Cleveland Clinic Florida's Department of Colorectal Surgery diagnoses and treats a broad array of diseases including colon cancer, rectal cancer, inflammatory bowel disease, and functional disorders such as fecal incontinence.
The department is world-renowned for achieving excellent outcomes and using innovative state-of-the-art treatments for colorectal conditions. Colorectal surgeons use a collaborative team approach with other specialties to provide high-quality patient care. On a national level, the mortality index and length of stay are considerably below the expected norms.
Cleveland Clinic Florida is the first hospital in Florida and second in the nation to earn accreditation from the National Accreditation Program for Rectal Cancer (NAPRC) administered by the American College of Surgeons. New NAPRC standards were developed to improve outcomes for rectal cancer care in order to lower rates of colostomy construction, local tumor recurrence and improve tumor-free survival rates for patients. The standards are consistent with Cleveland Clinic Florida's approach to providing rectal cancer patients with high quality care and the accreditation was achieved as a result of the multidisciplinary approach to patient care by the team of specialists at the Digestive Disease Center.
The Department of Colorectal Surgery is the largest colorectal surgery center in Florida and has the largest colorectal residency-training program in North America.
To schedule an appointment, call 1.877.463.2010.Download our free Colonoscopy Fact Sheet.
What We Treat
The nature of the practice of the Department of Colorectal Surgery is extremely diverse and the types of procedures performed are significantly different from the “average” colorectal surgeon’s practice. Inflammatory bowel disease, including mucosal ulcerative colitis and Crohn’s disease are some of the most common conditions managed in our department.
In addition, the most challenging cancers, specifically those tumors located in the mid and lower thirds of the rectum, are another mainstay of our workload. Also, other complex problems such as fecal incontinence refractory to surgery, recurrent inflammatory bowel disease, recurrent carcinoma and complex anorectal surgery are conditions that we frequently manage.
The Cleveland Clinic Florida staff continuously strives to introduce new ideas, techniques and technology into the armamentarium available to colorectal and general surgeons and gastroenterologists and therefore patients throughout the world.
- Colon Cancer
- Rectal Cancer
- Anal Cancer
- Inflammatory Bowel Disease
- Crohn’s Disease
- Ulcerative Colitis
- Gastrointestinal Bleeding
- Colon Polyps
- Bowel Obstruction
- Familial Adenomatous Polyposis
- Intestinal Fistula
- Rectal Prolapse
- Rectovaginal Fistula
- Rectourethral Fistula
- Stoma (Colostomy and Ileostomy) Complications
- Radiation proctitis
- Fecal Incontinence
- Anal condyloma
- Anal stenosis
- Anal infections
- Pilonidal Cyst
- Rectal bleeding
The Department of Colorectal Surgery is the epitomy of the growth. The department is internationally renowned for patient care, research and education, teaching, and training.
As we enter our 21st year in Florida, we owe a debt of gratitude to our patients, peers, residents and fellows, philanthropists, and corporate supporters. The collective trust which you have placed in us has allowed us to grow from four members of our department in 1988 to more than 50 in 2008.
As you peruse the information contained within the text to follow this introduction, you will note that tens of thousands of patient visits have resulted in the opportunity for our staff to assist through consultations and interventional procedures thousands of patients from throughout the world. In addition to directly improving the outcome for these individuals, we have indirectly touched the lives of many thousands more patients by training their physicians and surgeons when they have visited us from throughout the world.
Moreover, hundreds of medical students, residents, and fellows have spent periods ranging from one month to three years in our department to further their education and learn the methodology and techniques of evaluation and management of colorectal diseases at Cleveland Clinic in Florida.
Although these individuals were here to learn, they also helped to teach our staff by researching methods of improving outcomes. Specifically, they have helped us conduct prospective and prospective randomized trials as well as database and retrospectively review our results. By these labors, they have helped us to continually improve and expedite methods of diagnosis, reduce the adverse side effects of treatment, improve the curability of our therapeutic modalities, reduce recurrence rates, and improve the quality of life of patients throughout the world.
The fruits of these labors have yielded as an average one published manuscript per month in the medical literature over the last 20 years along with an average of one book chapter every three months during this same time period. Moreover, over the last several years, we have published approximately one textbook per year. All of these discoveries and innovations have enabled our staff and many of our former residents to become recognized as leaders within the field of colorectal surgery.
All of our staff and many of our former trainees have been asked to serve on important committees in regional, national, and international professional societies. They have been bestowed with honorary memberships and fellowships and have been recruited to travel throughout the world teaching the methodology developed and utilized in our department so that patients in other lands may benefit.
Sometimes one’s expertise is only recognized far from home; in proximity local politics and jealousies often sadly preclude utilizing the resources of even an internationally acclaimed individual. We are proud that in our local community our colleagues in colorectal surgery as well as in the allied fields of general surgery and gastroenterology have continually called upon our staff, both as a referral resource for their patients as well as an academic asset to further their education.
Our staff have been asked to organize the educational sessions for the South Florida Chapter of the American College of Surgeons, the Florida Chapter of the American College of Surgeons, the Florida Gastroenterologic Society, the Northeastern Society of Colon and Rectal Surgeons, the Welsh Surgical Society, and the Royal Society of Medicine Section of Coloproctology, as well as many other similarly prestigious societies.
