• 1.1 Hepato-Pancreato-Biliary (HPB) Surgeons
  • 1.2 Hepato-Pancreato-Biliary (HPB) Training Program


  • 2.1 Knowledge, Clinical Experience and Technical Skills
  • 2.2 Training in HPB Surgery and Transplantation
  • 2.3 Training in Research
  • 2.4 Training in Education
  • 2.5 Leadership in HPB Disease


  • 3.1 General Requirements
  • 3.2 Entry Competencies and Requirements from Applicants
  • 3.3 Other Requirements from Applicants
  • 3.4 Training in HPB Surgery
  • 3.5 Additional Essential HPB Training
  • 3.6 Research Training
  • 3.7 Services, Equipment, Facilities and Instruments


  • 1.1 An HPB surgeon is an expert surgeon who has obtained additional training and experience in the multidisciplinary approach to the diagnosis, treatment, and rehabilitation of HPB patients and devotes a major portion of his or her professional practice to these activities as well as HPB education and advancement of knowledge in the field.
  • 1.2 Hepato-Pancreato-Biliary (HPB) Training Program
    An HPB training program should provide the core knowledge and expertise to prepare its graduate/s to be expert HPB surgeons who interact with a multidisciplinary team to provide comprehensive care for HPB patients as well as leadership in the surgical, medical and lay communities in matters pertaining to HPB disease.


  • An HPB Fellowship Training Program should provide fellows with the following:
  • 2.1 Knowledge, Clinical Experience and Technical Skills
    • 2.1.1 Knowledge, Clinical experience and technical skills to provide comprehensive state of-the-art care to HPB patients.
    • 2.1.2 Knowledge and experience in the interpretation of HPB imaging studies, including ultrasound, computerized tomography, magnetic resonance imaging, cholangiography, pancreatography, and angiography.
    • 2.1.3 Knowledge and experience to determine disease stage and natural history as well as treatment options for individual HPB patients at the time of diagnosis and throughout the course of the disease.
    • 2.1.4 Knowledge of nonsurgical treatment options including endoscopic, interventional radiologic, oncologic and medical therapies. This requirement includes an understanding of disease biology, indications for
      interventions, complications and management of complications
    • 2.1.5 Experience and technical skill in performing complex HPB operations, including new techniques.
    • 2.1.6 Experience and technical skill in performing palliative surgical procedures and knowledge and experience of non surgical palliative options.
    • 2.1.7 Knowledge of HPB tumor biology, epidemiology, tumor markers and tumor pathology.
  • 2.2 Training in HPB Surgery and Transplantation
    • 2.2.1 A minimum of 24 months of clinical training in the surgical management of HPB patients is required for training in HPB Surgery.
    • 2.2.2 If liver transplantation is included, a minimum additional of 12 months on top of the 24 months of clinical training is required for training in HPB Surgery And Transplantation.
    • 2.2.3 Each HPB surgery fellow must participate in a minimum of 100 major HPB operative procedures. At the completion of the Fellowship Training the HPB fellow is expected to be able to perform major HPB operations
      independently and must have performed the critical part of the following minimum number of operations:

      Pancreatic – 20
      Hepatic – 20
      Complex Biliary – 20
    • With respect to these minimum case numbers the following are required:
      • Experience in each of the three HPB operation categories. Experience in Trans-abdominal and intra-operative ultrasound. Experience in Minimally Invasive HPB Surgery Staging
    • With respect to these minimum case numbers the following are highly desirable:
      • Experience in tumor ablation. Experience in minimally invasive HPB surgical procedures./td> Experience in Percutaneous or Endoscopic Diagnostic or therapeutic Procedures Experience in Minor Procedures such as Liver Biopsy, Pancreatic Biopsy and Cholecystectomy are expected but are NOT considered to be Major HPB Operative Procedures Each HPB surgery fellow must document his or her operative experience using the standard logbook prescribed by PAHPBSI.
    • 2.2.4 If additional training in liver transplantation is being sought, each HPB surgery fellow must participate in the critical or key portions of a minimum of 50 transplant procedures including the following

