Saint Vincent Health Center is a modern, 425–bed multidisciplinary hospital complex on the shores of Lake Erie in Erie, Pa. Two colon and rectal surgery fellows are accepted for each academic year. The attending staff for the Colon and Rectal Surgery Fellowship consists of four board-certified colon and rectal surgeons who work primarily at Saint Vincent Health Center, with secondary activity at Hamot Medical Center.
Surgical volume includes over 300 major abdominal cases, 400 anorectal cases, 100 physiologic studies and 3,000 colonoscopies annually. The teaching faculty represent the only colorectal surgical presence in northwest Pennsylvania, drawing from a population of over 750,000 from northwest and northcentral Pennsylvania, western New York and northeast Ohio.
The program is proud of its devotion to providing our patients with both modern minimally invasive treatments and evidence-based surgical treatment. Traditional laparoscopic surgery and single-incision laparoscopic surgery are routinely performed. Transanal endoscopic microsurgery is also part of our armamentarium for appropriate rectal tumors. The exposure to and experience with ileal pouch and complex IBD surgery is supplemented with a two-week rotation at the Cleveland Clinic Foundation. A wide variety of minimally invasive fistula treatments are performed including LIFT, collagen plug and fibrin glue procedures. Advanced topical therapy and Botulinum toxin chemical sphincterotomy are employed as alternatives to surgical sphincterotomy. Skin-sparing alternatives to hemorrhoidectomy and traditional pilonidal surgery are also available.
The same devotion extends to the endoscopic and physiologic assessment services. In addition to routine diagnostic colonoscopy, both narrow band imaging and chromoendoscopy, are selectively employed. Therapeutic modalities include wall stenting, argon beam coagulation and endoscopic mucosal resection of lesions. Available physiologic studies include anal manometry, RAIR and sensory threshold evaluation, pudendal nerve terminal motor latency determination, and video defecography. This is supplemented by anal ultrasound for sphincter and fistula evaluation as well as rectal ultrasound for tumor staging.
In addition to surgical cases, the full spectrum of challenges in the diagnosis and management of constipation, incontinence, pelvic floor disorders and inflammatory bowel disease is seen through the office-based component of the residency. The office exposure also includes the fundamentals of practice management, coding, billing and revenue cycle evaluation. There is active interest in both prospective as well as retrospective clinically based research with several projects ongoing annually.
Each resident is expected to prepare a manuscript suitable for oral presentation to the American Society of Colon and Rectal Surgeons. Each resident is expected to present their research from the podium at the Pennsylvania Society of Colon and Rectal Surgeons’ spring meeting.The program is devoted to an ACGME competency-based approach to evaluating progress through the program. In recognition of the already completed five postgraduate years of experience, the residents are treated as junior colleagues engaged in adult learning. Residents alternate in preparing and delivering weekly evidence-based lectures covering the topics in the colorectal curriculum. This serves as the basis for energetic discussion of key points and controversies within the surgical literature. Additionally, journal club, pathology conference, tumor board, and radiology conference all meet on a monthly basis.
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