The medical specialty of coloproctology deals with the prevention, diagnosis, treatment and aftercare of coloproctological diseases, i.e. diseases of the rectum. This includes all benign and malignant diseases, malformations and functional disorders of the rectum:
- The colon (part of the large intestine, technically known as the colon),
- rectum (rectum) and
- anus
Diseases that are the focus of coloproctology include
Internal and external hemorrhoids @ Henrie /AdobeStock
Coloproctology centers offer a wide range of diagnostic methods as well as conservative and surgical treatment procedures for the diagnosis and treatment of coloproctological diseases.
The procedures frequently performed here include
- Proctoscopy (anal canal endoscopy),
- rectoscopy (rectoscopy of the rectum),
- colonoscopy (colonoscopy),
- surgical partial removal of the colon (colon resection),
- partial surgical removal of the rectum (rectal resection)
- and hemorrhoid surgery.
Colonoscopy is the most important medical examination for the early detection of colorectal cancer @ Issara /AdobeStock
Interdisciplinary collaboration and cooperation between all medical specialties and departments involved in the care of patients with rectal diseases is one of the most important requirements for certified coloproctology centers. In this way, optimal and holistic patient care - from diagnosis and treatment through to aftercare - is guaranteed.
In addition to visceral surgery, which usually takes over the management of the certified coloproctology center, the medical disciplines that work together in coloproctology centers include
There are three different levels of certification to choose from: competence center, reference center or center of excellence for surgical coloproctology:
- Certification as a competence center for surgical coloproctology can be obtained by those coloproctology centers that ensure high-quality and guideline-compliant treatment of rectal diseases through their staffing, equipment and experience.
- Coloproctology centers that also have further training skills and are scientifically active can be certified as a reference center for surgical coloproctology.
- Only those coloproctology centers that are among the leading and largest institutions in the field of surgical coloproctology receive certification as a center of excellence .
The certificate awarded as a competence, reference or excellence center for surgical proctology is valid for three years. After these three years, re-certification can take place.
The certification of coloproctology centers to one of the three certification levels mentioned aims to ensure and continuously improve the quality of care and treatment in surgical clinics specializing in the treatment of rectal diseases for the benefit of patients.
For this reason, the certification criteria are based on the latest medical findings and are geared towards the highest quality standards. As part of the certification process, coloproctology centers must prove that they have a high level of specialization, expertise and experience in the field of surgical coloproctology.
In 2021, a total of 10 clinics in Germanywere certified as "Reference Center for Surgical Coloproctology" @ Kzenon /AdobeStock
Criteria for certified coloproctology centers
The prerequisite for certification is that the clinic or department meets the quality requirements for certified coloproctology centers defined by the DGAV, DGK and CACP professional associations. It must also have successfully completed the certification procedure carried out by the Servicegesellschaft für Allgemein- und Viszeralchirurgie SAVC GmbH.
The quality requirements and certification criteria that coloproctology centers of all three certification levels must meet include the following requirements:
- Qualification of physicians: the responsible surgeons in coloproctology centers must be specialists in visceral surgery and be able to demonstrate extensive experience in surgical coloproctology.
- Departmental organization: Certified coloproctology centers must offer regular consultation hours at least once a week.
- Diagnostic equipment: In certified coloproctology centers, the following instrumental diagnostic procedures must be available and demonstrated, if necessary in cooperation with the relevant specialist departments: Endoscopy, abdominal ultrasound, endosonography, transit time determination, defecography, CT, MRI.
- Interdisciplinary cooperation: Certified coloproctology centers must prove that they cooperate on an interdisciplinary basis with the departments of urology, gynecology, gastroenterology, neurology, radiotherapy, oncology and pathology.
- Minimum case numbers: Certified coloproctology centers must demonstrate the following minimum numbers for diagnostic and surgical procedures, among others:
- Performance of at least 200 (competence center) or 500 (reference and excellence center) anal endoscopies (proctoscopies) and rectoscopies (rectoscopies)
- Performing at least 200 (competence center) or 500 (reference and excellence center) colonoscopies (colonoscopies)
- Performance of at least 25 (competence center) or 100 (reference and excellence center) endosonographies
- Performing at least 75 (competence center) or 150 (reference and excellence center) colon resections
- Performance of at least 25 (competence center) or 50 (reference and excellence center) rectal resections
- Performance of at least 30 (competence center) or 50 (reference and excellence center) haemorrhoid operations
- Performance of at least 50 (competence center) or 100 (reference and excellence center) operations for abscesses, fistulas, fissures or pilonidal sinus
- Quality assurance: Certified coloproctology centers must participate in the quality assurance procedures defined by the CACP and record treatment and follow-up data, e.g. through the Study, Documentation and Quality Center StuDoQ of the DGAV. In addition, certain quality indicators for the treatment of rectal cancer and anal fistulas must be met and recorded (e.g. number of recurrences, number of deaths, length of hospital stay after surgery)
- Own further training: The responsible surgeons at the coloproctology center must participate in one of the following continuing education events at least once a year: CACP meetings as part of the Surgeons' Congress, CACP meetings as part of the Visceral Medicine Fall Conference, CACP Fall Conference, DGK Coloproctology Congress, ESCP Annual Meeting. At least 16 continuing education points must be acquired per year.
Certification procedure for coloproctology centers
The certification procedure for competence, reference and excellence centers for surgical coloproctology is organized by the Servicegesellschaft für Allgemein- und Viszeralchirurgie SAVC GmbH on behalf of the DGAV, the DGK and the CACP.
This first formally reviews the written application in which the coloproctology center to be certified explains the extent to which it meets the quality requirements.
The next step is an on-site audit. This audit checks whether the information provided in the application is correct and whether the clinic to be certified actually fulfills the certification criteria. For example, the structural and organizational processes, the equipment, the premises and the number of operations are checked.