Our doctors are recognized by our peers as “the best” in publications including The Best Doctors in America (national editions, 1994-2008), The Best Doctors in America (southeast edition, 1997-1998), Town and Country (1990), South Florida (1991), American Health (1996), Good Housekeeping (1999), Miami Metro (2000), Where to Find the Best Doctors (2000), America’s Top Doctors (2002-2007), and America’s Top Cancer Doctors (2005-2007).
From late 1987 through the opening of Cleveland Clinic in Florida on February 28, 1998 until July 2, 2001, Cleveland Clinic in Florida was split between two campuses.The hospital was located on A1A just south of Oakland Park Boulevard in Fort Lauderdale while the outpatient clinic facility was in a series of three buildings on West Cypress Creek Road and NW 31st Avenue in northwestern most Fort Lauderdale.
Through a variety of steps undertaken by our former CEO, Harry K. Moon, MD, Cleveland Clinic in Florida successfully relocated to a 68-acre unified campus in Weston, Florida. Weston is the geographic epicenter amongst Palm Beach, Broward, Miami-Dade, Lee, and Collier Counties.
This imminently convenient 500,000 square foot location includes the multi-million dollar interactive David G. Jagelman, MD Conference Center. Most of the 153 beds are in private rooms. Both the physical plant and level of service are far more akin to a five star hotel than to a conditional hospital.
The hospital has become a destination for both health care providers and patients from around the world. In fact, over 80% of the patients seeking surgery in the Department of Colorectal Surgery live outside of the five-county area of Monroe, Miami-Dade, Broward, Palm Beach, and Martin Counties. Despite the small size of the hospital, the colorectal service generally occupies 25% to 35% of the hospital census. On most days, 2 to 3 colorectal operating rooms are in session from 7:30 a.m. until some time in the evening serving an ever-increasing number of patients.
None of these accomplishments would have been possible without the efforts and visions of our founding late chairman, David G. Jagelman, MD Although more than five years have elapsed since David’s untimely passing, on August 9, 1993, his teachings are imparted to our residents and students on a daily basis. His energy and enthusiasm for our specialty continues to be transmitted and his name will live on forever.
Although he is not here with us in a corporeal sense, he continues to be our guiding light as we follow the path which he outlined to success. We are delighted that the multimillion dollar interactive conference facility in Weston is named “The David G. Jagelman, MD Conference Center.” It is a fitting tribute to a man who made so many innovations and touched in a positive way so many lives throughout the world.
None of the accomplishments in this department would have been possible without the participation of our patients by allowing us the privilege of serving their health care needs. We could not have treated these patients had our colleagues from communities throughout the world not relied upon us as a referral resource for these problems.
We could not have learned how to better treat the patients of these physicians had our clinical and research residents, fellows, and students not been here to continually stimulate us to work at our best and to mercilessly, and in a brutally honest fashion, scrutinize our results. These results could not have been properly analyzed, presented, and published without the financial support of our philanthropic patients and corporate donors.
Unfortunately, funding for research and education is increasingly difficult to secure. We must rely upon such altruism to continue our activities.
As you peruse the sections that follow this introduction, I ask you to think about the impact made on the quality of life for patients throughout the world by the advances made in our department. I would like you to reflect upon the importance of continuing to teach current and future generations of surgeons how to evaluate and manage these problems. Lastly, I would like you to volunteer to help us as best you can to perpetuate Dr. Jagelman’s legacy in providing the finest possible care for diseases of the colon, rectum, and anus.
In the acknowledgements section, you will find a list of our major donors to date. I hope to see your name on the next iteration of this list. I thank you in advance for your anticipated generosity.
Steven D. Wexner, MD, FACS, FRCSEd, FASCRS, FACG
Director, Digestive Disease Center
Chairman, Department of Colorectal Surgery
Professor of Surgery, The Cleveland Clinic Foundation Health Sciences Center of The Ohio State University
Clinical Professor, Department of Surgery, University of South Florida
Research Professor of Biomedical Science, Florida Atlantic University
21st Century Oncology Chair in Colorectal Surgery
In 1921, Cleveland Clinic was established by four physicians, Drs. George Crile, Frank Bunts, William Lower, and John Phillips. At that time, the group practice model was rare, only being found at the Mayo Clinic and in military units. Their mission was to establish a medical facility dedicated to quality patient care, education, and research into the diseases of the patients they treated. This mission culminated in the formation of Cleveland Clinic.
Seventy years and two million patients later, that mission statement remains a guiding principle for Cleveland Clinic, a not-for-profit group practice in which clinical care, research, and education are inextricably linked in order to provide each patient with the best possible care. Through the years, Cleveland Clinic has changed and grown and now is one of the world’s foremost leaders in healthcare.
Similarly, in 1988, Cleveland Clinic Florida was established to provide similar care in a region where academic medicine and group practices were rare. Since 1988, Cleveland Clinic Florida has grown in all aspects and is internationally recognized as a healthcare leader.
The Department of Colorectal Surgery is the epitomy of the growth. The department is internationally renowned for patient care, research and education, teaching, and training. Moreover, numerous publications and presentations as well as new and innovative techniques makes the department one of the most well respected academic colorectal units in the world.
