Colorectal Surgical Unit

Introduction

The RAH Colorectal Unit comprises the largest tertiary referral colorectal surgical unit in South Australia, performing approximately 250 - 275 major colorectal surgical procedures and approximately 600 colonoscopic procedures per annum. General surgical activity is limited to participation in the RAH emergency on call roster on a one in four basis. Core activities other than clinical service provision include an active research programme and teaching at undergraduate, pre and postfellowship levels. The Stomal Therapy Department exists within the structure of the Colorectal Unit.

The RAH Colorectal Surgical Unit is part of an extended cross campus association of colorectal units (together with The Queen Elizabeth Hospital and Lyell McEwin Health Service colorectal units) known as the Northern Colorectal Unit. This combined clinical entity serves the northern half of Adelaide (approximately 400 000 people) and provides a unique opportunity for integration of clinical services and research activities.

Colorectal Unit Staff

Location

The Colorectal Unit is located on Ward Q6, in the North wing of the hospital. For enquiries call (08) 8222 5449

Clinical Services

Acute Inpatient Care
Clinical services are directed primarily at the provision of a comprehensive service for the assessment and management of the full range of colorectal surgical problems. The unit undertakes 2 full day operating lists and 7 hours of colonoscopy per week. Per annum, the unit performs approximately 130 -140 resections for colorectal cancer , 40 for inflammatory bowel disease (including pouch surgery) and 20 -30 for diverticular disease. A well developed laparoscopic colorectal resection service exists and the unit is an accredited institution for the ALCCaS trial of laparoscopic colorectal cancer surgery. The unit has increasing experience with transanal endoscopic microsurgery (TEMS) in selected cases of rectal neoplasia. Pelvic floor and continence surgery is supported by a full anorectal physiology service (including endorectal ultrasound , manometry and pudendal nerve electrophysiology studies) and, a dedicated combined nursing / physiotherapy continence clinic.

Outpatient Clinics
Outpatient clinics are conducted on Tuesday and Friday mornings on level 7 Outpatients. For appointments call (08) 8222 5589

Stomal Therapy
A comprehensive stoma, wound management and continence service is provided by a committed team of enterostomal therapy nurses. For further information please call (08) 8222 4416

Training

The unit is accredited as a post for intern training (CEPTSA), prefellowship surgical training (RACS) and by the CSSA / RACS Section of Colon and Rectal Surgery Training and Accreditation Committee for post-fellowship training in colorectal surgery.Trainees working on the unit will be responsible to the Head of Unit and can expect significant exposure to and training in:

• Tertiary referral colorectal cancer and diverticular disease management
• Inflammatory bowel disease including ileoanal pouch procedures
• Assessment and management of faecal incontinence including anorectal physiology studies, endoanal / rectal ultrasound and other new technologies including dynamic graciloplasty
• Laparoscopic colorectal surgery
• Complex anal fistula surgery and other anorectal procedures
• Trananal endoscopic microsurgery
• Advanced colonoscopic techniques including argon plasma coagulation therapy and colonic stenting

The position of Colorectal Fellow is funded by Gastrointestinal Services as a Senior Registrar with terms and conditions in accordance with the South Australian Salaried Medical Officers Enterprise Bargaining Agreement. The fellow provides remote call for the unit's emergency commitments.

Current Research Projects

A randomised prospective controlled trial of lateral internal sphincterotomy versus injections of botulinum toxin for the treatment of idiopathic fissure in ano.

The Australasian, multi-centre, prospective, randomised, clinical study comparing laparoscopic and conventional open surgical treatments of colon cancer in adults (ALCCaS).

Quality of life of rectal cancer patients undergoing radiotherapy.

Postoperative analgesia - a study of the efficacy of continuous local anaesthetic wound perfusion following midline laparotomy incisions for colonic resections.

Changes in anorectal physiology after radiotherapy for carcinoma of the prostate.

Review of parastomal hernia repair: a 10 year follow-up.

Recent Publications

Brundell s, Ellis T, Dodd T, Watson DI, Hewett PJ.
Haemtogenous spread as a mechanism for the generation of abdominal wound metastases following laparoscopy.
Surg End. (accepted for publication)

Hardingham JE, Hewett PJ, Sage RE, Finch JL, Nuttall JD, Kotasek D, Dobrovic A.
Molecular detection of blood-Borne epithelial cells in colorectal cancer patients and in patients with benign bowel disease.
Int. J. Cancer 89:8-13 (2000)

Texler ML, Hewett PJ.
Pathogenesis: Transportation of tumour cells in animal studies. In Reymon MA, Bonjer HJ, Kockerling F, eds. Port-site and Wound Recurrences in Cancer Surgery. Berlin Heidelberg
New York: Springer-Verlag, 2000. pp. 44-51.

