Colorectal

The Colorectal department is based on Wards 10, 22 and 33, which include Extended Care Units (ECU) post-surgery beds offering higher levels of nursing support and monitoring.
We are involved in the diagnosis and management (including operations where necessary) of all conditions affecting the large bowel i.e. the colon, rectum and anus.
As a subspecialty of general surgery, we also offer most treatment for most general surgical conditions including lumps and bumps, hernias, abscesses and abdominal pain.
We partake in internal and external research studies, including oncology trials and higher surgical training.

Clinical services we provide include:

•    Robotic colorectal surgery
•    Trans-anal Minimally Invasive Surgery (TAMIS)
•    Bowel Cancer Screening Programme (Coventry & Warwickshire)
•    Multi-visceral Resections Services for Gynaecological and Urological Cancers
•    Stoma Care 
•    Pelvic Floor and Functional disorders
•    Diverticular Disease
•    Haemorrhoids/Piles
•    Anal Fistula
•    Anal Fissure
•    Pilonidal Sinus Surgery 
•    Abdominal Wall Reconstruction (AWR) and Parastomal Hernia (PSH) Repair  
•    Intestinal Failure service
•    Emergency General Surgery and Bowel Surgery 

Bowel Cancer Screening

Robotic colorectal surgery

Trans-anal Minimally Invasive Surgery (TAMIS)

Multi-visceral Resections Services for Gynaecological and Urological Cancers

Stoma Care Team

Inflammatory Bowel Diseases Services 

Pelvic Floor and Functional disorders

Diverticular Disease

Haemorrhoids/Piles

Anal Fistula

Anal Fissure

Pilonidal Sinus Surgery

Abdominal Wall Reconstruction (AWR) and Parastomal Hernia (PSH) Repair

Intestinal Failure Services

Emergency Care 

 

Bowel Cancer Screening

For details on Bowel Cancer Screening, click here.

Robotic colorectal surgery

Colorectal surgeons have access to two robotic surgery platforms and UHCW has a national and international reputation for performing and teaching robotic large bowel surgery. Robotic minimally invasive (keyhole) surgery allows surgeons to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. The benefits of minimally invasive surgery include fewer complications such as less pain and blood loss, quicker recovery and smaller, less noticeable scars.
Robotic surgery still involves risk, some of which may be similar to that of conventional keyhole and open surgery. 
Surgeons at UHCW are using robotic platform for cancer and non-cancer related bowel surgeries.

Trans-anal Minimally Invasive Surgery (TAMIS)

Trans-anal minimally invasive surgery (TAMIS) is a cutting-edge technique to remove large, more complex rectal polyps and early stage rectal cancer.
There are two main groups of people who make good candidates for TAMIS. 
1.    People who would be very high risk (older people with lots of medical problems) for having a long anaesthetic and major operation to remove their early cancer or even their polyp. 
2.    Anyone else who has an early rectal cancer or a large complex rectal polyp who does not want to have a larger operation, or someone with a very low lesion who wanted to avoid the necessity of having a permanent stoma. 

If you have been diagnosed with a rectal cancer or polyp and want to know if you are suitable for this procedure, your scans, endoscopy and biopsy results will need to be assessed by a specialist multidisciplinary team (MDT).
Here, we sit down with a surgeon, radiologist, endoscopist, oncologist and often a pathologist to make an assessment of all the information. Sometimes it is necessary to repeat a scan or an endoscopy as we look for specific things to see if the lesion could be removed by this technique. Not all rectal cancers or polyps are suitable for this and this is based on a specialist assessment.

Multi-visceral Resections Services for Gynaecological and Urological Cancers
We offer other affiliated cancer services for gynaecological and urological cancers where these cancers have spread to, or around, the large bowel. We work with your specialist to remove the part of bowel involved with cancer in minimally invasive ways. 

Complex cases where removal of the bowel is required are discussed in multidisciplinary meetings and the best strategies to remove your cancer are formulated.

