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Colorectal surgery

 

The RAH Colorectal Unit is the largest tertiary referral colorectal surgical unit in South Australia, performing approximately 300 major colorectal surgical procedures and approximately 900 colonoscopic procedures per annum.

The RAH Colorectal Unit comprises six consultant surgeons (all of whom are CSSANZ members), one colorectal fellow, an advanced surgical trainee, a registered medical officer, three interns and a research fellow.  

The unit provides specialist colorectal surgical services and participate in a 1 in 6 dedicated colorectal oncall roster with fellow participation during working hours. The unit also contributes to emergency general surgical cover after hours supported by a dedicated Acute Surgical Unit. 

The colorectal unit undertakes high volume major open and laparoscopic colorectal cancer surgery, complex inflammatory bowel disease cases, interventional colonoscopy and trans-anal endoscopic microsurgery. Involvement in weekly formalised multidisciplinary oncology and Inflammatory bowel disease (IBD) meetings is strongly promoted within the unit. Pelvic floor and continence surgery is supported by a full anorectal physiology service and a dedicated continence clinic. Robotic surgery is offered in highly selected cases, utilising facilities in the private sector.  

Research is an important part of the unit and planned for expansion. The funded research fellow position is part time research (funded) and part time clinical with exposure to clinical meetings, assistance with oncall cover, and private assisting.

Contact

Emergency Call Centre: (08) 7074 0000

Outpatient Call Centre: 1300 153 853

Outpatient referral fax number: (08) 7074 6247

Referral forms are available here: https://www.rah.sa.gov.au/health-professionals/outpatient-referrals

Inpatient Reception (telephone enquiries): (08) 7074 5052

Inpatient Reception fax number: (08) 7074 6191

GP Liaison Nurse[email protected]

Cancer Support Nurse[email protected]

Stoma Therapy[email protected]

Location

The Colorectal Unit is located on Ward 5E, in the Royal Adelaide Hospital at the corner of North Terrace and West Terrace.

Training

The unit is accredited as a post for intern training (CEPTSA), pre-fellowship surgical training (RACS) and by the CSSANZ / RACS Section of Colon and Rectal Surgery Training Board in Colorectal Surgery 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 ileo-anal pouch procedures
  • Assessment and management of faecal incontinence including ano-rectal physiology studies, endoanal / rectal ultrasound and other new technologies including sacral nerve stimulation
  • Laparoscopic colorectal surgery Complex anal fistulae and other anorectal procedures Transanal endoscopic microsurgery
  • Advanced colonoscopic techniques including colonic stenting.

The Colorectal Fellow position 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. At the end of their year the fellow can expect to gain confidence in managing high volume elective and complex acute colorectal cases, and to develop well rounded evidence-based decision-making skills.

Colorectal cancer support nurse

The colorectal cancer support nurse:

  • Provides expert consultative and liaison service for patients with colorectal cancer, as well as their families, carers and health service providers
  • Provides counselling to patients and their families in regards to the diagnosis of colorectal cancer. This includes first diagnosis, pre admission, surgery, post-operative period & follow-up / surveillance
  • Acts as first contact for all enquiries, providing literature as well as communicating treatment plans, investigations required and results
  • Manages the post-operative colorectal surveillance program which includes 3 monthly CEA, 12 monthly CT and three yearly colonoscopies and follow-up of abnormal results
  • Coordinates the Colorectal MDT meeting which includes preparation of list, presentation of cases, & patient communication of treatment decisions.

Enhanced recovery after colorectal surgery

Aims
  • Early return of general function
  • Early return of bowel function
  • Minimal morbidity after surgery
  • Early discharge with low re-attendance
  • Satisfied less anxious patients
Preoperative
  • Patient education and expected post-op progress
  • Discharge and social planning
  • Cease smoking and alcohol consumption
  • Extended stomal therapy education if stoma is anticipated
  • Limited fasting pre-op and preoperative oral carbohydrate feeding and immuno-nutrition
Operative
  • Regional anaesthetic techniques
  • Titrate IV fluids to avoid overload
  • Intra-operative oxygen and in recovery
  • Prevention of hypothermia
  • No routine nasogastric tubes/drains
  • Routine antibiotics and deep vein thrombosis (DVT) prophylaxis
Post operative
  • Optimised post-operative analgesia (opiate minimization)
  • Prevention of post op nausea and vomiting
  • Early mobilisation and introduction of diet and protein drinks
  • Minimise intravenous fluid use
  • Early indwelling catheter removal
  • Restful environment
Discharge
  • Early discharge and social planning


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