Limb RI, Rudkin GE, Luck AJ, Hunt L, Hewett PJ. The pain of haemorrhoidectomy: a prospective study. Ambulatory Surgery 8 (2000)129-134.

Luck AJ, Hewett PJ. Ischiorectal fossa block decreases posthemorrhoidectomy pain. Dis Col Rect. 43;2:142-145 (2000)

Neuhaus S, Hewett P, Disney A. An unusual case of port site seeding. Surg End.

Leonardos L, Butler LM, Hewett PJ, Zalewski PD, Cowled PA. The activity of caspase-3-like proteases is elevated during the development of colorectal carcinoma. Cancer Letters. 143: 29-35 (1999).

Luck AJ, Copley J, Hewett PJ. (Accepted for publication). Ultrasound of colonic neoplasia: An intra-operative tool? Surg Endosc 1999.

Luck AJ, Pearson S, Maddern GJ, Hewett PJ. Video information: Its effects on pre-colonoscopy knowledge and anxiety levels. Lancet 1999. 354:2032-35

Luck AJ, Thomas ML, Roediger WEW, Hewett PJ. Localisation of the nonpalpable colonic lesion with intra-operative ultrasound. Surgical Endoscopy 13(5):526-7, 1999 May.

Hewett PJ, Moore J. Penfold JC. Adams W. Cartmill J. Chapuis P. Cunningham I. Farmer KC. Hoffmann D. Jass J. Jones I. Killingback M. Levitt M. Lumley J. McLeish A. Meagher A. Moore J. Newland R. Newstead G. Oakley J. Olver I. Platell C. Polglase A. Waxman B. et al. Practice parameters for the management of colonic cancer I: surgical issues. Recommendations of the Colorectal Surgical Society of Australia. [Review] [93 refs] Australian & New Zealand Journal of Surgery. 69(6):415-21, 1999 Jun.

Adams W. Cartmill J. Chapuis P. Cunningham I. Farmer KC. Hewett P. Hoffmann D. Jass J. Jones I. Killingback M. Levitt M. Lumley J. McLeish A. Meagher A. Moore J. Newland R. Newstead G. Oakley J. Olver I. Platell C. polglase A. Sarre R. Schache D. Solomon M. Waxman B. et al. Practice parameters for the management of colonic cancer II: other issues. Recommendations of the Colorectal Surgical Society of Australia. [Review] [106 refs] Australian & New Zealand Journal of Surgery. 69(7):472-8, 1999 Jul.

Luck AJ, Moyes D, Maddern GJ, Hewett PJ. Core temperature changes during open and laparoscopic colorectal surgery. Surgical Endoscopy 13(5):480-3, 1999 May.

Butler LM, Hewett PJ, Fitridge RA, Cowled PA. Deregulation of apoptosis in colorectal carcinoma: Theoretical and therapeutic implications. Aust NZ J Surg 1999; 69: 88-94.

Hensman C, Lionel G, Hewett PJ, Rao MM. Laparoscopic live donor nephrectomy. Aust NZ J Surg 1999; 69: 365-368.

Hewett PJ, Texler ML, Anderson D, Chatterton B. In vivo real-time analysis of intraperitoneal radiolabelled tumour cell movement during laparoscopy. Dis Colon & Rectum 1999; 42: No 6, 1-9.

Hensman C, Luck AJ, Hewett PJ. Laparoscopic assisted colonoscopic polypectomy. Surg Endosc 1999; 13: 231-232.

Hunt L, Luck AJ, Hewett PJ. Day case haemorrhoiedctomy. British Jour Surg 1999; 86: 255-258.

Texler ML, King G, Hewett PJ. From inside out: Microperforation of the gall bladder during laparoscopic surgery may liberate mucosal cells. Surg Endosc 1998; 12: 1297-1299.

Hewett PJ. The role of peritoneal immunity and the tumour-bearing state on the development of wound and peritoneal metastases after laparoscopy (Editorial).
Aust NZ J Surg 1999; 69(1): 1.

Texler ML, King G, Hewett PJ. Tumour cell movement during heating and humidifcation of insufflating CO2: An in vitro model. Aust NZ J Surg 1998; 68: 740-742.

Butler LM, Hewett PJ, Butler WJ, Cowled PA. Down-regulation of fas gene expression in colon cancer is not a result of allelic loss or gene rearrangement. Br J Cancer 1998; 77(9): 1454-1459.

Luck AJ, Hewett PJ. Laparoscopic gastrostomy: Towards the ideal technique. Aust NZ J Surg 1998; 68: 281-283.

Hewett PJ, Roberts-Thomson IC. Images in gastroenterology - Occult rectal prolapse and solitary rectal ulcer. J Gastro & Hept 1998; 13: 539.

