Transformation of Colorectal Surgery in South Tyneside Hospital

1. Transformation of Colorectal Surgery in South Tyneside Hospital Mr D Light ST5 Mr S Subramonia Consultant Laparoscopic Colorectal Surgeon Mr A Krishna Consultant Laparoscopic Colorectal Surgeon and Lead for Colorectal Cancer

2. South Tyneside Hospital • 152,600 population • 100 – 120 colectomies a year for cancer • 3 colorectal surgeons • 2 colorectal nurse practitioners

3. Recent changes • Appointment of two laparoscopic colorectal surgeons 2012 • May 2012 Mr Subramonia • June 2012 Mr Krishna • Changes in surgical practice • Enhanced recovery • Changes in endoscopic investigation

4. Recent experience • 37 procedures • Mean age 73 years (49 to 93 years) • 26 laparoscopic (70%) • 2conversions (bleeding IMA on colon side, 1 adhesions) • One defunctioning ileostomy for laparoscopic low anterior resection • Reversed at 3 months • Median post op stay • 6.5 days overall (IQR 5 – 10) • 7 days laparoscopic (IQR 4.5 – 10)

6. Complications • Two 28-day deaths (post op MI day 2, anastomotic leak day 20) • One 38-day death due to respiratory complications in known lung ca) • 2 major complications (anastomotic leak day 12 post open R hemi – ileostomy formed, rectal stump blow out post open low Hartmans with abdo wall dehiscence) • 4 pneumonia • 1ileus

7. Transformation to service

8. Endoscopy • Previous standard for colonic investigation was flexible sigmoidoscopy and CT colonography • Now simple and evidence based • Standardised follow up of lesions • Cancer follow up is now standardised to national guidelines

9. Any questions?