Dr Gratian Punch

B.MED. SCI. (HONS I), MBBS (HONS), FRACS

Provider No. 286162BW

Dr Gratian Punch is a Specialist General Surgeon. His subspecialty interests include Hepato-Pancreato-Biliary (HPB), Upper-Gastrointestinal (Upper GI), bariatric, skin cancer, hernia, thyroid and trauma surgery. Dr Punch is dedicated to providing individualised care of the highest standard to his patients at all times, both in a public and private hospital setting.

After growing up in Alstonville NSW, Gratian completed an undergraduate Medical Science Degree at the University of Sydney and graduated with First Class Honours in 2002, with publication of his research in Infectious Diseases. He went on to study Medicine, also at the University of Sydney completing his post-graduate MBBS with laboratory research based Honors in 2007.

Medical school followed by his years as an intern and resident strengthened his passion and commitment to General Surgery. In 2010, Dr Punch commenced specialty training through The Royal Australasian College of Surgeons (RACS) which incorporated intensive training across all disciplines. Gratian graduated as a Fellow of The Royal Australasian College of Surgeons in 2015. It was during this time that Dr Punch was accredited by the Conjoint Committee for Colonoscopy and Endoscopy to perform diagnostic and therapeutic gastroscopy and colonoscopy.

Dr Punch advanced his sub-specialty training with the Australia and New Zealand Hepatic, Pancreatic and Biliary Association (ANZHPBA). Commencing in 2016 the Fellowship in HPB Surgery involved two-years of clinical training and research in high volume, mixed HPB and Upper GI units dedicated to the full spectrum of benign to oncological management of complex HPB/Upper GI surgical care.

His first year was based at the Monash Medical Centre and Jessie McPherson Private Hospital (Melbourne) with an emphasis on minimally invasive techniques applied to liver, biliary and gastro-oesophgeal surgery, including laparoscopic surgery for morbid obesity. During his second year, based at Westmead Hospital (Sydney), Dr Punch received further training with an emphasis on liver, pancreas and oesophageal surgery for both benign and malignant pathology. Dr Punch applied specific HPB techniques including intra-operative ultrasound, ablation, laparoscopic and open complex major resections including vascular resections for advanced cancer where appropriate.

In 2018 Gratian is proud to return home to the Northern Rivers and will be working at the Lismore Base Hospital, Casino and District Memorial Hospital, Ballina District Hospital and St Vincent’s Private.

Dr Punch welcomes all general surgery referrals.

RACS

Dr Gratian Punch is a Fellow (General Surgery) of the Royal Australasian College of Surgeons (RACS). RACS is the leading advocate for surgical standards, professionalism and education in Australia and New Zealand.

GSA

As a member of General Surgeons Australia (GSA), Dr Punch pursues the highest standards of surgical care based on expertise, compassion, ethical practice, conscientiousness and scholarship.

AMA

Dr Punch is also a member of the Australian Medical Association (AMA). The AMA works to promote and protect the professional interests of doctors and the health care needs of patients and communities.

AUSTRALIA AND NEW ZEALAND HEPATIC, PANCREATIC AND BILIARY ASSOCIATION (ANZHPBA) | 2016 – 2018
Accredited Post Fellowship Training Program with the ANZHPBA
This two-year program has enabled me to further develop my advanced surgical skills in Acute General Surgery, Complex Benign and Oncological Hepato-Pancreato-Biliary Surgery. Involving two 12-month placements at ANZHPBA accredited high volume Tertiary Referral Hospitals, I have worked at the Monash Medical Centre in Melbourne (2016) and Westmead Public Hospital in Sydney (2017). I have successfully passed the ANZHPBA Fellowship Exam and will complete my clinical experience at the beginning of February 2018.
Skills courses:
– ANZGOSA Post-Fellowship Trainees Weekend, Melbourne, 2017– Attendee,
– ANZHPBA Operative Skills Course, Royal North Shore Hospital 2016 – Attendee,
– Royal Australasian College of Surgeons Annual Scientific Congress 2016 Laparoscopic Bile Duct Exploration Master Class – Attendee,
– ANZHPBA Post Fellowship Trainees Weekend, Brisbane, 2016 – Attendee.