Luck AJ, Hensman C, Hewett PJ. Laparoscopic colectomy for cancer: A review. Aust NZ J Surg 1998; 68: 318-327.

Watson DI, Neuhaus SJ, Texler ML, Hewett PJ. Port site metastases following laparoscopic surgery: A review. Brit J Surg 1998; 85: 735-741.

Bokey E.L., Moore J., Chapuis P,
Morbidity and mortality following laparoscopic right hemicolectomy for cancer
Dis. Colon Rectum 1996 39; S24-S28

Philipsen B., Moore J., Chapuis P., Bokey E.L.
Cost of open versus of laparoscopically assisted right hemicolectomy for cancer.
World J Surg. 1997 21:214-217

Moore J., Chapuis P., Bokey E.L.
Morbidity and mortality after single and double stapled colorectal anastomoses in patients with carcinoma of the rectum
Aust. N.Z.J. Surg 1996 66; 820-23

Moore J., Newland R., Chapuis P., Bokey E.L.
Lymphovascular clearance in laparoscopic assisted right hemicolectomy is similar to open surgery.
Aust. N.Z.J. Surg. 1996 66; 605-07

Hoffmann DC., Young J.F., Sweeney J.L., Hunter R.A., Moore J.
A modification of the single stapled colorectal anastomosis using the transanal insertion device (TAIS).
Aust. N.Z.J. Surg 1996 66 11; 768-9

Moore J. , Millard S., Roediger W.
Hydrogen sulphide produces diminished fatty acid oxidation in the rat colon in vivo; implications for ulcerative colitis.
Aust. N.Z.J. Surg. 1997 67: 245-49

Bokey EL, Moore J, Keating JP, Zelas P, Chapuis PH, Newland RC..
Laparoscopic resection of the colon and rectum for cancer
Br. J Surg 1997 84: 822-25

Roediger W.E.W., Moore J., Babidge W
Colonic sulfide in the pathogenesis and treatment of ulcerative colitis.
Dig. Dis. Sci. 1997 42: 1571-79

Moore J., Babidge W., Millard S., Roediger W.
Effect of sulphide on short chain acyl-CoA metabolism in rat colonocytes
Gut 1997 41: 77-81

Moore J., Babidge W., Millard S., Roediger W.
Thiol methyltransferase activity in the human colonic mucosa:
implications for ulcerative colitis.
J. Gastroenterol. Hepatol., 1997 12/9-10: 678-84)

J Moore, D Hoffmann, D Roder
Trends in survival from colorectal cancer: the impact of subspecialisation
ANZ J Surg, 1997 67: 842-45

Moore J., Babidge W., Millard S., Roediger W.
Colonic lumenal sulphide is not elevated in ulcerative colitis
Dig. Dis. Sci., 1998 43:

Moore J, Cowled P,
Hereditary Non Polyposis Colorectal Cancer: A Review. ANZ J Surg 1998 69: 6-13

Tam W, Moore J, Schoeman M
Treatment of radiation proctitis with argon plasma coagulation. Endoscopy 2000: 32 ;667-71

Rieger NA, Sweeney JL, Young J, Hoffmann DC, Hunter An Investigation of faecal incontinence with endoanal ultrasound. Dis Colon Rectum 1996; 39: 860-864.

Rieger NA, Downey PR, Wattchow DA.
Endoanal ultrasound during contraction of the anal sphincter- improved definition and diagnostic accuracy. Br J Radiology 1996, 69:665-667.

Gall CA, Rieger NA, Wattchow DA.
Proximal resection margins after resection of the oesophagus and stomach: effect on survival and symptom recurrence. Aust N Z J Surg. 1996,66:738-741.

Watkin NA, Rieger NA, Moisey CU.
Is the conservative management of the acute scrotum justified on clinical grounds? Br J Urology 1996, 78:623-627.

Rieger NA, Wattchow DA, Sarre RG, Cooper SJ, Rich CA, Saccone GTP, Schloithe AC, Toouli J, McCall JL. Prospective trial of pelvic floor retraining in patients with fecal incontinence. Dis Colon Rectum 1997;40: 821-826.

Rieger NA, McIntosh NA.
Port site metastasis from synchronous primaries of the colon and ovary following laparoscopic cholecystectomy. Eur J Surg Oncology 1998;24:144-145.

Rieger NA, Schloithe AC, Saccone GTP, Wattchow DA.
The effect of a normal vaginal delivery on anal function. Acta Obstet Gynecol Scand 1997;76:769-72.

Rieger NA, Sarre RC, Saccone GTP, Hunter A, Toouli J. Postanal repair for faecal incontinence: Long-term followup. Aust N Z J Surg. 1997, 67: 566-570.

