General Surgery Division

Bruce Schirmer, MD
Chief, General Surgery Division

The Division of General Surgery actively fulfills all the missions of our department. We provide exemplary clinical service, and the members of the division are among the busiest in the department in terms of numbers of patients seen and operative procedures performed. All surgeons use the full amount of their allotted clinic time to see new patients and perform surgical consultations in the outpatient setting. Various members of the team are in the operating room on all weekdays, and we use our allotted operative time at close to a 100% efficiency. We cover a high percentage of the night and weekend emergency general surgery call and consultation schedule as well. All members of the division have consistently provided greater than anticipated levels of clinical service and procedures on an annual basis.

While the members of the division handle all problems in general surgery when on call, their elective practices tend to focus on several areas. Drs. Friel, Hedrick and Hoang are all board certified colorectal surgeons and provide comprehensive service for diseases of the colon, rectum, and perianal conditions. Dr. Hallowell, myself and the annual Instructor in Minimally Invasive Surgery provide similar comprehensive service for diseases of the foregut, including metabolic and bariatric operative procedures, as well as repair of all forms of abdominal wall hernias and treatment of biliary tract disease and small bowel problems.

Members of the division have been consistently high performers in the clinical arena when measured by objective criteria such as numbers of operative procedures, numbers of RVUs per specialty, patient satisfaction scores, national quality review databases, and other measures of clinical outcomes. Several have received institutional awards for clinical excellence (including Drs. Hallowell, Hedrick and Friel). I have founded the metabolic and bariatric surgery service and pioneered the use of minimally invasive surgical techniques for many of the abdominal operations for which these are now used. Drs. Hedrick, Hallowell, Hoang and Friel are now using robotic approaches to cases where this is advantageous. Dr. Hedrick has been an international leader in the area of Early Recovery After Surgery (ERAS), and has, along with Dr. Friel, instituted that system to dramatic effect in improvement of results for our patients undergoing colorectal surgery. The ERAS system has now been adopted by all the other surgical services in the department, with great benefit to many patients.

While clinical service is a stellar accomplishment of our division, the quality of teaching by the members of the therein is probably unequaled in any other such size group in the entire institution. ALL members of the Division receive outstanding evaluations of their teaching efforts by residents and medical students. Dr. Friel and I have been awarded the Master Educator Award from the institution, its highest award for teaching and an award given annually to one individual from the entire medical school faculty. Dr. Friel has won a national award for teaching from the Association for Surgical Education, and institutional awards for his teaching that are lengthy in number but include Deans Award for Teaching, All-University Teaching Award, and awards for medical student teaching including Baccalaureate Speaker, Convocation Speaker, Robley Dunglison Award (twice), and graduation Marshall (twice). He has been Surgery Faculty Educator of the Year. He has served as Associate Program Director in Surgery for a decade prior to his becoming current Program Director in 2017. I personally have also been Faculty Educator of the Year for the Department on several occasions, served as Program Director from 2000 to 2017, and received a national teaching award from The Society for Surgery of the Alimentary Tract.

Bruce Schirmer, MD
Chief, General Surgery Division

Patients with both benign and malignant diseases of the colon and rectum are treated with the most advanced, evidence-based surgical therapies available. Drs. Friel, Hedrick, and Hoang are all board certified in colorectal surgery and have the experience and expertise to take on even the most challenging problems in this area.

The program provides comprehensive care for patients suffering from surgical diseases of the colon and rectum, including both diagnostic and therapeutic services. Cancer of the colon and rectum, inflammatory bowel diseases, diverticular disease, rectal prolapse, anal sphincter injury, and a wide variety of benign anorectal conditions including hemorrhoids, fissures, and infections are all treated with data driven bests practice treatments. Advanced operative techniques including sphincter-saving procedures, transanal endoscopic microsurgery, robotic surgery, and laparoscopic techniques are all used when indicated. Certified enterostomal therapists are available for inpatient and outpatient needs.

There is a comprehensive multi-discipline group that treats patients with inflammatory bowel disease. Along with collaboration with our colleagues in Gastrointestinal Medicine, treatments for inflammatory bowel diseases ranging from immunotherapy to supportive medical therapy to minimally invasive surgical therapy to maintain and restore as much function of the lower digestive system as possible are all offered as appropriate to patients. Extensive screening programs for patients at higher risk for complications are available. Our goals of care include restoration of symptom-free digestive health and function.

Anorectal problems are often misunderstood and incorrectly diagnosed and treated by non-expert care providers. They are common and often present significant symptoms for patients. They can be the sign of other more concerning problems as well. Advanced techniques in treating anorectal problems with minimization of invasiveness and maximization of correct diagnosis and symptomatic relief are available in our weekly clinics.

Colon and rectal cancers are the second most common form of life-threatening cancer among the entire population. The members of the Colorectal Surgical team provide comprehensive diagnosis and surgical treatment for these forms of cancer. All patients are reviewed by a multi-discipline tumor board, and an optimal course of treatment is recommended. The surgical component of such treatment is provided by our surgeons who use the latest in surgical approaches to provide the highest likelihood of oncologic success while preserving as much functional capacity as possible. The team is supported by outstanding ostomy therapists, nutritional consultants, and the counterpart medical oncologists and radiation therapists to provide optimal tumor treatment. Cancer care is rendered convenient to the patient by providing comprehensive care of all these services in one location at the Emily Couric Cancer center.

For questions about the Colon and Rectal Surgery Service at the University of Virginia, or for patient referrals, please call 434-243-9970.