GASTROENTEROLOGICAL SOCIETY OF AUSTRALIA (GESA) | AUSTRALIA | JANUARY 2016
Accredited by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy with approval to perform the following procedures:
– Colonoscopy adult,
– Gastroscopy adult.

ROYAL AUSTRALASIAN COLLEGE OF SURGEONS | MELBOURNE, VIC | 2010 – 2015
Accredited Surgical Education and Training (SET) in General Surgery.
The SET Training Program in General Surgery provides trainees with the clinical and operative skills required to become competent and independent practitioners, meeting the requirements of all identified RACS competencies. I completed my training and was admitted as a Fellow of The Royal Australasian College of Surgeons on August 2, 2015.
Skills courses:
– Early Management Severe Trauma (EMST),
– Care of the Critically Ill Surgical Patient (CCrISP),
– Australian and New Zealand Surgical Skills Education and Training (ASSET),
– Early Management Sever Burns (EMSB),
– Management of Surgical Emergencies (MOSES).
– American College of Surgeons (ACS) Courses:
– Advanced Surgical Skills for Exposure in Trauma Course (ASSET),
– Advanced Trauma Operative Management Course (ATOM).

UNIVERSITY OF SYDNEY | SYDNEY, NSW | 2003 – 2006
Bachelor of Medicine, Bachelor of Surgery with Honours – M.B.B.S. (Hons)
Completion of Graduate Medical Program with academic awards:
– Winner of the Harold Alfred Waldron Memorial Prize for Essay in Bacteriology (Infectious Diseases) with the essay entitled “Bacteria Multi-Resistant to Antibiotics”,
– Winner of the Harold John Ritchie Memorial Prize for Clinical Medicine with submission of honours research thesis entitled “Effect of Hypertonic Saline on Pseudomonas aeruginosa Colonization and Chronic Carriage in Cystic Fibrosis”.

UNIVERSITY OF SYDNEY | SYDNEY, NSW | 1999 – 2002
Bachelor of Medical Science with First Class Honours – B. Med. Sci. (Hons I)
Completion of undergraduate degree with third year majors in Infectious Diseases and Immunology, leading to an Honours research year in the Department of Infectious Diseases with submission of:
– Honours thesis entitled “Molecular Characterisation of Non-Bacterial Infectious Agents in Cystic Fibrosis Patients Enrolled in the National Hypertonic Saline Trial” – awarded First Class,
– First author academic publication – “Method for detection of respiratory viruses in the sputa of patients with cystic fibrosis” Punch G, Syrmis M, Rose B, Harbour C, Bye P, Nissen M, Elkins M, Sloots T. European Journal of Clinical Microbiology & Infectious Diseases. 24(1):54-7, 2005 Jan,
– Contributions to academic publication – quantitative and molecular microbiology research with the National Hypertonic Saline in Cystic Fibrosis (NHSCF) Study Group with research included in the publication “A Controlled Trial of Long-Term Inhaled Hypertonic Saline in Patients with Cystic Fibrosis”. Authors: Mark R. Elkins, Michael Robinson, et al. New England Journal of Medicine Vol.354 No.3, January 19, 2006.

AUSTRALIAN DEFENCE FORCE | AUSTRALIAN ARMY RESERVE | 2001 – 2004
Diploma of Government (Management), Diploma of Personnel and Operations Management
Diplomas awarded through Royal Military College, Duntroon, under the Australian Qualification Framework. I completed this training in conjunction with Officer Training and Commissioning in the Australian Army Reserve.
Advanced Diploma of Management
Diploma awarded through the Royal Australian School of Infantry, Singleton, under the Australian Qualification Framework. I completed this training in conjunction with Infantry Platoon Commander qualification for the Royal Australian Infantry.

WESTMEAD HOSPITAL | SYDNEY, NSW | FEBRUARY 2017 – FEBRUARY 2018
Upper GI Surgery Fellow – Australia and New Zealand Hepatic, Pancreatic and Biliary Association (ANZHPBA) Accredited Position (successfully completed ANZHPBA Fellowship Exam Nov 2017).
Mixed Upper Gastrointestinal (Upper GI) and Hepatic, Pancreatic and Biliary (HPB) in a high-volume Tertiary Referral Hospital responsible for:
– Peri-operative and operative management of patients with Complex Benign and Oncological Upper GI and HPB pathology,
– On call Acute General Surgery services,
– Assistance to Trauma Surgery Department where required.

