Colorectal services - information for professionals

The colorectal department is concerned with the prevention, diagnosis and surgical treatment of diseases arising within the small and large intestine, and in the anal area. These include the broad groups of bowel cancer and polyps, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), diverticular disease, functional bowel problems (constipation, incontinence, irritable bowel, obstructed defaecation, pelvic floor disorders and rectal prolapse etc.), and many anorectal problems (haemorrhoids/“piles”, fistulae, abscesses, pilonidal disease and anal fissures).

Each year we treat approximately 240 patients with newly diagnosed bowel cancer, including those diagnosed through the Tees Bowel Screening Programme offered within the hospital. All patients with cancer diagnosis are considered for the modern multi-modal treatment in the weekly multi-disciplinary team meeting (MDT) that includes surgeons, nurses, oncologists, pathologists, gastroenterologists and radiologists, and is the designated regional MDT for T1 rectal cancers (“early rectal cancer” that could be considered for local resection through the anus). Outcomes for all major colorectal operations are closely monitored and reviewed through the National Bowel Cancer Audit (NBOCAP) and the North of England Cancer Network (NECN).

For patients with inflammatory bowel disease, the department works in close collaboration with the medical gastroenterologists and performs up to 60 operations annually. A monthly inflammatory bowel MDT, including surgeons, gastroenterologists, specialist nurses, radiologists, pathologists and dietitians is in place to help optimise the management of these complex patients.

Operations offered for functional bowel problems and ano-rectal conditions include advanced techniques such as ventral mesh rectopexy, sacral nerve stimulation (SNS), stapled transanal rectal repair (STARR), stapled haemorrhoidopexy (PPH) and haemorrhoidal artery ligation operations (HALO); suitable patients with functional bowel problems are considered for the non-operative biofeedback treatment.

Our team consists of five consultant colorectal surgeons, three senior and two junior surgical trainees from the Northern deanery, two trust-appointed senior surgical fellows, two trust-appointed junior middle-grade doctor, and four foundation-grade junior ward doctors. The team also consists of six colorectal nurse specialists, a colorectal nursing assistant, a functional bowel nurse advisor and two nurse endoscopists, as well as four administrative staff. Patients are seen in the trust’s outpatient clinics and the endoscopy units, but all major and complex surgery is carried out at the North Tees site where the critical care unit and a level I surgical observation unit (SOU) have great experience in the management of colorectal patients. Specialist investigations and care for stoma patients are coordinated through the colorectal unit (CRU) at the University Hospital of North Tees, which houses a state-of-the-art anorectal physiology laboratory, as well as several treatment and counselling rooms.

Minimally invasive surgery is well advanced within the unit and all suitable patients are offered laparoscopic procedures, also including cutting-edge single incision laparoscopic surgery and transanal endoscopic operations (TEMS/TEO). Many patients are managed within a well-established enhanced recovery programme to ensure rapid recovery following surgery and shorter hospital stays.

The department participates actively in several large national multi-centre research projects (such as EnROL, DREAMS, NSCCG, CreST, TREC and FoxTRot), and conducted/conducts several research studies locally, including cutting-edge research into single-incision laparoscopic surgery, regenerative surgical approaches for the treatment of fistulae-in-ano and new pathology techniques.