective analysis was adopt to complete the research. 143 patients received percutaneous vertebroplasty for osteoporotic vertebral compression fracture from April 2011 to March 2014 were covered in this study. All patients were followed up for 1 year. Cases developed adjacent segment fracture (re-fracture group). The other cases were not observed new fracture (control group). After operations, X-rays were taken from all patients. Index I to V was used to describe the position and shape of cement in vertebrae, and volume-cubage index was computed based on the cement volume and vertebral cubage. Age, gender, bone mineral density, distribution index, volume-cubage index, cement leakage was evaluated in the 2 groups. Then the significant indictors were used to be in variables in Logistic regression analysis. Results: 134 cases were followed up for 1 year at last. 18 cases (13.4%) developed adjacent vertebral fractures. BMD in re-fracture groups was lower than that of control group (P<0.05). While the rates of cement leakage of re-fracture group was higher than that of control group (P<0.05). There was significant difference in distribution index between refracture and control groups (P<0.05). While the differences in age, gender, cement volume and volume-cubage index were not significant between the 2 groups (P>0.05). Bone mineral density, cement leakage and distribution index affected on adjacent fractures by Logistic regression analysis. Conclusion: Low bone mineral density, cement leakage and poor distribution of cement in vertebrae might be the risk factor affecting adjacent vertebral fracture after percutaneous vertebroplasty. Key words: osteoporosis compression fracture percutaneous vertebroplasty vertebral fracture

  • Fibromatosis, a benign breast disease mimicking carcinoma. A case report.
    Speaker
    Arwa Ashoor
    King Fahad Hospital of the University
    Saudi Arabia
    Biography

    Arwa Ashoor is a Breast oncoplastic Surgeon. Her main interest is breast surgical oncology and oncoplastic breast surgery. With the aim to achieve maximum oncological treatment with the best appearance of the breast. She has many publications with regards to breast cancer field as well as book chapters. She is a member of The Oncoplastic Breast Consortium Society.

    Abstract

    Introduction: Fibromatosis is an uncommon breast lesion that can mimic breast carcinoma in its clinical presentation. Case summary: We present a clinical case in which a diagnosis and treatment dilemma existed, in terms of ultrasound findings that were not clear and suspicious, as well as results of Fine needle aspiration cytology. Our findings are compared with previous published cases. Also literature review regarding fibromatosis presentation and diagnosis has been discussed, as well as treatment options. Conclusion: Management of breast fibromatosis remains controversial because of the low incidence and further efforts needed to establish evidence-based treatment guidelines.

  • Palliative Medicine In Surgery: The palliative medicine at the end of life
    Speaker
    Hilda Romero Zepeda
    Universidad Autonoma de Queretaro
    Mexico
    Biography

    Dr Romero-Zepeda is one of the academic collaborators to establish the Three Nations Consortium Mex-USA-Can (2006-2011) on Bioethics and public policy for science, and also the three nations Consortium for the Caribbean Research Ethics Education Initiative CREEI (2013-2018) between Clarkson University (USA), Saint George University (Grenada) and Universidad Autónoma de Querétaro (Mexico). Her interests of research has allow her to establish and execute different intervention programs on chronic degenerative diseases and public health programs for both urban and rural indigenous communities, and its participation in processes of mainstreaming institutional curriculum for the equity of gender and eradication of violence towards vulnerable groups. Nowadays she is working on intervention programs for community development and sustainability but from the ethics perspective for technology and biotechnology transferences to indigenous and marginal rural communities. Dr Romero-Zepeda coordinates the Master Degree Program on Applied Ethics and Bioethics, interdisciplinary studies in applied ethics and bioethics. She is the co-organizer and speaker at the international certificate in applied ethics and bioethics (2007 – 2016) and for the International Diplomado CREEI. She is the compiler in five interdisciplinary research and applied ethics books, co-author in 14 chapters of books, 8 indexed articles by invitation; Director or 11 joint Bachelor's, master's and doctoral thesis advisor; 6 projects of research and bonding in joint in health public, development sustainable, bioethics and gender

    Abstract

    The palliative medicine promotes its appropriate use respect to the will and dignity of the patient. It should be applied by a multidisciplinary team, who accompany the patient throughout the progression of their condition, strengthening doctors and health team`s relationship with the patients and their families. The present presentation will describe and reflect the ethical and legal bases of palliative medicine: The concepts of palliative medicine, the patient-health team relationship and the right of the patients to receive palliative care, its application in surgery, the criterion defining the terminally ill, proportionate and disproportionate measures, drugs and procedures used, personnel to administrate it and for how long and how to avoid therapeutics obstinacy, will be reviewed, where it supports the palliative medicine at the end of the life. Key words: Palliative medicine, bioethics, law.