MONASH MEDICAL CENTRE / JESSIE MACPHERSON PRIVATE HOSPITAL | CLAYTON, VIC | FEBRUARY 2016 – FEBRUARY 2017
Upper GI Surgery Fellow – Australia and New Zealand Hepatic, Pancreatic and Biliary Association (ANZHPBA) Accredited Position
Mixed Upper GI and HPB in a high-volume Tertiary Referral Hospital and co-located Private Hosptal. Responsibilities included:
– Peri-operative and operative management of patients with Complex Benign and Oncological Upper GI and HPB pathology,
– Peri-operative and operative management of Public Metabolic / Bariatric Surgery patients,
– On call Acute General Surgery services,
– Outpatient HPB Oncology and General Surgery Clinics,
– Supervision and employment assessment of Junior Medical Officers through the Department of Surgery,
– Surgical Tutor to Year 3 Monash University Medical Students assigned to Monash Medical Centre, Clayton.

NORTHERN NSW LOCAL HEATH DISTRICT | LISMORE, NSW | AUGUST 2015 – FEBRUARY 2016
Consultant General Surgeon
Locum Consultant General Surgeon for A/Prof Austin Curtin. Inpatient and Outpatient rebateable care in elective and emergency General Surgery.
Elective lists conducted at:
– Lismore Base Hospital,
– Casino and District Memorial Hospital,
– Ballina District Hospital.

ST VINCENTS PRIVATE HOSPITAL | LISMORE, NSW | AUGUST 2015 – FERUARY 2016
Consultant General Surgeon
Locum Consultant General Surgeon for A/Prof Austin Curtin. Conduct private consulting in rooms and private elective General Surgery where required.

RACS SOUTHERN NSW TRAINING NETWORK | JANUARY 2010 – JULY 2015
Surgical Registrar (RACS Accredited SET Position)
Ongoing employment on a six-month rotational basis:
2015
– Upper GI Surgery – Liverpool Hospital with Prof Neil Merrit, Prof Peter Cosman, Prof Robert Wilson and Dr Amitabhad Das.
2014
– Upper GI Surgery – Campbelltown Hospital with Professor Neil Merrit, Dr Frank Wang, Dr Surgei Fedorine and Dr Ali Zarrouk.
– Colorectal Surgery – Liverpool Hospital with Prof Les Bokey, Dr Scott Mackenzie, Dr Stephen Fulham and Dr Katherine Gibson.
2013
– Upper GI Surgery – Tweed Heads Hospital with Dr Candice Silverman, Dr Michael Ghusn, Dr Victor Liew.
– Head & Neck / Endocrine / General Surgery – Liverpool Hospital with Dr Peter Campbell, Dr Jonathan Clark, Dr Bruce Ashford, Dr Navin Niles and Dr Aashit Shah.
2012
– Trauma – Liverpool Hospital with Dr Scott D’Amours, Dr Khim Hong, Dr Surgei Fedorine and Dr Riccardo Hamilton.
2011
– Colorectal Surgery – Tweed Heads Hospital with Dr Stephen White and Dr Isabella Mor.
– Vascular Surgery – Wollongong Hospital with Dr David Huber and Dr Arthur Stanton.
2010
– Upper GI and General Surgery – Wollongong Hospital with Prof Noel Tait, Dr Ulvi Budak and Dr Andrew Still.
– General Surgery – Nowra Hospital with Dr “Sithi” Thiagarajan Sitharthan and Dr Sami Dayoub.

ROYAL PRINCE ALFRED HOSPITAL | CAMPERDOWN, NSW | 2008 – 2010
Resident Medical Officer
This placement at the Royal Prince Alfred Hospital incorporated participation in overtime, call back and on-call rosters.

THE WOLLONGONG HOSPITAL | WOLLONGONG, NSW| 2007 – 2008
Junior Medical Officer – NSW Board Registration No: 346094
This placement at the Wollongong Hospital incorporated participation in overtime and on-call rosters as well as relief placements in Regional Hospitals affiliated within the South East Sydney Illawarra Area Health Service.

AUSTRALIAN ARMY RESERVE | NSW | 2009 – 2010
Captain – Training Officer, Sydney University Regiment
Military instruction to Staff Cadets of the Ares GSO FAC in preparation for Royal Military College, Duntroon.