      Liver transplant – 30
      Donor procurement – 20
    • At the completion of the Fellowship Training the HPB Fellow receiving additional training in Liver Transplantation is expected to be able to perform Organ Procurement and Liver Transplantation independently.
    • 2.2.4 The following are the required Index Cases for HPB Fellowship Training:

      Liver (20)
      • Major Hepatectomies
      • Segment-specific Anatomic Resections
      Pancreas (20)
      • Pancreaticoduodenectomies
      • Distal Pancreatectomies
      • Pancreatic Drainage Procedures
      Complex Biliary Tract (20)
      • Ampullary or Bile Duct Resections
      • Biliary Anastomoses (Intra- and Extrahepatic)
  • 2.3 Training in Research
    • 2.3.1 Knowledge of the design and implementation of a prospective data base
      2.3.2 Knowledge of the design of clinical trials.
      2.3.3 Knowledge of the interface between basic science and clinical care to facilitate translational research.
  • 2.4 Training in Education
    • 2.4.1 Knowledge and skills to train students and residents in the multidisciplinary management of HPB patients.
      2.4.2 Knowledge and skills to train non-physicians (physician assistants, nurse practitioners, etc.) in specialized HPB care.
      2.4.3 Skills to organize and conduct HPB-related public education programs.
  • 2.5 Leadership in HPB Leadership
    • Skills to develop and support:
      • Institutional programs related to HPB malignancies including a tumor registry.
      • Institutional policies regarding HPB surgery training,
      • Multidisciplinary conferences on HPB disease, patient care and research, and
      • Psychosocial and rehabilitative programs for HPB patients.


  • 3.1 General Requirements
    • An HPB Fellowship Program consists of a minimum of 24 months of continuous education and training following completion of a general surgery residency. An additional minimum of 12 months are required if liver transplantation is included. A portion of the program should be devoted to clinical research. Fellows should have access to faculty who can mentor them in basic science research and have the option for such an experience if desired.
      • 3.1.1 The HPB Fellowship Program must be accredited by the Philippine Association of Hepatopancreatobiliary Surgeons, Inc. (PAHPBSI)
        An adequate opportunity should be provided to interact with interventional radiologist, pancreatobiliary endoscopist, gastroentrologists, hepatologist, transplant surgeons, medical oncologist, radiation on specialty services, participation in structured multidisciplinary conferences, attendance at specialty tumor clinics, or inclusion of specialty patients on a single HPB service. Trainees should be taught the appropriate approach to interacting and communicating with referring physicians and nonHPB surgeons a well as to perform consultations for HPB patients.
        3.1.2 Initial outpatient assessment, preoperative decision making, perioperative management, and patient follow-up are essential to the training experience. To the greatest extent possible, HPB fellows should participate in the preoperative evaluation, assessment, treatment planning, and postoperative ambulatory care of patients in whose surgery they participate. As a guide, HPB fellows should see preoperative and postoperative ambulatory patients at least one full day out of five, or its equivalent.
        3.1.5 Clinical experience alone is insufficient education in HPB surgery. The training program must have a regularly scheduled didactic program consisting of the following: Pre- and Postoperative Case Conferences (at least 24 per year) Lectures/Journal club (at least 4 per year) Attendance in at least 1/year in an HPB Conference or Convention Multidisciplinary Team Meetings (at least 10 per year) Debate series, and other for educational activities covering not only clinical surgical problems but also nonsurgical, basic science, clinic research, and ethical problems.
        3.1.6 The HPB surgery fellowship program must not conflict with the regular general surgical training programs at the participating institution. HPB fellows’ clinical responsibilities must be in accordance with the guidelines of governing surgical trainee review bodies. In other words, the fellows’ experience should not diminish the experience of general surgery trainees in the final year of training.

