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| Colorectal Surgery | ||
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The Department The Department of Colorectal Surgery at Cleveland Clinic Florida is a very busy clinical and research oriented department in which patients with a broad spectrum of colorectal pathology are treated. A one year comprehensive clinical colorectal residency is offered by our department. Four colorectal residents are chosen each year through the National Residency Matching Program. An optional research year is also strongly encouraged. In addition, there are between six and ten international research residents whose appointments are on a staggered basis of six months to two years. Approximately 5,200 patients were seen in the office clinic in 2003 and over 2,300 operations were done by the three full time, board certified faculty and staff colorectal surgeons, Drs. Steven D. Wexner (appointed 1987), Juan J. Nogueras (appointed 1991), and Eric G. Weiss (appointed 1994), and Dana Sands (appointed 2002). Cleveland Clinic Florida recently opened in Naples, Florida to serve the Southwest Florida community. We are fortunate to have recruited Anthony M. Vernava, III, M.D. (appointed 2000) from St. Louis University to spearhead the Naples colorectal effort. We subsequently transferred Dr. Jonathan Efron (appointed 2000) from Weston to Naples to further bolster that practice. Other staff includes nurse clinicians who facilitate patient care and help with the day-to-day patient management including assisting in the office and in the operating room. They also perform preoperative history and physical examinations, handle patient phone calls, and calling in prescriptions. Their invaluable assistance allows the residents more time for interaction in the operating room, the endoscopy suite, office, and physiology lab. There are also three dedicated colorectal clinic nurses, two enterostomal therapists, one biofeedback therapist, and two research nurses. Clinical Procedures Over 150 patients are seen in the office each week and evaluated for a wide gamut of colorectal complaints. Procedures such as rubber band ligation of internal hemorrhoids, excision of thrombosed external hemorrhoids, superficial fistulotomies, incision and drainage of abscesses, incision and drainage of pilonidal abscesses, rectal and perianal biopsies, and fulguration of lesions are performed in the clinic. In addition, there are approximately 20 rigid proctoscopies and over 75 flexible sigmoidoscopies performed in the clinic setting each week. In addition, approximately 15-20 colonoscopies are performed each week, approximately two-thirds of which are therapeutic, rather than diagnostic. There are over 25 abdominal and anorectal surgeries performed in the hospital each week. The most frequently performed procedures are restorative proctocolectomy with J-pouch and ileoanal anastomosis and restorative proctectomy with colonic J-pouch and coloanal anastomosis. However, all major colorectal procedures are performed with regularity; a large portion of the practice includes reoperative surgery. In 1991, Drs. Wexner and Jagelman became interested in the potential applications of laparoscopy to colorectal surgery. As a result, we now have one of the world's largest series of laparoscopic colorectal surgical procedures. All residents gain intensive laparoscopic training (25 or more cases per resident per year over the last few years). There is heavy emphasis on anorectal procedures relating to disorders of evacuation such as sphincteroplasty for fecal incontinence and perineal rectosigmoidectomy with levatoroplasty for rectal procidentia. Our surgeons have significant experience with the artificial bowel sphincter, radio frequency, and sacral nerve stimulation for fecal incontinence. Our published series of sphincteroplasty for fecal incontinence and colectomy for constipation are among the largest homogeneous series in the world. In addition, the standard spectrum of anorectal operations is also performed. Overall, there are over 200 anorectal, 400 abdominal, and 800 endoscopic procedures performed each year. Anorectal Physiology Laboratory One of the highlights in the department is a very busy Anorectal Physiology Laboratory. This multi-disciplined specialty unit allows the evaluation of disorders of evacuation, including chronic constipation and fecal incontinence. Included in the lab are anal sphincter electromyography, pudendal nerve terminal motor latency assessment, anorectal manometry with rectal compliance evaluation, anal ultrasonography, cinedefecography with proctography, pancolonic transit times, and small bowel transit evaluation. Over 20 of these procedures are performed on a weekly basis and greatly aid in the understanding of the etiology behind these diseases as well as in the formulation of the appropriate therapeutic outline. The residents are encouraged to participate as much as possible in activities in the Anorectal Physiology Laboratory. In addition, there is an intrarectal ultrasound unit located in the Department which permits a high volume experience. The residents are encouraged to become familiar with the performance and interpretation of rectal ultrasonography. Teaching Conferences
Other Meetings Cleveland Clinic Florida hosts and sponsors the Annual International Colorectal Disease Symposium each year in February in Fort Lauderdale. Having become one of the largest annual postgraduate colorectal courses in the United States, over 700 registrants throughout the world attend this event. This intensive three day symposium provides in-depth analytical review of colorectal diseases. Popular areas covered include, but are not limited to, laparoscopy, colorectal carcinoma, inflammatory bowel surgery, and pouch surgery. A comprehensive review of both basic and advanced principles of diagnosis and management of a broad spectrum of commonly seen colorectal diseases will occur along with emphasis on controversial topics including pouch surgery, surgical emergencies, physiologic tests and applications, recurrent disease, and new diagnostic and therapeutic modalities. The department covers the cost for our residents and fellows to attend this symposium. In addition, support is provided for colorectal residents to attend a meeting(s) as a registrant or participant with the approval and/or direction of the department chairman. STAFF SURGEONS
CLINICAL RESIDENTS/FELLOWS
CLINICAL RESEARCH RESIDENT
RESEARCH RESIDENTS/FELLOWS
Departmental Fax: 954-659-5757 For more information, please contact Janisse Delgado at 954/659.5240 or 866/293.7866, ext 5240, via e-mail at: delgadj@ccf.org or fax at 954/659-5757. |
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Colorectal
Surgery
Janisse Delgado Residency Program Coordinator, Clinical Residency Program 954.659.5240, 866.293.7866 x5240, Fax 954.659.5757 delgadj@ccf.org |
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