Introduction

St. Vincentís University Hospital, Dublin, comprises a 480 bed public hospital in Southeast Dublin. Our hospital, which has treated over 1,500 inflammatory bowel disease patients and 2,000 colorectal cancer patients in the past two decades, offers a multidisciplinary and individualised approach to treatment of patients with colorectal diseases. The screening, diagnostic and therapeutic services incorporate all of the elements discussed above and our facilities range from the first Irish combined medical/surgical colorectal clinic to the provision of complex surgical interventions and medical therapies for colorectal cancer patients and those with inflammatory bowel diseases. Our collaborative approach has been achieved largely because of continued close surgical and medical interaction resulting in a strong tradition in the joint management of colorectal diseases.

Large bowel disease results in considerable mortality and morbidity in the Irish population. Colorectal cancer is the most common malignancy affecting both males and females in Ireland today, while Crohnís disease and ulcerative colitis are chronic inflammatory disorders that affect large numbers of Irish persons, especially at a young age. Other significant large bowel diseases include primary and secondary pelvic floor diseases, sphincter disorders and colonic dysmotility syndromes.

The prognosis of these debilitating diseases is optimised by effective diagnosis and treatment, and it is increasingly recognised that multidisciplinary teams working within a structured framework provide the best care for such patients. The ideal primary team includes colorectal surgeons, gastroenterologists, oncologists, pathologists, radiologists and specialist paramedical and nursing personnel. Core members also work closely with hepatobiliary surgeons, geneticists, haematologists, biochemists and microbiologists and maintain close links with gynaecology, urology, anaesthetic, intensive care and neurophysiology colleagues.

In addition to diagnosing and treating potentially severe colorectal diseases, a holistic treatment approach recognises that dignity and quality of life are of major importance to patients and their families. Optimising day to day living and function is therefore a crucial aspect of contemporary clinical care and requires close collaboration between patients, medical and nursing staff, physiotherapists, nutritionists, social workers, occupational therapists, psychologists and palliative care team members where appropriate.

Although primarily established to provide clinical care, a further essential facet of a successful and comprehensive colorectal service is the provision of education and training both for health care professionals and the general population. Continuing medical education and professional development ensures that new treatments and technologies are incorporated into clinical practice. In addition, community education programmes allow the public to play an active part in ensuring their good health and a strategic role in the development of health care facilities.

The centre provides individual aspects of care to patients from other regions within Ireland where such specialist facilities may not be available. Specialist care areas also includes pelvic floor and colonic dysmotility diagnostic services, diagnostic and therapeutic endoscopic services, advanced pre- and post-surgical clinical and pathological staging services, provision of complex anorectal and colonic surgical procedures, planning services for hepatobiliary and colorectal re-operation and a comprehensive pre and post-operative chemoradiation service.

Our information systems include sophisticated electronic databases established almost 20 years ago to allow us to track the progress of our thousands of patients through their initial and subsequent treatment. These comprehensive databases also provide valuable data for clinical investigation and audit.



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