This is the one of the busiest colorectal unit in the UK, with an average of 400 colon and 100 rectal cancers resected per year. There is an equally high number of resections undertaken for non-malignant disease, as well as the full range of recognised procedures in proctology, pelvic floor disorders and functional problems.
Cancer and Benign Resections: the results from the unit (as collated by SCAN) show excellent results compared to other unit. Elective and emergency outcomes after major resectional surgery are better than UK average figures.
Laparoscopic resections: The percentage of minimal access operations has steadily increased year on year, being over 50% of all resections now.
TEMS: there is a focus on quality management of early rectal cancer. There are 3 surgeons undertaking TEMS, with the largest experience in Scotland at over 150 patients to date. A national TEMS course was held in Edinburgh this year run by the surgeons at the WGH.
Exenterative work: Currently we are getting 50 referrals / year with half coming to surgery. 40% of these have recurrent rectal carcinoma, 40% have advanced primary rectal cancer and 20% another type of malignancy. In the exenterative work for advanced primary colorectal cancer and recurrent cancer, survival rates are much better than the target figure of 40% at medium term follow-up.
There is an established team of collaborating surgeons from colorectal, urology and plastics to allow multidisciplinary operating where required. There is also a weekly multispecialty exenterative list for complex gynae oncology patients.
Sarcomas: there are between 10 and 20 complex intra-abdominal or pelvic sarcomas per year, discussed at a WGH based MDT and operated on at the WGH.
Benign work
Inflammatory bowel disease: There are over 50 pouch operations performed per year in the unit, with an experience of over 600 cases, and an active pouch clinic. Surgical results have been published nationally and internationally. Results are amongst the best in the international field. Surgical support for paediatric laparoscopic resections in IBD is also provided.
Joint medical and surgical research is a mainstay of the department The TOPPIC trial was developed and run from a collaborative group of colorectal surgeons and gastroenterologists at the western general.
Prolapse, Pelvic floor and functional bowel disease there is a comprehensive pelvic floor service with a full range of investigations, medical and surgical treatment available for prolapse and incontinence. Anorectal manometry, endoanal ultrasound, sacral nerve stimulation and all procedures for prolapse are undertaken. There is a regular MDT with the urogynaecologists, gastroenterologists and radiologists and joint operating where appropriate. There are links to medical gastroenterology motility clinic, biofeedback and irrigation service.
Endometriosis: there is regular combined laparoscopic operating with colorectal surgeon and gynaecologists for deep infiltrating endometriosis including rectal shave for rectovaginal disease. Complex case MDT, pre operative endoscopic assessment. 12 – 18 cases a year.
EMR: Endoscopic mucosal resection for complex colonic polyps. High definition colonoscopies with NBI and near focus assessment. 30 – 45 cases per year
Enhanced Recovery after Surgery
ERAS has been undertaken successfully in the Western General hospital for over 10 years, with the late Prof Fearon one of the founder members of the ERAS trial and previously chair of ERAS worldwide.
It has been clearly shown that a co-ordinated pathway pre, peri and post operatively with patient education at the core, can significantly reduce length of stay. Support for ERAS with appropriate ward level input and universal emphasis on early post op mobilisation, feeding and accelerated recovery is central to hospital policies.