AUSTRALIAN ARMY RESERVE | NSW | 2001 – 2009
Lieutenant – Second in Command Infantry Rifle Company
Planning, administrative, instructional and tactical management of 70 Army Reserve soldiers employed at Bravo Company, the 4^th/3^rd Royal New South Wales Regiment based at Wollongong.
Achievements include:
– Awarded Officer of the Year 4^th/3^rd Battalion, Royal New South Wales Regiment, 2004,
– Awarded Australian Defence Medal, 2006.

AUSTRALIAN ARMY | SOLOMON ISLANDS | FEBRUARY – AUGUST 2007
Lieutenant – Infantry Platoon Commander
Successful training and deployment as part of the Australian contingent to the Multi-National Regional Assistance Solomon Islands (RAMSI).
Tasks and achievements included:
– OP ANODE Solomon Islands CTF 635, Infantry Platoon Commander,
– Civil peace enforcing and stabilisation missions,
– Lead and manage an Infantry Platoon of 30 soldiers comprising of a variety of ranks, ages and experience,
– Awarded Australian Service Medal with Clasp Solomon Islands II, 2007.

UNIVERSITY OF SYDNEY | SYDNEY, NSW | 2006
University Tutor – Department of Infectious Diseases
Teacher and instructor for 3^rd year Undergraduate Bachelor of Medical Science students in three-hour practical laboratory sessions.

Publications:

High-dose versus low-dose botulinum toxin in anal fissure disease. Ravindran P, Chan DL, Ciampa C, George R, Punch G, White S. Tech Coloproctol. 2017 Oct; 21(10):803-808. Epub 2017 Oct 28. doi: 10.1007/s10151-017-1700-2.
Rare case of bouveret syndrome. Di Re AM, Punch G, Richardson AJ, Pleass H. ANZ J Surg. 2017 Oct 13. doi: 10.1111/ans.14215.
Loop and drain technique for subcutaneous abscess: a safe minimally invasive procedure in an adult population. Gaszynski R, Punch G, Verschuer K. ANZ J Surg. 2016 Sep 12. doi: 10.1111/ans.13709.
Blunt trauma pancreatic duct injury managed by non operative technique, a case study and literature review. Zala A, Gaszynski R, Punch G. Trauma Case Reports 1 (2015) 13–16, http://dx.doi.org/10.1016/j.tcr.2015.03.003.
An unusual cause of right iliac fossa pain – extra-peritoneal omentum with torsion. Gaszynski R, Punch G, Lambrakis P. ANZ J Surg. 2015 May 12. doi: 10.1111/ans.13150.
What proof is in your Christmas pudding? Is caring under the influence possible? Brieger D, Amir A, Punch G, Lim C, Toh J. Medical Journal of Australia 2014; 201: 702-704. doi: 10.5694/mja14.01478.
Method for detection of respiratory viruses in the sputa of patients with cystic fibrosis. Punch G, Syrmis M, Rose B, Harbour C, Bye P, Nissen M, Elkins M, Sloots T. European Journal of Clinical Microbiology & Infectious Diseases. 24(1): 54-7, 2005 Jan.

Conference Presentations / Oral Abstracts:

