Does establishment of colorectal surgical unit improve colorectal operations?

Abstract

Purpose: The aim of this study was to investigate the effect of establishing Colorectal Surgical Unit (CRSU) in a reference Hospital on the volume and characteristic of colorectal operations.

Patients and Methods: Between 2003 and 2008, the patients underwent colorectal surgery in General Surgery Department of School of Medicine of Mersin University were evaluated. The patients were divided into two groups: before CRSU (group 1) and after (group 2). The two groups were compared in terms of volume and characteristic.

Results: Total of 1631 colorectal operations were performed, of which 617 in group 1 and 1014 in group 2. Hemorrhoidectomy and drainage of anal abscesses were similar in both groups. The operations for stromal tumors two, inflammatory bowel disease seven, colorectal cancer two, benign colorectal diseases three times increased, while anal fissure operations decreased three times after CRSU. Peritonectomy, rectovaginal fistulas, anal incontinence, anal stenosis and rectocele being performed after CRSU.

Complex anal fistulas was 10% in group 1, whereas 40% in group 2. Cutting setons were performed for the all complex fistulas in group 1, whereas advancement flap 66%, loose seton 22%, anoplasty 8%, colostomy 5% in group 2. Rectal cancer/all colorectal cancer operations was 29% in group 1 while 45% in group 2. From 5% to 13% anterior resection, from 14% to 24% low or very low anterior resection increased. Abdominoperineal resection decreased from 10% to 7.5%. Stoma decreased from 22% to 9% after CRSU.

Conclusion: The establishment of a Colorectal Surgical Unit improved quantity and characteristic of colorectal operations. Some operations, which had not performed previously, could be done.