Pelvic floor and functional bowel disorders refer to a series of symptoms and anatomic findings that effect men and women of all ages. These may include: constipation, difficult evacuation, fecal incontinence, irritable bowel disorders, diarrhea, pelvic organ prolapse, urinary and sexual dysfunction and pain. Although not life threatening, these disorders can severely affect quality of life and individual performance.
Over the past two decades I have dedicated my career to working with other specialists for comprehensive care for individuals with pelvic floor disorders. In July 2017, I joined The Department of Surgery, Division of Colorectal Surgery at Stanford University as the Medical Director of the Pelvic Health Center. I previously spent the prior decade at Cleveland Clinic running a multidisciplinary clinic and performing over 200 combined procedures in conjunction with colleagues in urology and urogynecology. We developed a robotic surgical approach to woman with vaginal and rectal prolapse and performed many surgeries to repair intestinal and rectal fistula (abnormal communications between the intestine and vagina).
Prior to that I established a Pelvic Floor Center at Maimonides Medical Center received a Jahnigan Career Development Award looking at multicompartment prolapse in elderly women. In addition to performing surgery and teaching throughout my career, I have maintained a commitment to long-term follow up of patients after surgery.
Although my training and focus is around surgical techniques and solutions for anorectal disorders and pelvic health, I believe that prevention, non-surgical alternatives, diet, exercise, and behavior management are vitally important to patient success.
One of my many goals is to educate patients, health care providers, and trainees about pelvic floor disorders.
When I am not at work I enjoy quality time with my three teenagers, dog, friends and I practice yoga.
- General Surgery
- Rectal Prolapse
- Pelvic Floor Dysfunction
- Fecal incontinence
- Slow transit constipation
- Obstructed defecation syndrome
- Colovaginal fistula
- Rectal vaginal fistula
- Anal fistula
- Robotic Surgery
Clinical Professor, Surgery - General Surgery
Medical Director Pelvic Health Center, Stanford (2017 - 2020)
Medical Education:Drexel University College of Medicine Orthopaedic Surgery Program (1994) PA
Residency:Icahn School of Medicine at Mount Sinai Hospital General Surgery Residency (2000) NY
Board Certification: Colon and Rectal Surgery, American Board of Colon and Rectal Surgery (2003)
Board Certification: General Surgery, American Board of Surgery (2001)
Fellowship:Cleveland Clinic (2001) FL
Editorial: Botox for levator ani.
Techniques in coloproctology
View details for PubMedID 30993476
Resection Rectopexy Is Still an Acceptable Operation for Rectal Prolapse
2018; 84 (9): 1470–75
The aim of this study was to compare resection rectopexy (RR) with ventral mesh rectopexy (VMR). This institutional review board-approved retrospective study compared patients with rectal prolapse, who underwent RR or VMR from 2009 to 2016. The primary end point was the comparison of complications and prolapse recurrence rates. Seventy-nine RR and 108 VMR patients qualified. Using propensity score matching, the two groups were not significantly different (P = 0.818). There were no differences regarding gender (female 103 vs 72; P = 0.4) and age (59.3 vs 53.9; P = 0.054). Patients in the VMR group had a greater body mass index (25.5 vs 22.9; P = 0.001) and poorer physical status (American Society of Anesthesiologists 3 57.4% vs 41.8%; P = 0.04). The VMR group had more: robotic approaches (69.4% vs 8.9%; P < 0.001), concomitant urogynecological procedures (63 vs 19; P < 0.001), and longer operative time (269 vs 206 minutes; P < 0.001) but a reduced length of stay (2 vs 5 days; P < 0.001). The median follow-up (16 vs 26 months; P = 0.125) and the median time of recurrence (14 vs 38 months; P = 0.163) were similar. No differences were observed for complications or recurrence (10.2% vs 10.1%; P = 0.43). We failed to identify superiority based on surgical technique.
View details for Web of Science ID 000445896600052
View details for PubMedID 30268178
Levator ani syndrome: transperineal botox injections
TECHNIQUES IN COLOPROCTOLOGY
2018; 22 (6): 465–66
View details for PubMedID 29850943
First Reported Case of Intussusception Caused by Escherichia coli O157:H7 in an Adult: Literature Review and Case Report.
Intussusception is the process by which one segment of intestine "telescopes" into another segment. Escherichia coli O157:H7 is a rare cause of intussusception that uncommonly requires a surgical procedure.Case report and literature review.We reviewed 25 cases of infection with E. coli O157:H7 that resulted in intussusception, all of which involved minors. Our case identifies the first reported adult with intussusception secondary to E. coli infection necessitating surgical intervention. In total, two (8%) required operation. Hemolytic uremic syndrome did not develop in any patient, and there were no deaths.E. coli O157:H7-associated intussusception is rare and does not commonly require operation. If conservative management fails, a surgical procedure may be necessary to resect the pathologic lead point.
View details for PubMedID 30359547
Should we offer ventral rectopexy to patients with recurrent external rectal prolapse?
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
2017; 32 (11): 1561–67
For patients with rectal prolapse undergoing Ventral Rectopexy (VR), the impact of prior prolapse surgery on prolapse recurrence is not well described.The purpose of this study was to compare recurrence rates after VR in patients undergoing primary and repeat rectal prolapse repairs.This study is a prospective cohort study.IRB-approved prospective data registry of consecutive patients undergoing VR for full-thickness external rectal prolapse between 2009 and 2015.Rectal prolapse recurrence was defined as either external prolapse through the anal sphincters or symptomatic rectal mucosa prolapse warranting additional surgery. Preoperative and postoperative morbidity and functional outcomes were analyzed. Actuarial recurrence rates were calculated using the Kaplan-Meier method.A total of 108 VRs were performed during the study period. Seventy-two were primary and 36 repeat repairs. Seven cases were open, 23 laparoscopic, and 78 robotic. Six cases were converted from laparoscopic/robotic to open. In 63 patients, VR was combined with gynecological procedures. There were no statistical differences between primary or recurrent prolapse for the following: demographics, operative time, concomitant gynecologic procedures, complications, blood loss, and graft material type. Length of stay was longer in patients with a history of prior prolapse surgery (p = 0.01). Prolapse recurrence rates for primary repairs were reported at 1.4, 6.9, and 9.7% and for recurrent prolapse procedures 13.9, 25, and 25% at 1, 3, and 5 years (p = 0.13). Mean length of follow-up was similar between groups. Time to recurrence was significantly shorter in patients undergoing repeat prolapse surgery 8.8 vs 30.7 months (p = 0.03).VR is a better option for patients undergoing primary rectal prolapse repair.
View details for PubMedID 28785819