History of the Department
As in all successful endeavors, an initial development person is usually behind that success. The case is no different in Cleveland Clinic Florida's Department of Colorectal Surgery.
Dr. David G. Jagelman
The late Dr. David G. Jagelman (1939-1993) was the driving force in the department. Dr. Jagelman was born in England where he received all of his undergraduate and graduate education. He trained at such prestigious institutions as Westminster Medical College, the Metropolitan Hospital, and St. Mark’s Hospital. Dr. Jagelman then trained as a fellow in colorectal surgery at Cleveland Clinic in Ohio in 1974-1975 and remained on staff in the department. In 1987, he was recruited to begin to build the Department of Colorectal Surgery in Fort Lauderdale.
Dr. Jagelman was one of the founding fathers and Chairman of both the Department of Colorectal Surgery and the Division of Surgery. His world famous reputation and expertise in rectal cancer, inflammatory bowel disease and familial adenomatous polyposis (FAP) allowed the department to quickly blossom.
In Cleveland, Dr. Jagelman had established the polyposis registry which became one of the largest and most respected registries in the world. After entering 240 families into the registry, Dr. Jagelman set up an identical registry in Florida. Between 1988 and 1993, he entered 33 new families into the Florida registry. Dr. Jagelman remained chairman until his untimely death at the age of 53 in 1993.
In 1987, prior to Dr. Jagelman leaving Cleveland, he recruited Steven D. Wexner, MD, from the University of Minnesota, to help begin the vision of a world-class department. A native of New York, Dr. Wexner received his undergraduate education at Columbia University, his medical schooling at Cornell University, and his surgical training at The Roosevelt Hospital in New York.
In early 1988, when Cleveland Clinic Florida opened, Dr. Wexner established the Anorectal Physiology Lab. At the time of its inception, the physiology lab was one of the first comprehensive interdisciplinary testing facilities in North America. Since that time, it has become one of the premier physiology laboratories in the world, evaluating hundreds of patients and training dozens of physicians each year.
In 1988, Drs. Jagelman and Wexner were among the first surgeons in the world to perform and disseminate the benefits of a new type of ileal pouch anal anastomosis called the double stapled technique. This exciting new modification to the pouch procedure revolutionized surgery for mucosal ulcerative colitis. It has been applied to almost 1000 patients in our department and has been adopted by countless surgeons worldwide, thereby benefiting many thousands of patients.
In 1991, Drs. Jagelman and Wexner began to pioneer laparoscopic colorectal surgery. That program has now developed into one of the most extensive of its type in the world. Thousands of surgeons from throughout the world have come to receive training while over 1,000 patients at Cleveland Clinic Florida and hundreds of thousands more worldwide have now undergone this impressive new technique. Other new and innovative procedures pioneered in total or in part at Cleveland Clinic Florida's Department of Colorectal Surgery include:
- sacral nerve stimulation for fecal incontinence
- stimulated graciloplasty for fecal incontinence
- the artificial bowel sphincter for fecal incontinence
- the use of sodium hyaluronate/carboxymethylcellulose bioresorbable membrane for prevention of postoperative adhesions
- a new technique of multilayered sphincter repair for fecal incontinence
- management of sigmoidoceles for chronic constipation
- graciloplasty for rectourethral and rectovaginal fistulas
- scoring systems for both fecal incontinence and chronic constipation developed at Cleveland Clinic Florida have become the most commonly used validated scoring systems.
Dr. Steven Wexner
Since 1993, Dr. Wexner has been the Chairman of the Department of Colorectal Surgery as well as serving as Director of the Residency Program from 1989 to the present. He served as Vice-Chairman of the Division of Surgery until 1995 when he was appointed as Chairman of the Division of Research and Education.
He chaired the Institutional Review Board and the Continuing Medical Education Committee until November 1997 when he resigned from those positions to accept the appointment as Chief of Staff. His duties as Chief of Staff include Cleveland Clinic Florida, and Cleveland Clinic and currently include the additional responsibilities of Chairman of the Medical Executive Committee, and 21st Century Oncology Chair in Colorectal Surgery.
Dr. Wexner was also appointed Professor of Surgery at Cleveland Clinic Health Sciences Center of The Ohio State University, Research Professor of Biomedical Science at Florida Atlantic University, and Clinical Professor in the Department of Surgery at the University of South Florida as well as honorary professor at the University of Siena in Siena, Italy, the University of Nanjing, China, University of Belgrade, Serbia, and Tokyo University, Japan.
Dr. Wexner is also a Visiting Professor at Hadassah University Medical Center in Jerusalem, Israel. He has also received fellowships from the Royal College of Surgeons in London and the Royal College of Surgeons in Edinburgh. Dr. Wexner has been president of numerous professional societies including the South Florida Chapter of the American College of Surgeons, the Florida Gastroenterologic Society, and the Section of Colon and Rectal Surgery of the Southern Medical Association.
From 2006-2007, Dr. Wexner was President of SAGES, the largest general surgery association in the U.S.A. with over 6,000 surgeon-members. Other leadership roles have included the residency review committee for Colon and Rectal Surgery of the ACGME, the American Board of Colon and Rectal Surgeons, the executive council of the ASCRS, and a governor of the American College of Surgeons.