Stoma Care Team

Stoma nurses and support workers are dedicated to providing individualised high quality nursing care for patients with either a stoma, enterocutaneous fistula or internal pouch. This will begin when you meet your specialist nurse, usually before surgery or following your emergency operation. 
You will be given information regarding your surgery and the ideal site for your stoma will be selected/marked. On admission to the hospital, your specialist nurse will talk to you about whether you have understood this information and discuss any questions or anxieties. 
After your operation you will be shown how to care for your stoma, including how to empty and change the appliance independently. You will be given information regarding your diet, ongoing supplies, returning to work and common problems. You will be followed up after you are discharged from UHCW either in the stoma clinic or by community stoma nurses. 
Inflammatory Bowel Diseases Services 
Inflammatory Bowel Disease is a term mainly used to describe two conditions: ulcerative colitis and Crohn’s disease. Both are long-term (chronic) conditions that involve inflammation of the gut (gastrointestinal tract). Ulcerative colitis only affects the colon (large intestine), while Crohn’s disease can affect any part of digestive system, from the mouth to the anus. 
Our Inflammatory Bowel Disease (IBD) services offer care to patients above the age of 16 to cover all aspects of medical, nursing and surgical treatments, psychological and nutritional support, research and education. Some services are offered via designated specialist multi-disciplinary clinic. We offer surgery for:
•    Medical treatment refractory ulcerative colitis
•    Complex  stricturing/fistulating Crohn’s disease
•    Perianal abscess/fistula
•    IBD linked cancer and dysplasia
•    Ileoanal pouch surgery
•    Formation of diverting stoma  
Specialist multi-disciplinary IBD team consists of medical doctors, nurses, bowel surgeons, clinical fellows, nutrition team, and pharmacists supported by psychological service, administrative and secretarial staff.
Pelvic Floor and Functional disorders
We offer management of patients with pelvic floor disorders including faecal incontinence, chronic constipation, rectal prolapse, anal pain and obstetric injuries.
Patients may be offered a wide range of investigations including anorectal physiology testing, defecating proctography or MRI scan. Complex cases are discussed and management strategies formulated in a multi-disciplinary team meeting that includes the Biofeedback team, clinical physiologists, radiologists, colorectal surgeon and urogynaecologist. A full complement of medical treatment options may be offered alongside biofeedback, dietary advice, rectal irrigation and psychological support. The department offers a range of pelvic floor surgical procedures. These include anal sphincter repair, perineal reconstruction, keyhole and perineal rectal prolapse surgery and stoma formation.

Diverticular Disease

Large bowel diverticula are small out pockets that can develop in the lining of the intestine as you get older. Most people with diverticula do not get any symptoms and only know they have them after having an endoscopy or CT/MRI scan for another reason. When there are no symptoms, it is called diverticulosis. When diverticula cause symptoms, such as pain in the lower tummy, it's called diverticular disease. You're more likely to get diverticular disease and diverticulitis if you do not get enough fibre in your diet. If the diverticula become inflamed or infected, causing more severe symptoms, it's called diverticulitis. 

The department of colorectal surgery provide care in cases of complication arising from diverticular diseases. These can present as acute diverticulitis leading to localised accumulation of infection (abscess), large perforation of bowel leading to peritonitis or active bleeding from diverticulum. Such cases are often managed without surgery but in some situations surgery is performed as a life-saving procedure.

Sometimes a planned surgery will be performed to remove a segment of bowel with diverticulosis (Sigmoid Colectomy) following recurrent episodes of diverticulitis needing hospital admissions, narrowing of bowel due to recurrent bouts of diverticulitis or development of connection between affected segment of bowel and bladder or vagina. 

Haemorrhoids/Piles
Piles are swellings that develop inside and around the back passage (anal canal). There is a network of small veins (blood vessels) within the lining of the anal canal and these veins sometimes become wider and engorged with more blood than usual.
The engorged veins and the overlying tissue may then form into one or more swellings (piles). Piles often don't cause any problems but can cause bleeding and sometimes pain.
Our department offers a spectrum of specialised treatments:
•    Medical treatments – Stool softening, avoidance of straining/constipation and topical creams/ointment/suppositories
•    Rubber band ligation – often performed in endoscopy department 
•    Suture ligation - Haemorrhoidopexy 
•    Haemorrhoidal artery ligation (THD/HALO equivalent)
•    Surgical formal removal of piles – Haemorrhoidectomy 

Anal Fistula
An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. They are usually the result of an infection near the anus causing a collection of pus (abscess) in the nearby tissue. When the pus drains away, it can leave a small channel behind and you may be able to see one or more holes near your back passage. These are the external openings of the tunnel which pass down from the back passage’s internal opening. The tunnel is often called as fistula tract. Anal fistulas can cause unpleasant symptoms, such as discomfort and skin irritation, unpleasant discharge and they will not usually get better on their own. Surgery is recommended in most cases. 