        • Rather, an HPB surgery fellowship program should complement an institution’s general surgery training program by developing a focus of excellence in HPB management that can be observed and experienced by all surgical trainees and attending staff. (cf. below “Boundaries and Overlaps with General Surgery Program”)
        3.1.1 Clinical experience alone is insufficient education in HPB surgery. The training program must have a regularly scheduled didactic program consisting of the following: Pancreaticoduodenectomies and Major Hepatectomies are cases for the HPB Fellows Minor liver resection cases involving Cirrhotic patients or those with associated endocrine and metabolic liver diseases, regardless of Child-Pugh Classification, must be referred to HPB Gallbladder Malignancies Stage T1b and worse must be referred to HPB Surgery All other Hepatobiliary Malignancies must be referred to HPB Surgery All cases of Portal Hypertension must be referred to HPB Surgery Complex liver, Pancreas and Biliary Trauma must be referred to HPB Surgery Hepatolithiasis and Benign Bile Duct Strictures may be decided on a case-to-case basis Bile Duct Injuries may be managed on a case-to-case basis
        3.1.59 Distal Pancreatectomy may be given to General Surgery
        3.1.7 On the Program Director and other Faculty
        The program director must be a PCS Fellow, a member of good standing in the Philippine Association of HPB Surgeons, Inc. (PAHPBSI) and a member at least one of any of the following International Hepato-Pancreato-Biliary Associations, the International HepatoPancreatoBilliary Association (IHPBA), the American Hepato-Pancreato-Biliary Association (AHPBA), the Asia-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA), or the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).
        Moreover, the Program Director must demonstrate evidence of scholarly activity in HPB Disease as evidenced by participation in Basic Science Research, Clinical Research Protocols, presentations in local, regional or national meetings and or publications in a peer reviewed journal.
        There must be at least three (3) faculty (including the Program Director) in each HPB Fellowship Training Program who are actively practicing in the sponsoring institution/hospital.
        The other faculty members must be a Fellow of the Philippine College of Surgeons (PCS) and a member of good standing of the Philippine Association of HPB Surgeons, Inc. (PAHPBSI).
        3.1.8 Each HPB fellow’s progress during the program must be formally evaluated in writing and feedback provided to the fellow at least quarterly by the HPB program director and faculty. The HPB fellow should be advised of any deficiencies in time to correct problems prior to completion of the fellowship.
        3.1.9 HPB fellows must be given the opportunity to evaluate the program overall, as well as all rotations, conferences, and faculty. These evaluations should be obtained in as confidential a manner as possible. The program director should regularly assess the post-training clinical and research activities of past HPB surgery fellows to determine whether the goals of the training programs are being achieved, namely, the production of effective HPB surgery specialists.
  • 3.2 Entry Competencies and requirements from candidates into an HPB Fellowship Training Program:
    3.2.6 Preferably Board-certified in General Surgery
    3.2.7 Certification of Good Moral Character by either the Philippine Medical Association or the Medical Director of the hospital/institution of practice or training in General Surgery
    3.2.8 Certified in Basic Laparoscopy by PALES (Philippine Association of Laparoscopic Surgeons) or a graduate of a PALES-accredited General Surgery Training institution or a recognized equivalent in a foreign-based institution.
    3.2.9 A letter of Recommendation from at least 2 PAHPBSI members in good standing.
  • 3.3 Other requirements from candidates into an HPB Fellowship Training Program:
    3.3.6 Certificate of Medical Fitness
    3.3.7 Hepatitis B Immunization
    3.3.8 Certificate of Psychological Fitness
    3.3.9 Admission Interview
    3.3.10 Curriculum Vitae
    3.3.11 NBI Clearance
  • 3.4 Training in HPB Surgery
    The HPB program should provide a minimum of 100 major HPB operative procedures per year as well as adequate training for both HPB fellows and general surgery trainees, if present.