Dr. Wexner is on 19 editorial boards, has delivered thousands of lectures on 6 continents. He has authored or coauthored 26 books, 191 book chapters, 1025 abstracts, and 476 manuscripts.
Dr. Juan J. Nogueras
In 1991, Dr. Juan J. Nogueras was recruited from colorectal surgery training at the University of Minnesota. Born in Puerto Rico, Dr. Nogueras moved to New Jersey at the age of ten years. His undergraduate training was at Princeton University, and he attended medical school at Jefferson Medical College in Philadelphia, Pennsylvania. He completed his surgical residency training at Columbia-Presbyterian Medical Center of Columbia University in New York.
Dr. Nogueras is in charge of the Cleveland Clinic Florida David G. Jagelman, MD, Inherited Colorectal Cancer Registry as well as the surgical registries in the Department of Colorectal Surgery. Dr. Nogueras has significant interest in genetics and in familial colorectal cancer syndromes. Dr. Nogueras is one of the world experts in endoanal ultrasonography and has pioneered some of its current uses in benign diseases such as fistulas, incontinence, and anorectal pain.
Dr. Nogueras served as Chairman of the Medical Advisory Committee of the Gold Coast Chapter of the Crohn’s and Colitis Foundation of America. He chaired the Medical Student Education Committee and was the interim co-chair for the Cancer Center at Cleveland Clinic Florida. In addition, he has served on many important national committees including the Program Committee for the American Society of Colon and Rectal Surgeons. In addition, he is an honorary member in seven international surgical societies.
In January 1999, Dr. Nogueras was appointed as the Vice-Chairman of the Department of Colorectal Surgery and was also appointed as Associate Professor of Surgery of Cleveland Clinic Health Sciences Center of the Ohio State University. Since 2000, Dr. Nogueras has served as Chairman of the Department of Surgery. His other leadership roles have included Secretary-treasurer of the South Florida Chapter of the American College of Surgeons.
Dr. Nogueras has delivered 233 lectures at 93 meetings in 16 countries on 3 continents. He has authored 23 book chapters, 150 abstracts, and 97 manuscripts.
Dr. Eric G. Weiss
In 1994, Dr. Eric G. Weiss was recruited after completing fellowship training in Cleveland Clinic Florida's Department of Colorectal Surgery. Dr. Weiss, a New Mexico native, received his undergraduate education at Pennsylvania State University, his medical education at Temple University, and surgical training at the Albert Einstein Medical Center in Philadelphia.
As the first alumnus member of the department, Dr. Weiss is integrally important to the residency training program. He has interests in laparoscopy, endoanal ultrasonography, colonoscopy, colorectal cancer, and inflammatory bowel disease, in addition to other facets of colorectal surgery.
Dr. Weiss has chaired the Patient Education Committee at Cleveland Clinic Florida since its inception. He also plays important roles in many national societies including as a member of the Young Surgeons Committee of the American Society of Colon and Rectal Surgeons.
In 1998, Dr. Weiss was appointed as Associate Program Director of the Residency Training Program in Cleveland Clinic Florida's Department of Colorectal Surgery, and in 2004 became the Residency Program Director. Since 1998, Dr. Weiss has also served as Chairman of the Graduate Medical Education committee.
Dr. Weiss served on many regional committees for several professional societies including SAGES and ASCRS. He was the representative from both these prestigious societies to the CPT coding panel of the American Medical Association and is a member of the residency review committee in colon and rectal surgery of the ACGME. Dr. Weiss is also a member of the executive council of the Program Directors Association in Colon and Rectal Surgery.
Dr. Weiss was also appointed as Assistant Professor of Surgery of Cleveland Clinic Health Sciences Center of the Ohio State University. He has delivered 178 lectures worldwide. He has authored or co-authored 550 abstracts, 1 book, 36 book chapters, and 225 manuscripts.
Dr. Dana Sands
In 2002, Dr. Dana Sands joined the department after completing the Colorectal Surgery fellowship here at Cleveland Clinic Florida. Prior to coming to Cleveland Clinic Florida, she received her undergraduate education at Renssalear Polytechnical Institute in Troy, NY. She attended the Hahnemman University School of Medicine in Philadelphia, PA and completed general surgery residency training at Jackson Memorial Hospital in Miami, FL.
Since joining the department, she became director of the Colorectal Physiology Center in 2002, and has expertise in benign anorectal diseases, pelvic floor dysfunction, fecal incontinence, constipation, inflammatory bowel disease, and colorectal cancer. Dr. Sands has an extensive experience with transanal endoscopic microsurgery(TEMs).
Dr. Fabio Potenti
During 2006, Dr. Fabio Potenti was recruited as a member of the Faculty for the Residency Program. Dr. Potenti completed his general surgery training at Brown University and after two years on Faculty at Brown came to Florida where he successfully completed both a research and clinical year in the Department of Colorectal Surgery.
After serving on the Faculty at Brown University for an additional five years, Dr. Potenti returned to South Florida and established practice in Broward County. Because of his abilities, results, and enthusiasm for teaching, Dr. Potenti was invited to join the medical staff in Cleveland Clinic Florida's Department of Colorectal Surgery. He has become an invaluable resource for the residents and has his operative and “on call” schedules completely integrated with the other members of the Department.