Rieger NA, Wattchow DA, Sarre RC, Cooper SJ, Rich CA, Saccone GTP, Marshall VR, McCall JL.
Prospective study of biofeedback for treatment of constipation. Dis Colon Rectum 1997,40:1143-1148.

Rieger NA, Sarre RG, Schloithe AC, Saccone GTP, Wattchow DA.
The correlation of PNTML with the results of anal manometry. Int J Colorectal Disease. 1997,12:303-307.

Rieger N, Stahl J, Wattchow D.
Case Report. Intractable Crohn's colitis and perianal disease responding to cyclophosphamide and epirubicin. Dig Dis Sci 1997,42:2367-2369.

Wood J, Amos L, Rieger N.
Third degree anal sphincter tears: risk factors and outcome. Aust N. Z. J. Obstet Gynaecol. 1998,38:414-417.

Rieger NA, Wattchow DA.
Letter to the editor. Dis Colon Rectum 1998,41;671-678.

Wattchow DA, Rieger NA.
Motility disorders of the colon and anorectum. In: Integrated basic surgical sciences. Editors Toouli, Russell, Devitt, Ingham Clark. 1998 Arnold Publishers. UK. In Press

Rieger NA, Saccone GTP, Schloithe AC, Wattchow DA.
A prospective study of anal sphincter injury due to childbirth. Scand J Gastroenterology 1998;33:950-955.

Rieger N, Collopy B, Fink R, Mackay J, Keck J, Woods R. Total colectomy for Crohn's disease. Aust N Z J Surg 1999,69:28-30.

Sweeney T, Rieger NA, Mackay JA.
Neutropaenic proctosigmoiditis complicating breast cancer chemotherapy. Aust N Z J Surg 1999,69:681-2.

Rieger NA, Wattchow DA.
The effect of vaginal delivery on anal function: A review. Aust N Z J Surg 1999,69:172-177.

Rieger NA, Slaven J, Keck JO, Mackay J, Woods R. Intestinal sleeve anastomosis. A comparative study with end to end anastomosis. Journal of Surgical Research. 1999,81:170- 173

Rieger NA, Stitz RW, Lumley JW, Stevenson ARL.
Tube seton and anal fistula: Increased diagnostic accuracy of endoanal ultrasound. Accepted for publication. Colorectal Disease.

Rieger NA, Stitz RW, Lumley JW.
Full thickness transrectal advancement flap for the treatment of anal fistula. Colorectal Disease 1999, 1:238-241.

Wattchow DA, Rieger NA.
Lancet Commentary. Faecal incontinence after vaginal delivery. Lancet 1999;354:965-966.

Rieger N, Kennedy R, Farrell S, Woods R.
Informed consent, patient satisfaction and length of hospitalisation: The contribution of written infromation leaflets. Health Promotion Journal of Australia. 1999;9:188-191.

Rieger N.
The Senna Story. Australian Continence Journal. 1999;5:91-92.

Voyvodic F, Scroop R, Schloithe AC, Wattchow DA, Rieger NA, Saccone GT.
Endosonographic evaluation of the neuropathic anal sphincter complex. Accepted for publication. Diseases Colon Rectum.

Investigation of faecal incontinence with endoanal ultrasound
N. A. Rieger, J. L. Sweeney, D. C. Hoffmann, J. F. Young, A. Hunter.
Disease of the Colon and Rectum 39 (8); 860-4, August 1996.

Post anal repair for faecal incontinence - long term follow up:N. A. Rieger, R. G. Sarre, G. T. P. Saccone, A. Hunter and J. Toouli. Aust. N.Z. J. Surg (1997) 67, 566 - 570.

Implications of delayed diagnosis in colorectal cancer. C. Young, J.L. Sweeney, A. Hunter. Aust. N.Z. J. Surg (2000) Vol 70, 9, 635-638

How to treat perianal haematoma Hunter.A. Practical Procedures. Modern Medicine of Australia, Sept. 1998, 109 - 111.

Segmental colonic transit after oral 67ga - citrate in normal subjects and those with chronic idiopathic constipation. D. Bartholomeusz, B. E. Chatterton, J. C. Bellen, R. Gaffney and A. Hunter. The Journal of Nuclear Medicine - Vol 40, No 2, February 1999.

Abnormalities of nerve fibres in the circular muscle of patients with slow transit constipation: A. J. Porter, D. A. Wattchow, A. Hunter, M. Costa Int. J. Colorectal Dis (1998) 13: 208-216.

Investigation of faecal incontinence using endoanal ultrasound. A. Hunter.The Journal of Stomal Therapy Australia. December, 2000 Vol. 20 : 4. Pge 19-21.