    3.4.6 The minimum periods for HPB Surgery Fellowship Training and HPB Fellowship Training with Liver Transplantation are outlined in 2.2.1 and 2.2.2 respectively.
    3.4.7 Minimum operative experience for each fellow in HPB Surgery for HPB Operations are outlined in 2.2.3 and for Liver Transplantation are outlined in 2.2.4, respectively.
    3.4.8 HPB programs that provide liver transplant experience should provide a minimum of 30 transplant cases per year as well as adequate training for both fellows and general surgery trainees, if present.
    3.4.9 The HPB program should provide experience in intra-operative ultrasound, tumor ablation, and minimally invasive staging as well as exposure to minimally invasive HPB operation.
    3.4.10 The program director should review the HPB fellow’s operative log regularly. The program director must have a system to address and correct operative experience deficiencies promptly.
  • 3.5 Additional Essential HPB Training
    3.5.6 The fellowship must provide exposure to and experience in the multidisciplinary management of HPB disease.
    3.5.7 The fellowship must provide opportunities to participate in multidisciplinary clinics, tumor boards, or conferences. Specialists involved in these opportunities should include interventional and diagnostic radiologists, pancreatobiliary endoscopists, gastroentrologists, hepatologists, medical oncologists, radiation oncologists, pathologists, and transplant surgeons.
    3.5.8 Composition of Multi-disciplinary Teams include board-certified specialists such as: Gastroenterologists/Endoscopists, Hepatologists, Interventional Radiologists, Diagnostic Radiologists, Radiation Oncologists, Medical Oncologists, Pathologists, Intensivists, Anesthesiologists, Pain Management Specialists, Palliative Care Specialists, Nutrition Medicine Specialists and other subspecialties of Internal Medicine (as needed).
    3.5.9 HPB fellows also should gain experience in providing supportive care to HPB patients, including pain management and parenteral and enteral alimentation, as well as rendering emergency surgical care. HPB fellows also should have an understanding of rehabilitative services in various settings.
  • 3.6 Policies on External Rotations – Foreign or Local Institutions
    3.6.6 First Year Fellows shall not be allowed to rotate outside of the sponsoring institution
    3.6.7 The rotation site must be a recognized high-volume center in HPB
    3.6.8 Rotation/s must be within the period of the Fellowship Training Program
    3.6.9 The maximum period of rotation must not exceed 6 months total.
    3.6.10 Observership Programs and Intensive Seminar Workshops with certification from globally-recognized HPB Centers are acceptable rotations
    3.6.11 Cross-linkages among local training institutions are highly encouraged
  • 3.7 Research Training
    3.7.6 Clinical research must be included in the training program. HPB fellow should have opportunities to design and implement clinical research protocols, and each HPB fellow should initiate or participate in an investigative project and should be sufficiently familiar with statistical methods to properly evaluate research results. Presentation and peer-reviewed publication of at least one research project is expected.
    3.7.7 Each HPB fellow must complete a course on clinical research on human subjects. Online courses approved by national research bodies are acceptable. Ethics of research on human subjects must be included in the curriculum.
    3.7.8 Laboratory research is optional. Fellows who desire this experience should be encouraged to work with basic science research faculty mentors on or off-site and as time and funding allows.
  • 3.5 Services, equipment, facilities & special HPB instruments
    3.5.1 Must be present in the sponsoring facility/institution:

    1. Level 3 DOH License
    2. Multi-detector CT-Scan
    3. General Ultrasound Services
    4. Intra-operative Ultrasound
    5. Pathology with Frozen Section capability (HPB Surgical Pathology is desirable)
    6. Medical Oncology Services
    7. Endoscopy Unit (Upper, Lower and Choledochoscopy) Minimally Invasive Surgery Services
    8. Level III Clinical Laboratory
    9. C-Arm or Portable X-ray unit
    3.5.2 Must be easily accessible to but not necessarily present in the sponsoring facility/institution:*

    1. Magnetic Resonance Imaging
    2. Catheterization Laboratory
    3. Nuclear Medicine Services
    4. Interventional Radiology Services
    5. Oncologic Radiology Services
    6. Palliative Medicine Services
    7. Endoscopic Retrograde Cholangio-Pancreatography Services (ERCP)
    8. Endoscopic Ultrasound Services
  • *Certain facilities/devices/services may not be physically present in the sponsoring facility/institutions but those facilities or institutions must show proof of easy access to such.