In addition to the full time faculty and Dr. Potenti, since 1998, a variety of Clinical Associates have helped maintain the high volume of patients and of complex cases. These individuals have included Drs. Jay Singh, Josh Katz, Jonathon Efron, Susan Cera, Jenny Speranza, Jill Genua, and Christina Seo.
Our rise from our inception during 1987 to our birth early 1988 to the present day has been dramatic. Our international acclaim is due to the efforts of far more individuals than the Staff and Clinical Associates listed on the website. Numerous other individuals play an important role on a daily basis, including our clinical coordinators, Clinic and Hospital nurses and physician assistants, publications manager, clinical research coordinators, data managers, intra-stomal therapists and our allied healthcare providers.
All of our laudations from patients and peers relative to direct patient interaction are in large measure due to the expert assistance of all of these individuals. Many visiting professors have taken time from their busy schedules to help teach our residents and each year over 40 internationally renowned top level surgeons from around the world come help us teach at our annual international colorectal disease symposium.
This symposium has be held each year since 1990, and has become the largest international colorectal surgeon gathering in the United States. We certainly owe a debt of gratitude to both the visiting professors and the faculty of our annual course, as well as the surgeons who take time from their daily practices and spend considerable sums money to register for and participate in our annual international colorectal disease symposium.
In addition, we must our thank our referring physicians and their patients whose trust and respect for us, the best barometer of our abilities, and the chief reason for our sustained growth. Lastly, none of our education and research efforts would be possible without the humanitarian altruistic assistance of our benefactors.
Our benefactors are listed by category below.
- American Medical Systems
- Ana-Tech LLC
- Bruel & Kjaer
- ClinTrials Research, Inc.
- Ethicon Endo-Surgery, Inc.
- Ethicon, Inc.
- C. B. Fleet Co., Inc.
- Genzyme Corporation
- Hoechst Celanese/Hoechst Roussel/Hollister, Inc.
- Johnson and Johnson
- Karl Storz Endoscopes
- Konsyl Pharmaceuticals
- Marion Merrell Dow
- Medtronic, Inc.
- Olympus Corporation
- Power Medical Interventions
- Sandhill Scientific
- Smith Klein Diagnostics
- 3M HealthCare
- United States Surgical Corporation
- Vision Sciences, Inc.
- Fabio M. Potenti, MD
- Deborah A. DeMarta, MD
- Olaf Johansen, MD
- Sandy Binderow, MD
- The Eleanor Naylor Dana Charitable Trust
- The Marcus Foundation
- Florida Fish for Life
- Mr. and Mrs. George Greenberg
- The Caporella Family
- The Gallo Family
- The Lea Family
- The Mayer Family
- The Marcus Family
- The Marchiol Family
Treatments & Procedures
What Treatments & Procedures We Offer In South Florida
- Advanced polyp removal
- Laparoscopy (Minimally invasive surgery) for Colon and Rectal Diseases with state of the art operative equipment
- Colon resection
- Rectal resection
- Re-operative Colon and Rectal Surgery
- Surgical treatment of Inflammatory Bowel Disease
- Sphincter sparing procedures (Rectal reconstruction)
- Transanal Endoscopic Microsurgery
- Surgery for fecal incontinence
- Surgery for constipation
- Repair of rectal prolapse
- Stoma creation
- Anal reconstructive surgery
- Fistula repair
- Emergency Colon and Rectal Surgery
- Enterostomal nurses with expertise in wound healing
- Colorectal Physiology Center
Evaluation of fecal incontinence, constipation other functional disorders:
- Anal Manometry
- Anorectal Ultrasound
- Intestinal transit studies
- Nerve testing
Cleveland Clinic interdisciplinary consultations with Gastroenterologists, Urogynecologists, Plastic Surgeons, Internists, and most other specialties. If you do not have a diagnosis, see us for the following symptoms:
- Rectal bleeding
- Fecal Incontinence or Medically intractable Constipation or Diarrhea
Pelvic Floor Physiology Laboratory
Since 1989, the Pelvic Floor Physiology Laboratory has included anal ultrasonography, anal sphincter electromyography and pudendal nerve motor latency assessment, defecography, manometry, and small bowel and colonic transit studies. This composite of tests offered by the department draws numerous patients with challenging disorders who cannot be properly cared for without this technology.
These studies are crucial to the appropriate management of patients with constipation, incontinence, rectal prolapse, rectal cancer, mucosal ulcerative colitis, and numerous other disorders. The number of patients evaluated in our lab is among the largest in the world.
Under the direction of Dr. Dana Sands, the Pelvic Floor Physiology Laboratory works in close conjunction with the Urogynecology and Female Urology sections at Cleveland Clinic Florida.
Endoscopic procedures are a significant component of a colorectal surgery practice. Colonoscopy performed on an outpatient basis is performed twice weekly by three of four members of the department. Therapeutic endoscopy with either biopsy or polypectomy is performed in almost two-thirds of cases with only one-third being purely diagnostic.
Several studies attesting to surgical endoscopists’ expertise in performing colonoscopy have been performed in the department as part of multi-institutional trials. In addition, we have participated in several bowel prep trials leading to major advances in bowel cleansing regimens.
