SECTION OF COLON AND RECTAL SURGERY
August 2015 has become a mile stone time for the City of New Orleans and the State of Louisiana with the opening of the New State of the Art Tertiary Hospital: the University Medical Center New Orleans (UMCNO). UMCNO will develop into one of the most important Tertiary Healthcare Centers in the Southeastern United States. It is an Academic and Research Center that’s foundation is based on the History of the Charity Hospital, one of the most recognized Academic Teaching Centers in the USA.
The LSU Section of Colon and Rectal Surgery, which began in 2012, and is dedicated to the treatment of people with benign and malignant Diseases of the Colon, Rectum and Anus.
The LSU Section of CRS is an integral part of the new Inflammatory Bowel Disease Center, which is under the direction of the LSU Department of Gastroenterology at UMCNO. The LSU Section of CRS has a vast experience in the surgical therapy of people with Crohn’s Disease and Ulcerative Colitis.
The LSU Section of CRS is and integral part of the Multidisciplinary Oncology Clinic at UMCNO for patients with Colon, Rectal and Anal Cancers. This is a multidisciplinary team, including specialized physicians in Medical Oncology, Radiation Oncology, Pathology, Diagnostic and Interventional Radiology in the management of people with colon, rectal and anal cancers. This team has a special Colon, Rectal and Anal Cancer Patient Navigator that assures these people that they will receive timely diagnostic testing and treatment with a “one on one” personal liaison. The LSU Section of CRS has an extensive experience in sphincter sparing surgical approaches to Rectal Cancers, that when indicated, will spare people from a life with a permanent ostomy. However if an ostomy is required either on a temporary or permanent basis there is a specialized nurse to educate these people on how to manage and live with their ostomy.
The LSU Section of CRS works with the Division of Female Pelvic Floor Medicine and Reconstructive Surgery in treating women with Pelvic Floor Disease. Especially posterior compartment diseases: Rectal Prolapse, Rectocele and Fecal Incontinence. The LSU Section of CRS has expertise in managing people with Fecal Incontinence utilizing the latest technology for anal rectal ultrasound, anal manometry and Pudendal Nerve Motor Latency Studies to better diagnosis the cause of their Fecal Incontinence. To assist in formulating a plan for treating their Fecal Incontinence which may include bio-feed back, surgery or sacral nerve stimulation.
The LSU Section of CRS utilizes state of the art surgical approaches to all major bowel surgery including Laparoscopic, Hand Assisted and Robotic Assisted colon and rectal procedures. The entire spectrum of benign diseases of the anus is treated either in the office setting or with outpatient procedures. The Section manages people with the following: complex anal fistula, rectovaginal fistula and anovaginal fistula; malignant diseases of the anus such as Paget’s Disease and Bowens Disease; pre malignant diseases (Human Papilloma Virus (HPV)); the entire spectrum of benign diseases of the colon, including constipation, diverticulosis/ diverticulitis, colovesicle fistula, Mega colon/ Mega rectum, volvulus of the colon, enterocutaneous fistula of small and large bowel, benign/malignant polyps of the colon, rectum and small bowel.
Colon and Rectal Surgery Fellowship- ACGME Accredited
Number of Residents (per year): 1
Number of Faculty (ABCRS Certified): 4
Eligibility: Board eligible/board certified general surgeon
Case Mix/Number of Cases: LSU-UMCNO training program encompasses the entire spectrum of benign and malignant disease of the small bowel, colon, rectum, and anus. A single trainee will be able to achieve and exceed all required defined categories. Fellows are expected to complete between 650-750 total cases: including 200-250 abdominal procedures (40% minimally invasive); 200-250 anorectal procedures; > 250 colonoscopy (diagnostic and therapeutic).
Strengths of Program: With a high ratio of faculty to colorectal surgery fellow, the fellow is offered close one-on-one attention. The University Medical Center New Orleans (UMCNO) which opened August of 2015, it is a state of the art academic medical center and Level I trauma center, boasting 440 beds. UMCNO has two Robotic Platforms; the new Senhance Surgery TransEnterix Robotic System and a Dual Console Da Vinci Robot (Si) System ideal for teaching robotic colorectal surgery. All operating rooms have 60-inch LED wall mounted video monitors and boom mounted mobile LED monitors for all minimally invasive platforms (including standard laparoscopic) for colon and rectal resections. LSU-UMCNO also cares for a high-risk patient population, which offers a high level of complex disease management, including treating a high percentage of locally advanced and late-stage colorectal malignancies. LSU-UMCNO Colorectal Surgery partners include the LSU Gastroenterology Inflammatory Bowel Disease Clinic, which affords us a high volume of complex patients with Crohn’s Disease and Ulcerative Colitis. In addition, LSU-UMCNO serves a large stable HIV/AIDS population, offering management of advanced diseases of the anus (high incidence of anal canal cancers) and rectum in immunosuppressed patients.
Clinic and/or Office Experience: : University Medical Center Colorectal Clinic and LSU Healthcare Network Colorectal Clinics have two half days/week each, with the full spectrum of patients with anorectal disease and the experience includes anoscopy, proctoscopy, and THD digital high resolution anoscopy (HRA) system.
Interaction with General Surgery Residents: The LSU General Surgery Residency graduates 10 Chief residents per year covering 3 cites in Louisiana (New Orleans, Lafayette and Baton Rouge). The relationship of the GS and CRS program is collegial and interactive. The CRS service includes general surgery junior and mid-level residents on service, usually a PGY-1 or -2 one PGY-3. The CRS service also has (3) third year medical students and fourth year acting interns. The fellow will oversee the CRS service, with attending supervision but with ample opportunity for supervised independent clinical and didactic teaching, as he/she progress through the fellowship.
Conferences: Weekly didactics based on the ASCRS Textbook of Colon and Rectal Surgery 3rd edition, Morbidity & Mortally Conference and Multidisciplinary Tumor Board. Monthly Colorectal Journal Club and Multidisciplinary Inflammatory Bowel Disease Conference. A bimonthly Hepatobiliary Multidisciplinary Conference, which CRS attends when we present patients with colorectal metastatic disease.
Anorectal Physiology: Anal manometry, endorectal ultrasound, MRI defecography
Outside Rotations: N/A
Research Year: Not currently offered. One half-day per week of dedicated research time
Requirement for Paper: The fellow is expected to develop a project of his/her own design during the fellowship that will result in a publication or a presentation at a national (ASCRS Annual Scientific Meeting) and/or a regional scientific meeting.