Since its incorporation in 1952, the Surgical Service Department of the VA Caribbean Healthcare System has been an integral part in the training and development of general surgery residents. With a cadre of faculty members with subspecialty training in areas such as vascular, thoracic, critical care, colorectal and endoscopy, amongst others, the Surgical Service Department of the VA Caribbean Healthcare System provides state-of-the-art surgical training with unparalleled dedication and commitment.

Residents of all levels rotate through the VA Caribbean Healthcare System program, permitting close interaction between the surgical trainee and a board-certified, full-time practicing surgeon. This working atmosphere is clearly structured and organized to permit operating room participation, clinic time involvement, patient evaluation via consultation both at emergency room and at ward, as well as academic involvement in activities such as tumor board, general surgery conferences and morbidity and mortality rounds.

There are four designated divisions within the general surgery department that specifically focus on specialty areas; general surgery, vascular surgery, critical care and, surgical endoscopy.

The Division of General Surgery provides comprehensive diagnosis and treatment for patients suffering from diseases of the gastrointestinal tract. Residents work closely with the surgical staff to provide every patient optimal surgical treatment and clinical care for both chronic and acute conditions. Colonic, gastric, hepatobiliary and esophageal problems are among the most common.

Diagnostic and therapeutic services cover the full spectrum of gastrointestinal diseases, including minimally invasive procedures. Being part of an academic program as well as a VA system assures that a multidisciplinary approach is employed in each case, getting expert support from colleagues in other departments and providing patients with the skilled care they need. This is exemplified by our Tumor Board conference, where all treating and diagnosing specialties convene on a weekly basis to analyze complex and challenging oncologic cases. The San Juan VHA Oncology Service is fully accredited by ACS Commission on Cancer.

The Division of Vascular Surgery is committed to provide state-of-the-art care for patients with all types of vascular diseases. The division’s clinical services include all elements of vascular care:

  • Diagnostic evaluations and medical management
  • Invasive & Non-invasive vascular testing
  • Surgical care (including both open and endovascular)
  • Inpatient services and critical care.

The Division of Surgical Endoscopy was formally established in 1992. With in initial setup of one non-video colonoscope, and one non-video gastroscope, the service has continue to expand, assuring that the ACGME endoscopy requirements for all surgery residents can be completed at the institution. Presently, the service has two full-time surgical endoscopists, three portable units and 15 endoscopes including diagnostic and therapeutic colonoscopes, gastro scopes, duodenoscopes and bronchoscopes.

Basic and advanced endoscopic procedures are performed, and the surgery resident is guided through this process, starting with surveillance upper and lower endoscopies, progressing to diagnostic procedures such as polypectomies, and then progressing into therapeutic procedures such as percutaneous endoscopic gastrostomies. As the resident enters the final year of training, advanced procedures such as ERCP’s with papillotomy, balloon extraction of stones or biliary stenting of benign and malignant conditions, as well as balloon dilatation of benign and malignant strictures in the GI tract culminate the rotation in surgical endoscopy. It is a policy of our service; to follow-up all our surgical patients in order to offer the resident as complete a follow-up as possible when it comes to surveillance of a patient that has undergone a surgical procedure.

The Surgical Critical Care Division at VA Caribbean Health Care System is composed by two Board Certified General Surgeons with additional Certification in Surgical Critical Care and a Board Eligible Pulmonologist/Critical Care trained internist. This is the only Intensive Care Unit in Puerto Rico with a Combined Surgical/ Medical approach, this combination makes care of our veterans one that is balanced and comprehensive. The Surgical Intensive Care Unit at the VA has nine Surgical Intensive Care Unit beds, two Cardiothoracic Intensive Unit beds and four Cardiac Intermediate Care beds. The Surgical beds serve all the surgical sub-specialties: General Surgery, Urology, Otorrhinolaryngology, Orthopedics, and Neurosurgery. There is a very active Open Heart Surgery Program that takes care of over one hundred cases per year with the lowest mortality of the VA system.


  • Carlos Ramirez-Tanchez, MD, FACS – SECTION CHIEF
  • Adriana Arcila, MD.-CRITICAL CARE
  • Ivonne Baerga, MD, FACS-CRITICAL CARE
  • Ricardo Jimenez-Lee, MD.-PLASTIC SURGERY
  • Reynaldo Reyes-Delfaus, MD, FACS-LAPAROSCOPIC SURGERY
  • Norma Santiago, MD, FACS-GENERAL SURGERY