“International publication trends for HPB Surgery: emergency compared to oncology”. Punch G, Lam V, Richardson A. Oral presentation in free paper session at Annual Meeting ANZHPBA, Adelaide 2017.
“High dose vs low dose botulinum toxin in anal fissure disease – a case control study”. Ravindran P, Chan D, Ciampa C, George R, Punch G, White S. Association of Surgeons of Great Britain and Ireland International Congress, Glasgow 2017.
“Predictors of recurrence following botulinum toxin in anal fissure disease”. Ravindran P, Chan D, Ciampa C, George R, Punch G, White S. ANZ J. Surg. 2017; 87 (S1) p 21. Royal Australasian College of Surgeons 86th Annual Scientific Congress, Adelaide 2017.
“The criminal “Grassi” and his ways”. Ruggiero B and Punch G. ANZ J. Surg. 2017; 87 (S1) p124, Royal Australasian College of Surgeons 86th Annual Scientific Congress, Adelaide 2017.
“High dose botulinum toxin A in treatment of chronic anal fissure”. Ravindran P, Ciampa C, George R, Gore N, Punch G, White S. ANZ J. Surg. 2016; 86 (S1) p27. Royal Australasian College of Surgeons 85th Annual Scientific Congress, Brisbane 2016.
“Success of the minimally invasive loop and drain technique for subcutaneous abscesses in a rural adult population”. Gaszynski R, Verschuer K, Punch G. ANZ J. Surg. 2016; 86 (S1) p63. Royal Australasian College of Surgeons 85th Annual Scientific Congress, Brisbane 2016.
“Discovering our Gallipoli ANZAC FRACS/FRCS Edinburgh Forefathers”. Lim C and Punch G. ANZ J. Surg. 2015; 85 (Suppl. 1) p114. Royal Australasian College of Surgeons (RACS) Annual Scientific Congress, Perth 2015.
“‘Medic!’ An historical contrast of ANZAC medical evacuation plans, Gallipoli and modern day”. Cavanagh S, Lim C, Punch G. ANZ J. Surg. 2015; 85 (Suppl. 1) p78. Royal Australasian College of Surgeons (RACS) Annual Scientific Congress, Perth 2015.
“High dose botulinum toxin a related outcomes in the treatment of chronic anal fissure”.Punch G, Newman S, Duncan C, Warner R, White S. Journal of Gastroenterology and Hepatology, Volume 28, Issue Supplement S2, pages 142–144, October 2013. Presented at Australian Gastrointestinal Week (AGW), Melbourne 2013.
“Laparoscopic resection of a massive distal oesophageal diverticulum”. Punch G, Duncan C, Newman S, Rajasagaram N, Ghusn M, Silverman C. Journal of Gastroenterology and Hepatology, Volume 28, Issue Supplement S2, pages 148–150, October 2013. Presented at Australian Gastrointestinal Week (AGW), Melbourne 2013.

Conference Poster Abstract Presentations:

“Post hepatectomy bile leak at an Australian tertiary public hospital”. Punch G, Croagh D, Bowers K, Cullinan M, Spilias D, Berry R. ANZHPA Annual Meeting, Gold Coast 2016.
“Post hepatectomy liver failure at an Australian tertiary public hospital”. Punch G, Croagh D, Bowers K, Cullinan M, Spilias D, Berry R. ANZHPA Annual Meeting, Gold Coast 2016.
“Post hepatectomy haemorrhage at an Australian tertiary public hospital” Punch G, Croagh D, Bowers K, Cullinan M, Spilias D, Berry R. ANZHPA Annual Meeting, Gold Coast 2016.
“ALPPS kinetic growth future liver remnant at an Australian tertiary public hospital”. Holden D, Punch G, Croagh D, Bowers K, Cullinan M, Spilias D, Berry R. ANZHPA Annual Meeting, Gold Coast 2016.
“Establishing a minimally invasive oesophagectomy practice at an Australian academic tertiary public hospital”. Punch G, Dhir A, Dubrava Z, Gribbin J, Cullinan M, Low L, Cashin P. ANZGOSA & SUGGS Annual Meeting, Double Bay 2016.
“Harmonic shears dissection in laparoscopic appendicectomy – a faster cost-neutral alternative”. Hibbard A, Punch G, Mackenzie S. General Surgeons Australia Annual Scientific Meeting, Cairns 2015.
“Emergency laparoscopic cholecystectomy – patient demographic trends”. Guevara R and Punch G. ANZ J. Surg. 2015; 85 (Suppl. 1) p49. Royal Australasian College of Surgeons (RACS) Annual Scientific Congress, Perth 2015.
“Appendicectomy: benchmarking our metropolitan non-ASU hospital”. Guevara R and Punch G. ANZ J. Surg. 2015; 85 (Suppl. 1) p46. Royal Australasian College of Surgeons (RACS) Annual Scientific Congress, Perth 2015.
“Interpreter use for surgical consults and emergency surgery at Liverpool Hospital in Sydney” Guevara R, Punch G, Lambrakis P. General Surgeons Australia Annual Scientific Meeting, Perth 2014.
“A 10-year single institution audit of emergency surgery for perforated peptic ulcer disease”. Mostafa S, Craig S, Punch G. Combined meeting – Sino-ANZ Conference and the 56th Victorian ASM, October, 2014. Published in the On-line ANZ J Surg 2015, http://www.anzjsurg.com/SpringboardWebApp/userfiles/anzjs/file/ans_13006_Rev.pdf