FALS Proctology Guidelines

(Fellowship of Advanced Proctology Surgery)

About FALS Proctology Fellowship Course

This course is to train senior or advanced laparoscopic surgeons and to keep the members abreast with recent advancements in advanced FALS Proctology procedures.

A. FELLOWSHIP CATEGORY

Eligibility Criteria:

IAGES MEMBERSHIP IS MUST.
Those who are not members may apply for membership online. See the website www.iages.in for more details.

1. Members of collaborating associations who have signed MOU with IAGES are also eligible. They are expected to get their application endorsed by the respective collaborating association prior to joining the course.
   
   
2. Non-Examination category
   
   • Surgeons who have been doing laparoscopic surgery and Proctology in the chosen field for 10 or more years are eligible for Non-Examination Category.
     
     
   • Candidates should have performed more than 100 laparoscopic / Proctology surgeries in the chosen subspecialty and need to submit a logbook to substantiate the claim.
     
     
   • All the candidates will be interviewed by the IAGES board for final assessment before the award of fellowship
     
     
3. Examination Category
   

Post graduate degree ( Post MS / DNB) ) in General surgery is mandatory.

B. Non-Fellowship Category

• • FALS Proctology course is also open to Non-members and all surgical postgraduates and interested surgeons across the globe, under the non-Fellowship category wherein they are eligible to take this course and receive the Certificate of completion of FALS Proctology course.
    
    
  • They could register and participate in the annual national conference as Postgraduates or Non-member category
    
    

Logbook

• Age/Sex/Surgery/Role/Post-op course/Complication/Remarks
• Role – Assisted/undersupervision/Independent (as drop down)
• Post-op course – Uneventful / Eventful (as drop down)
• Complications – Infection, Bleeding, Leak, Stricture, Obstruction, Others (type if others) as drop down
• Remarks – Type the outcome of the event, if patient has been conservatively managed, Recovered, Diseased, Transferred, etc

FALS PROCTOLOGY FELLOWSHIP COURSE MODULES

S.No	TOPICS
I	Fundamentals
1.	Anatomy as relevant to the surgeon
2.	Clinical examination of the anorectal complex
3.	Essential imaging for Anal Fistula
4.	Local Anaesthesia and postop analgesia for proctological procedures
5.	Anal Fissure
6.	Lateral internal sphincterotomy
7.	LASER sphincterotomy
8.	Hemorrhoids
9.	The Milligan Morgan Technique
10.	Stapler Hemorrhoidopexy MIPH
11.	Hybrids and LASER
12.	Chivates procedure
13.	Office procedures
14.	Anal Fistula
15.	Procedure selection
16.	The identification of fistula openings
17.	Acute Abscess in Fistula
18.	Supralevator abscesses in Fistula
19.	Surgery for intersphincteric and transsphincteric fistula
20.	Setons
21.	Primary Sphincteroplasty for anal fistula
22.	LIFT
23.	VAAFT ?
24.	LASER Fistula
25.	Pilonidal Sinus
26.	MIS for pilonidal sinus LASER & EpSiT
27.	Excisional surgery for pilonidal sinus
28.	Flaps for pilonidal sinus
29.	Special situations
30.	Anal tubercuIosis
31.	IBD anal fistula
32.	Anorectal vaginal fistulae
33.	Anal warts
34.	Pruritus ani
35.	Reconstructive anal
36.	Anoplasty – Step by step
37.	Graciloplasty – Indication and technique
38.	Newer sphincter repairs – Indication and evidence
39.	Pelvic floor
40.	Assessment and Treatment of ODS
41.	STARR
42.	Solitary Rectal Ulcer – Optimal Management
43.	Rectal Prolapse – Case based approach
44.	Altemiers operation – Indication and technique
45.	Suture and posterior rectopexy
46.	Ventral suspension rectopexy
47.	Oncology
48.	Early rectal malignancies – TAMIS
49.	Advanced anal cancer / Low anterior resection
50.	Intersphincteric resection
51.	Optimal TME in Carcinoma Rectum
52.	TATME
53.	Panels
54.	Complications in Proctology Surgery
55.	Enhancing outcomes and revision surgery for rectal prolapse
56.	Anastomotic complications in surgery for carcinoma rectum discussion

Assessment of FALS fellowship candidates/Exam category

The candidate is expected to know all important facts in Chosen subspecialty in laparoscopic surgery.

• • • Written Paper Timings: 60 minutes
    • Maximum number of marks: 100
    • The written paper should have 100 MCQ questions (single best response type).
      
      

Practical Examination:

• Interview/assessment for approximately 10 minutes on each candidate. The candidates are divided in to batches and are interviewed by the two or more senior most faculty members of IAGES depending upon the number of candidates. Maximum of 50 marks are allotted for the interview.
  
  
• Outcome of written and practical assessment will be prepared by the organizing team and to be signed and to be sent to the President with a copy to Hon Secretary Office and FALS board and results will be published in the IAGES website.
  
  
• Successful candidates would be expected to attend the subsequent annual conference and convocation to receive the fellowship certificate. The Fellowship certificate would be posted to the candidate if he /she fails to attend two consecutive annual congress/convocation.
  
  

Guidelines about conduct of FALS and selection of faculty:

• Topics for lectures have already been finalized and by and large were similar in all the fellowship course held in the past and alteration may be done in forthcoming courses according to the newer developments.
  
  
• The local organizing chairman may bring the changes after discussing with the president, chairman fellowship board and the secretary. The faculty is selected on the basis of their experience and field of interest. Speakers to be selected amongst present and past executive
  members and other eminent IAGES members.
  
  
• The services of executive committee members both present and past, eminent and senior members can be utilized throughout the
  fellowship course. They are involved as the speakers, as chairpersons, as faculty in meet the professor session, for performing surgery in
  work shop, for interviewing the candidates, and for checking the answer sheet.
  
  
  • Duration of lectures – 20minutes.
  • Discussion time – 5 minutes
    
    
• The speakers are given liberty to prepare the lecture in their own way to cover all the important aspect related to the topic in allotted time.
  The text should be evidence based, authentic and well documented and should help in enhancement of basic understanding of subject. It
  is to be delivered expressively with support of excellent slides and video. Since the large number of delegates are new in the field of laparoscopic surgery, the importance to be safe and to prevent complications should be highlighted whenever required.
  
  
• Speakers and chairpersons have to stick to the timeline. Only one liner introduction of speakers and chair persons will save time for the
  lecture.
  
  
• Chairpersons have to ensure that there is no encroachment on other speaker or discussion time and they have to facilitate interaction
  between speaker and audience and which should be to the point.
  
  
• All speakers and topic of their lecture should be finalized at least 1 to 2 months in advance by the local organizing committee in consultation and knowledge of the president, chairman-fellow ship board or any consigned officer. Alternative replacement has to be made for any last-minute withdrawal due to unavoidable circumstances
  
  
• The Feedback assessment form is given to all the delegates for their comments and suggestions.
  
  
• Presentation of mementos to be avoided on the stage since lots of time is wasted and time scheduled is disturbed and delayed. It is
  preferable to place it in the registration bag.