An integral part of the Department of Colorectal Surgery is enterostomal care. Two full-time enterostomal therapists provide care for patients with stomas and wound problems.
The enterostomal therapists provide both inpatient and outpatient care for patients with all types of stomas including ileostomies, continent ileostomies, colostomies, urostomies, and continent urostomies. They provide preoperative information, consultation, stoma marking, and postoperative care. They are also active in facilitating support groups for patients with stomas. Many enterostomal therapists and ET students spend study periods benefiting from the expertise of our stoma therapists.
Enterostomal Therapy Nursing: Helping You To Recover
The Role of the Enterostomal Therapy (E.T.) Nurse
People with ostomies, fistulas, pressure ulcers and incontinence have very special needs. Recognizing these needs and the concerns you may have about them, Cleveland Clinic Florida employs an E.T. nurse devoted specifically to helping you overcome any initial anxiety or insecurity you may feel.
The E.T. nurse is board certified by her professional organization and has received special training. She keeps abreast of state-of-the-art equipment and treatment programs and quickly makes such innovations available to patients.
Each day at Cleveland Clinic Florida, our E.T. nurse cares for people with ostomies and fistulas. As part of the Skin Care Team, she works with people who have skin problems related to pressure or incontinence. Each year, she provides counseling during outpatient visits. She cares for children, adolescents, and adults.
How the E.T. Nurse Can Help You
While your E.T. nurse does not function as your primary nurse, the E.T. nurse’s goal is to help ensure a smooth recovery and to return you to normal daily life as rapidly as possible.
Your E.T. nurse is available to provide individualized care and instruction at the bedside before surgery and after, in the outpatient clinics, and by phone even when you are at home.
If you have a urinary or fecal diversion (ostomy) or fistulas...
Nearly one million people in North America have ostomies. People learn to lead very normal lives with temporary and permanent ostomies of all kinds. They work, have children, eat well, travel and lead active lives. E.T. nurses offer preoperative counseling, working individually with patients to help them prepare for surgery and to inform them about what to expect after surgery.
E.T. nurses play an important role in stoma siting, or finding the best spot on the abdomen for the surgeon to create the stoma, or opening. They try to identify a spot which will help ensure both comfort and a reliable seal with the ostomy pouch.
After surgery, E.T. nurses provide instruction on the techniques, appliances and equipment necessary to care for an ostomy, and ways to protect the skin with low-profile, odor-proof pouching systems. The E.T. nursing staff cares for patients with colostomies, conventional and continent ileostomies, urostomies and fistulas.
If you have pressure ulcer problems...
The E.T. nurse, as part of the Hospital Skin Care Team, consults with staff nurses about preventing and treating pressure ulcers (bed sores).
If you are incontinent...
The E.T. nurse helps patients with skin care and odor management. Your E.T. nurse will help identify the best collection or absorption device and skin care products for you, and will instruct you in their proper use.
Enterostomal Therapy Nursing and Cleveland Clinic
Rupert B. Turnbull, Jr., MD, a pioneer in colorectal surgery at Cleveland Clinic, developed the concept of enterostomal therapy.
In 1958, Dr. Turnbull offered Norma Gill, an ostomy patient herself, a position as the world’s first enterostomal therapist. The two established the first enterostomal therapy training program, later named the R.B. Turnbull Jr., MD, School of Enterostomal Therapy Nursing.
Since then, the school has graduated more than 600 of the approximately 2,000 E.T. nurse specialists practicing in this country, the Orient, Europe and South America.
If You Have Questions
Please ask questions of your E.T. nurse. Any question you have is important; none is too difficult or too trivial. If you have a question, you can reach an E.T. nurse by calling: 954.659.5251, 8 a.m. – 5 p.m., Monday through Friday.
For a Consultation
To make an appointment with an E.T. nurse, call 954.659.5251
For hospital consultations: Ask your physician to write an order for an E.T. nursing consultation.
Some medical insurers cover E.T. nursing services. Check with your insurer to find out about your specific coverage.
Familial Adenomatous Polyposis
Familial adenomatous polyposis (also know as FAP) is an inherited condition of the colon in which polyps may develop into cancer if not detected and removed early enough. It is an autosomal dominant inherited condition, so children of affected patients have a 50% chance of developing the disease.
FAP continues to be a condition that generates a significant number of patient visits annually. Although relatively few patients undergo surgery for the disease, these patients require frequent screening for cancer via colonoscopy. Surgical treatment of this condition is most commonly a total colectomy with an ileal J pouch with pouch anal anastomosis (also know as an ileal J pouch, restorative proctocolectomy, or pullthrough), with good outcomes seen in the majority of patients.
The ileal J pouch was first developed simultaneously in England and in Japan during the 1970s. The technique was then modified by our staff in 1989 to a safer method with better outcomes. That modification, simultaneously introduced in England and at Cleveland Clinic Florida has now become the “gold standard” throughout the world. Surgeons at Cleveland Clinic Florida have one of the largest experiences in the world with this technique. The ileal J pouch allows removal of the cancerous and/or precancerous tissue with reconstruction of a new rectum to avoid the need for a permanent bag (stoma).
The diagnosis and treatment of fecal incontinence and pelvic floor dysfunction is led by Dr. Dana Sands and is conducted in conjunction with the Women’s Center for Pelvic Disorders to offer women comprehensive evaluation of pelvic problems. Our specialists work as a team and are constantly investigating new treatment alternatives for these patients.