The following treatments are on offer to patients at UHCW: 
•    Lay opening
•    Insertion of seton
•    Video assisted minimally invasive surgery - VAAFT 
•    Fistula Plug
•    LIFT procedure
•    Advancement flaps and stoma formation  

VAAFT is a new treatment that allows identification of a fistula tract under direct vision using a camera and, once the tract is burned, washed and cleaned, it promotes healing of fistula tract.  Often this procedure is combined with closing the inner opening of fistula and covering the opening with an internal bowel lining patch. The reported success rate with VAAFT surgery is 70-80 per cent. 

Benefits of VAAFT in comparison to other treatments are that it helps to identify any possible secondary tracts or chronic abscesses, preserves anal continence( no cutting of anal sphincter muscles) and the wounds are quite small.

Anal Fissure
An anal fissure is a small tear in the skin lining the back passage (anus). Although the tear is small, it can be very painful as the skin in the anal canal is very sensitive. Fissures can occur in adults and children. It can be a ‘one off’ problem, caused by constipation or diarrhoea. The pain can be sharp when you open your bowels and may last up to several hours after. You may also notice some bleeding on the tissue paper when wiping, or in the toilet bowl. Some people may experience some itching and discharge. 

Treatments for anal fissure include:
•    GTN/Diltiazem cream application
•    Injection of Botox into anal sphincter
•    Lateral sphincterotomy 
•    Advancement flaps

Pilonidal Sinus Surgery 
A pilonidal sinus is a small tunnel in the skin at the top of the buttocks where they divide (the cleft). It does not always cause symptoms and only needs to be treated if it becomes infected. Most people with a pilonidal sinus do not notice it unless it becomes infected and causes symptoms. An infection will cause pain and swelling, and a pus-filled cavity (abscess) can develop.
Treatments for symptomatic pilonidal sinus disease include:
•    Incision and drainage – if patient present with an abscess 
•    Primary excision of sinus and skin closure -  sometime wound is left open 
•    Excision and advancement flaps 
•    Endoscopic Pilonidal Sinus Treatment  (EPSiT)

Endoscopic Pilonidal Sinus Treatment (EPSiT) is a new treatment performed at University Hospitals of Coventry and Warwickshire NHS Trust. It is a less invasive surgery using a tiny camera to explore the sinus. The internal lining of sinus is safely burnt (cauterised) and cleaned with a brush. Some people will need more than one EPSiT for complete healing of their sinus. This procedure is often performed as a day-case procedure under a brief general/spinal anaesthetic (awake anaesthesia with a needle injection into the back for patients with significant heart or lung diseases) or under local anaesthesia in selected patients.

Benefits compared to traditional surgical removal of sinus are the surgeon can see the sinus (tunnel) and its branches using a tiny camera, the natal cleft is not affected, wounds are quite small and early return to routine activities.

Abdominal Wall Reconstruction (AWR) and Parastomal Hernia (PSH) Repair  

A hernia of the tummy (abdominal) wall is a bulging of the abdominal contents through an area of weakness in the wall. This weakness happens when layers of tummy muscles split apart and leave a gap. This can happen suddenly or through a scar from previous surgery (called an incisional hernia) or for other complex reasons. A parastomal hernia is a special type of incisional hernia that occurs at the site of a stoma.   

AWR service is for patients who have a complex or large abdominal wall hernia. This service comprises of many stages in the pathway. All patients with complex abdominal wall and parastomal hernias are discussed in monthly abdominal wall reconstruction MDT and best treatment strategies are recommended. UHCW now offers adjuvant therapies of Botox injection to abdominal wall prior to hernia surgery to facilitate effective hernia repair. We are developing AWR services in collaboration with plastic surgeons, weight loss specialist dieticians and pre-operative assessment teams to provide a comprehensive service. 