  • Venoplasty: A less frequent but essential procedure
    Speaker
    Abdullah Al Jamil
    Asgar Ali Hospital
    Bangladesh
    Biography

    He graduated from Sher-E-Bangla Medical College, under Dhaka University, Bangladesh in 1988. He started career as House Physician in Department of Medicine, IPGMR, Dhaka. Then he served in CCU and Internal Medicine, Dhaka Medical College Hospital as Assistant Registrar and Registrar. He obtained Fellowship in Medicine from Bangladesh College of Physicians and Surgeons in 1997. Subsequently he worked as Junior Consultant, Medicine, Shaheed Suhrawardy Hospital, Dhaka for 3 years. He obtained MD Cardiology from Dhaka University in 2001. He worked as Assistant & Associate Professor of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka over 3 years. Then he joined at Square Hospital as Consultant, Interventional Cardiology in January 2007. He joined the present working place in June 2016. He attended several International Conferences as faculty, and presented papers in USA, Switzerland, Japan and Singapore. He performed 2130 procedures including PCIs, Device Implantations, Balloon Valvuloplasties, Peripheral Angioplasties and EPS & RFA.

    Abstract

    Statement of the Problem: Balloon venoplasty and stenting of venous obstruction was introduced in late 1980s and 1990s. Earliest venous stenting was done in 1997.1 It is less frequent but recognized essential procedure. Its clinically significant is more common in upper than lower extremities. Most commonly affected sites include axillary, brachial, cephalic, Subclavian, Superior vena cava, Femoral and Iliac veins. Majority of cases are hemodialysis catheter related from intimal hyperplasia and fibrosis due to intimal trauma secondary to catheter movement during cardiac cycle or due to propagating infection along the venous wall from entry point. Other causes include central venous catheter, pacemaker leads, radiation, trauma or external compression. Venous stenosis presents with swelling of affected area of drainage. Duplex scanning is less reliable in subclavian vein whereas venography is less reliable in femoral and iliac vein obstruction.2 Endovascular therapy is the effective modality of treatment. Balloon angioplasty preferred in subclavian veins and stenting preferred in femoral or iliac veins. Outcome: In subclavian balloon angioplasty luminal diameter improvement in 70%, elastic recoil in 23% and failed in 7%.3 Restenosis develops in 81% at 7.6 months; one-year patency 35% and two-year patency 6%.4 Primary patency in subclavian stenosis varies from 20% to 70%.5 Repeat procedure is needed in large number of patients. Femoral or iliac vein stenting has no in-stent restenosis at 27±4 months but stent thrombosis in 4%.6 Conclusion & Significance: Majority of venous obstructions are iatrogenic mostly hemodialysis patients. It’s a less frequent procedure but essential to keep open the vein related to dialysis, the lifeline for the patient. Need for repeat procedure is very high.

Otorhinolaryngology Surgery
Ophthalmic Surgery
Oral & Maxillofacial surgery (OMS)
Endocrine Surgery
Cardiothoracic surgery
Transplantation surgery
Obstetrics and Gynaecological Surgery
Urology surgery
Perioperative Care and Anaesthesiology
Acute Care Surgery
Neurosurgery
Plastic Surgery
Orthopaedic Surgery
Advancements in Surgery

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Delegates are personally responsible for their belongings at the venue. The Organizers will not be held responsible for any stolen or missing items belonging to Delegates, Speakers or Attendees; due to any reason whatsoever.

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Cancellation Policy

If an allied academy cancels this event for any reason, you will receive a credit for 100% of the registration fee paid. You may use this credit for another allied academies event which must occur within one year from the date of cancellation.

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If allied academies   postpones an event for any reason and you are unable or unwilling to attend on rescheduled dates, you will receive a credit for 100% of the registration fee paid. You may use this credit for another e allied academies event which must occur within one year from the date of postponement.

 

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All fully paid registrations are transferable to other persons from the same organization, if registered person is unable to attend the event. Transfers must be made by the registered person in writing to surgery@alliedconference.org Details must be included the full name of replacement person, their title, contact phone number and email address. All other registration details will be assigned to the new person unless otherwise specified.

Registration can be transferred to one conference to another conference of Allied academies. if the person is unable to attend one of conferences.

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Keeping in view of increased security measures, we would like to request all the participants to apply for Visa as soon as possible.

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If the registrant is unable to attend, and is not in a position to transfer his/her participation to another person or event, then the following refund arrangements apply:

Keeping in view of advance payments towards Venue, Printing, Shipping, Hotels and other overheads, we had to keep Refund Policy is as following slabs-

·         Before 60 days of the conference: Eligible for Full Refund less $100 service Fee

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Accommodation Providers (Hotels) have their own cancellation policies, and they generally apply when cancellations are made less than 30 days prior to arrival. Please contact us as soon as possible, if you wish to cancel or amend your accommodation. Allied academies will advise the cancellation policy of your accommodation provider, prior to cancelling or amending your booking, to ensure you are fully aware of any non-refundable deposits.

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