Patients with fecal incontinence generally will undergo or have had sphincter repairs performed in the past. In addition, more advanced reconstructive procedures are available for more complex or reoperative cases, and surgeons are assisting in the development of other investigational methods of repair, such as neosphincter procedures, stimulated graciloplasty, sacral nerve stimulation, artificial bowel sphincter, the use of radiofrequency, and injectable materials.
These innovative techniques are offered to patients who would otherwise be relegated to a permanent colostomy. This department is one of only a few centers in the world offer all five of these procedures in high volumes.
Inflammatory Bowel Disease
Crohn’s disease and mucosal ulcerative colitis comprise a large proportion of the surgical cases and patients treated in this department, making us one of the premier centers in the United States and around the world for the treatment of inflammatory bowel disease. In addition to innovative surgical techniques, reoperative surgical management of both abdominal and anorectal problems associated with inflammatory bowel disease are a forte in our department.
Patients who suffer from Crohn’s disease and mucosal ulcerative colitis are treated by gastroenterologists as well as colorectal surgeons at Cleveland Clinic Florida. These two specialties work as a team to diagnose and identify the optimal approach to the management of these patients.
Innovative therapies – many pioneered by Cleveland Clinic Florida physicians and surgeons – allow patients to lead higher quality lives.This department receives worldwide referrals, particularly for complex and severely affected patients, due to its participation in clinical trials and its excellent outcome of surgical cases.
Laparoscopic Colorectal Surgery
Surgeons in this department have been involved since 1991 in research studies to assess the safety and efficacy of laparoscopic colorectal surgery. Based upon the results of the published data produced in part by pioneering surgeons at Cleveland Clinic Florida, the technique has gained worldwide acceptance.
Laparoscopy has significant proven benefits for the treatment of a wide array of benign and malignant disorders, including less pain, shorter hospitalization, quicker return to full activities, and less scarring. Fifteen years of experience has shown that the approach can be at least as safe as traditional surgical methods, when performed by a surgical team with special training and extensive experience. Laparoscopic surgery offers the patient an identical operation, performed through an incision that is often 5cm or less in length.
Our surgeons were among the first in the world to gain international acclaim for their expertise in laparoscopic colorectal surgery. In fact, our staff members have performed laparoscopic colorectal surgery procedures for cancer and other disorders of the colon and rectum longer than the faculty in virtually any other training program.
Eligible patients may include individuals with Crohn’s disease, diverticulitis, endoscopically irretrievable polyps, rectal prolapse, mucosal ulcerative colitis, and colon and rectal cancer.
Surgeons in our department have extensive experience treating rectal cancer and treat among one of the highest volume of patients in the United States with this condition.
One of the factors that set us apart is the number of treatment options available to save the sphincter and avoid the need for colostomy. These options include transanal excision and radical surgery with anastomosis of the colon to the anus, and more recently, incorporating a colonic J pouch reconstruction or coloplasty procedure. Using these techniques, our surgeons can avoid the need for a permanent colostomy in over the majority of cases while still achieving some of the lowest recurrence rates in the world.
The number of patients with rectal cancer operated on by our department is shown in the graph below.
Transanal Endoscopic Microsurgery (TEM)
Dr. Dana Sands, one of our staff surgeons, has become expert in transanal endoscopic microsurgery, a minimally invasive technique used to treat selected rectal tumors. The technique allows removal of benign and certain malignant tumors of the rectum without needing an abdominal operation.
Rectal prolapse occurs when the rectum protrudes through the anus, usually as a consequence of weak or injured pelvic floor muscles.Surgical repair for rectal prolapse is generally advised. This repair can be undertaken using an abdominal operation or an anal operation, with the exact approach being tailored to each individual patient.
Surgeons in this department have performed these procedures in high volume for the past 14 years.
The nature of the practice is extremely diverse and the types of procedures performed are significantly different from the “routine” colorectal surgeon’s practice. Functional disorders requiring surgery as well as complex anorectal surgery, cancer, and inflammatory bowel disease form the nucleus of the cases performed.
Functional disorders include constipation, rectal prolapse, incontinence, and several other less common problems. Those patients with incontinence generally had sphincter repairs performed but in addition, 23 patients have undergone a stimulated gracilis neosphincter procedure and 9 patients have undergone the implantation of an artificial bowel sphincter. Both of these “neosphincter” procedures offer the latest technology to those patients who would otherwise be relegated to a permanent stoma. Our Department is one of only a few in the world to offer both procedures. Moreover, we have one of the largest experiences with both of these procedures of any institution.
Rectal prolapse is a relatively common disorder seen and treated in the department. The vast majority of patients are treated via a perineal approach which offers significant decreases in hospitalization and shorter recovery. Several recent publications attest to the excellent results derived from our Department. Constipation and sphincter repair are amongst the disorders for which we have become an international tertiary referral center and our data remain among the largest published experiences in these areas in the world.