We offer minimally invasive (conventional laparoscopic and robotic assisted laparoscopic) and open surgery for complex abdominal wall and parastomal hernia. A range of open abdominal wall procedures on offer including Rives-Stoppa surgery, anterior and posterior component separation, transverse abdominis release (TAR), Modified Sugarbaker and Keyhole mesh reinforced techniques for laparoscopic and open repair of parastomal hernia.

Intestinal Failure Services

Intestinal Failure is a rare condition in which the small intestine is unable to digest and/or absorb the correct amount of nutrients or is not able to reabsorb fluids produced by the intestine. Most commonly, this is a result of surgery or a chronic condition causing the gut to fail. Most patients will require a period of intravenous nutritional support in order to stabilise their clinical condition.
UHCW has been selected as a regional intestinal failure centre to provide services to patients in the West Midlands, especially in Coventry and Warwickshire. Our intestinal failure team provides specialist nutritional, gastroenterology and surgical services in specialised gastroenterology areas (Wards 32 and 33).  Patients are reviewed on a daily basis by our specialist team and multidisciplinary team will provide specialist assessment and management of patients with complex nutritional problems such as entero-cutaneous fistulae or high output stoma secondary to short bowel syndrome. 

Emergency care
We provide high quality emergency care presenting with large bowel and anal symptoms. Surgical Admission Unit (SAU) based at ward 22, has an area for initial assessment, treatment and management of conditions including:
•    Large bowel obstruction 
•    Bowel perforation
•    Rectal bleeding 
•    Acute diverticulitis 
•    Acute appendicitis 
•    Acute colitis refractory to medical treatment 
•    Complicated Crohn’s disease
•    Perianal and Pilonidal abscess 
•    abscess 
•    Strangulated haemorrhoids
•    Large bowel trauma and perineal injuries 

If your GP feels that you need to see a bowel surgeon, they will send a referral to us via the choose and boom service. Referrals are reviewed and prioritised to ensure appointments are made in the appropriate clinic. If you are waiting for your clinic appointment and would like to check the status of your appointment, please contact our appointment booking office team on 0800 252060.

We have specialised urgent clinics for patients with suspected cancer or serious symptoms like rectal bleeding, anaemia, weight loss, recent alteration in bowel habits, rectal/abdominal mass. If your GP has referred you to an urgent (fast track/two week wait) clinic, you should receive an appointment for consultation or test within two weeks. If you do not hear from us within that time frame, you can contact our appointment booking office team on 0800 252060.

If your consultant or team caring for you has organised radiology or endoscopy-related investigations and you would like to check the status of your appointment for these investigations, please contact relevant departments directly.

Ultrasound 02476 966933
CT scan 02476 966952
MRI scan 02476 967122
Flexible sigmoidoscopy/Colonoscopy/Gastroscopy 02476 966955 (University Hospital)
01788 663445 (Hospital of St Cross)


If you are waiting for result of your bowel investigation, please contact the secretary of your consultant. Their details are at the bottom of this page.

Abby Barnwell Lead Colorectal Practitioner - TWW LGI 02476 965687
Claire Jackson
Lead Colorectal Practitioner - TWW LGI  
02476 965687
Nicola O'Connell Colorectal Practitioner - TWW LGI 02476 965687
Martin Pratt Trainee ACP - TWW LGI 02476 966186
Louise Brown Colorectal Cancer Navigator 02476 965687
David O'Connell Colorectal Cancer MDT Co-ordinator 02476 965568
Michelle Hicken Lead Colorectal/Stoma Nurse CNS 02476 965825
Hannah Davis Colorectal/Stoma Nurse CNS 02476 965753
Sarah Thompson
Colorectal/Stoma Nurse CNS  
02476 965825
Helen Taylor
Colorectal/Stoma Nurse CNS  
02476 965825
Caroline Ling
Colorectal/Stoma Nurse CNS  
02476 965825
Deepa Philip
Colorectal/Stoma Nurse CNS  
02476 965825
Karen Faulkner Stoma Assistant Practitioner 02476 965825
Fay Toal Stoma Assistant Practitioner 02476 965825

Meet the team

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