The Department
The Department of Colorectal Surgery at Cleveland Clinic in 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. A preliminary optional research year is also offered for one of the four positions. In addition, there are between ten and twelve research residents whose appointments are on a staggered basis for one year or more.
Approximately 5,200 patients were seen in the office clinic in 1997 and over 2,300 operations were done by the three full time, board certified faculty and staff colorectal surgeons, Drs. Steven D. Wexner, Juan J. Nogueras, Eric G. Weiss and Dana R. Sands. 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
Approximately 80-100 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 10-20 rigid proctoscopies and 15-25 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 approximately 15-20 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. 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 the largest U.S. experience with the stimulated gracilis neosphincter for fecal incontinence and are also utilizing the artificial sphincter 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. About 12-15 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
- Core Curriculum Conference
- Ultrasound Conference
- Anorectal Physiology Conference
- Teleconference with Cleveland Clinic Foundation Colorectal Surgery
- Practice Talks
- Radiology Conference
- Pathology Conference
- Colorectal Surgery Tumor Board
- Journal Club
- Research Forum
- Surgical Grand Rounds
- Surgical M & M
- CARSEPS Conference
- Other Meetings
Cleveland Clinic in 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 world, approximately 1,000 registrants were in attendance during the 1998 symposium, approximately 60% of whom were from 61 foreign countries. 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.
More Information
Wanda Diaz-Rapalo
Graduate Medical Education
Cleveland Clinic Florida
Phone: 954.659.5240
800.359.5101, ext. 56211
Fax: 954.659.5184
Email: diazw@ccf.org