Colon and rectal carcinoma comprise almost one-fifth of all major abdominal operations performed in the department. Rectal ultrasonography, performed by Drs. Nogueras and Weiss, allows precise preoperative evaluation of tumor size and depth of penetration as well as lymph node involvement. A newer technology recently acquired by the institution, a rectal MRI coil, may allow even better imaging of the tumor and nodes and will be routinely employed in the evaluation of rectal cancer. The availability of this technology at Cleveland Clinic Florida allows optimal management in all cases. Multiple means for caring for patients with rectal cancer are available and include transanal excisions, low anterior resections, abdominoperineal resections, and most recently and now routinely used the colonic J-pouch reconstruction. Several years ago, colonic J-pouch reconstruction was studied as a means of reconstruction after rectal cancer surgery. Our landmark prospective randomized study clearly demonstrated the superiority of this technique. Since that time, a follow-up study has shown continued superiority in even more patients over a longer time. Other studies from outside Cleveland Clinic Florida have substantiated our results and, in part as a result of our work, this technique is employed worldwide. Similarly, laparoscopy can now be applied for cure of colon carcinoma within the confines of a multi-institutional trial sponsored by the National Institutes of Health. Cleveland Clinic Florida is among a few centers in the Southeast United States at which this exciting technology can be offered within the safety of the national trial. Our overall laparoscopic experience remains one of the most extensive in the world.
Resources in South Florida
The Department of Colorectal Surgery at Cleveland Clinic Florida is world-renowned for its excellent outcomes and cutting edge, state-of-the-art tests and treatments. Since 1988, we have pioneered numerous innovations to improve the quality of life of our patients and of patients around the world. We have developed techniques to treat a broad array of diseases including cancer, inflammatory bowel disease, and functional disorders such as fecal incontinence. Our surgeons are leaders in local, national, and international medical organizations and have been recognized for their expertise by our peers from around the world.
The compassionate care offered by this expert team of surgeons is complimented by some of the finest residents and fellows selected on an annual basis. These individuals assist with the management of our patients as do all of the other members of the department. The end result of this large team of highly motivated, exceptionally dedicated, and clearly talented individuals is optimal patient care. This website shows the profile from each of the staff surgeons and therefore gives a glimpse into their many academic and clinical accomplishments. In addition, the website shows some of the excellent outcomes in many of the more commonly performed procedures in our department.
The Department of Colorectal Surgery at Cleveland Clinic Florida is the highest volume colorectal surgery center in the state of Florida and has the largest colorectal residency training program in North America. In addition, we have been pioneers and innovators in virtually every major advancement in colorectal surgery. We are eager to share this depth and breadth of experience with all of our patients.
Publications and Information Resources
Instructions To Prepare For A Colonoscopy
- Colonoscopy Preparation for MiraLAX®
- Colonoscopy Preparation for MiraLAX® (SPANISH)
- Colonoscopy Preparation for Polyethylene Glycol 3350 Generic (Golytely, Nulytely or Trilyte)
- Colonoscopy Preparation for Polyethylene Glycol 3350 Generic (Golytely, Nulytely or Trilyte) (SPANISH)
Cleveland Clinic Florida Department of Colorectal Surgery is one of only 35 training programs in colon and rectal surgery recognized by the Accreditation Council for Graduate Medical Education (ACGME). Our program has recently been reviewed by the ACGME and has received a full five year accreditation. We are extremely proud of this review. Our program has grown from initially one clinical resident to our current status of five clinical residents. Overall, these 35 programs train 63 surgeons each year; the residency training program participates in the National Resident Matching Program to fill these positions.
Our program also offers one of the five clinical residents an optional one year full time research fellowship. These funded residency and fellowship positions are highly sought after; typically close to 100 applications are received of whom 35-40 are granted interviews. Nineteen residents have been trained in the clinical training program, twelve of whom (*) also participated in the research fellowship during the year prior to or after their clinical fellowship.
All of our graduates limit their practices to colorectal surgery. A variety of practice types are chosen by the graduating residents although more than 75% practice in an academic or academic affiliated setting.
The Department of Colorectal Surgery at the Cleveland Clinic Florida has a world renowned reputation in education and research. Besides our ACGME accredited residency training program in colorectal surgery, we offer a variety of opportunities for international physicians and surgeons interested in colorectal surgery to develop and explore the specialty.
In many countries throughout the world, colorectal surgery is not a recognized specialty and, therefore, advanced training is not possible. Physicians and surgeons from other countries visit the department on an almost daily basis and spend from several days to over one year in the department. Primarily, these individuals learn anorectal physiology; however, a wide array of clinical experience is offered to these physicians. Typically, these residents and fellows publish a myriad of chapters and manuscripts in relation to their work and research at the Cleveland Clinic Florida Department of Colorectal Surgery.
It would be impossible to list everyone who has spent time in the department. However, those trainees who have spent more than two months from 1990 to 2014 are listed below as are their respective countries of origin.
The Department of Colorectal Surgery has graduated 59 clinical residents and dozens of research residents and fellows from our training program. Alumni are spread out throughout the world in a variety of practice settings.
In an effort to continue contact and give alumni a central site to communicate through, the Alumni Association has been created. The Alumni Association will hopefully allow collaborative or multi-institutional trials involving members of the association to participate. In addition, a website will be developed and will have a separate area for alumni to read about and hear of activities of alumni. Any one of the alumni will attest to the “family” in the Department of Colorectal Surgery.