Obesity is one of the current worldwide most serious and rapidly increasing medical problems. It accounts for the fact that our children may not live as long as we do. Associated medical problems such as hypertension, type 2 diabetes, sleep apnea, degenerative joint disease, increased risk for cardiovascular disease, and increased risk for many forms of cancer all are due to the problem of obesity. Currently nearly 40% of Americans are obese. Diet therapy is generally successful in only 3% of patients with severe obesity (BMI over 40 kg/m²). For such individuals, the options of endoscopic or surgical therapy to address their obesity are provided by our group of trained bariatric surgeons. This program has been in existence for 34 years, and the experience of its surgeons is unmatched in any other program in the state. A multi-discipline team of nutritionists, nurse practitioners and care coordinators, and supporting bariatric certified medical specialists and psychologists and exercise consultants are available for our patient’s comprehensive needs. All procedures include extensive preoperative assessment, counseling and education, and close postoperative follow-up and support for optimal outcomes. We are a Center of Excellence of the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and an approved program for all the leading insurance plans in the area. Both surgical and endoscopic procedures are now offered as part of our comprehensive program. We have the long-term experience to offer metabolic and bariatric surgery to those patients which other programs feel may be too high risk. Our most common patient observation after surgery is “I wish I had done this sooner.”

For questions or referrals to the Metabolic and Bariatric Surgery Service, please call 434-924-2121.

Drs. Hallowell and Schirmer and the Instructor in MIS Surgery provide full service diagnostic consultation, assessment, and therapeutic procedures to repair all forms of abdominal wall hernias. This includes inguinal hernias, umbilical hernias, diaphragmatic hernias, incisional hernias, parastomal hernias, flank hernias, and other abdominal wall hernias. Operative procedures range from standard suture repair of smaller hernias to large component separation repairs of extensive abdominal wall hernias. Both open, laparoscopic and, at times, robotic approaches are used, depending on which approach offers the optimal treatment for the patient. Recommendation for observation, conservative therapy, or operative repair and approach is based on the latest evidence for optimal outcomes and patient specific conditions. Both Dr. Hallowell and Dr. Schirmer have many years of experience repairing hernias, and the MIS Instructor also is fully trained to repair them as well, with support from senior faculty for difficult cases. Our group repairs well over 200 hernias annually, with excellent outcomes as benchmarked by national standards. Many procedures are outpatient. Laparoscopic approaches can allow faster recovery and discharge if indicated. Dr. Hallowell also treats sports hernias for athletes with that particular problem.

For questions about the Hernia Surgery program, please call the numbers for Drs. Hallowell or Schirmer.

The Division of General Surgery offers comprehensive diagnosis and treatment program for benign diseases of the esophagus and stomach. These include benign esophageal diseases such as gastroesophageal reflux disease (GERD), achalasia, esophageal motility disorders such as achalasia, and diaphragmatic and hiatal hernias. Disorders of the stomach such as ulcers, emptying disorders, and benign and malignant tumors are also evaluated and treated with state-of-the-art procedures. Full diagnostic and therapeutic services are provided. Most of these diseases are treated with a combination of medical and surgical therapy, and multidiscipline teams are used when indicated. This is especially true for tumors.

The vast majority of surgical procedures are done laparoscopically whenever possible, allowing the most rapid recovery possible. The group also offers placement and care of enteral feeding tubes for nutritional support for patients with disorders that require tube feeding on a temporary or permanent basis.

For questions on the Program for Diseases of the Esophagus and Stomach, please call the numbers for Drs. Schirmer or Hallowell.

Our Colon and Rectal Surgery Program offers the latest innovations in successfully treating tumors of the rectum with as little loss of continence as possible and with as high a success rate of tumor eradication as possible. For benign tumors of the rectum, Transanal Endoscopic Microsurgery (TEM) allows our surgeons to perform procedures to remove benign rectal tumors through the anus, thereby eliminating painful incisions and allowing rapid recovery. For cancers of the rectum, the surgeons in our program use the most advanced approaches to tumors including multimodal diagnostic and staging procedures, then preoperative chemotherapy and/or radiation therapy if appropriate, which may often shrink the tumor enough to allow a surgical removal and still preserve anal function and avoid a colostomy. Removal of rectal tumors within only 2 inches of the anus or above are successfully treated in this fashion. This offers the patient the combination of the highest likelihood of complete cure of their cancer as well as the highest likelihood of avoiding a permanent colostomy.

The Colon and Rectal Surgery Program, under the guidance of Dr. Traci Hedrick, along with cooperation and coordination with representatives from the Department of Anesthesiology, initiated a program to promote early recovery after surgery for their patients. This was successfully introduced several years ago, and involves less use of opiate narcotics postoperatively with alternative pain medications used instead, more local anesthetics given in wounds, as well as less fluids given during surgery, more rapid oral intake of fluids after surgery as well as some before, more rapid ambulation after surgery, and overall protocols to stimulate faster recovery after surgery. The results of the program were remarkable, with decreases in duration of hospitalization to one half of previous stay duration, decreases in wound complications, respiratory complications, overall complications, and a major increase in patient satisfaction. The program was so successful it was quickly adapted by most of the other surgical programs in the institution, with also good results. Dr. Hedrick has become an international authority on the topic, and is President Elect of the American Society of Enhanced Recovery.

Endoscopic sleeve gastroplasty (ESG) is an endoscopic procedure that reproduces the same changes to the stomach that occur during the performance of the operative procedure sleeve gastrectomy. Sleeve gastrectomy has become the most popular metabolic operation in the world, producing weight loss of 60% of excess weight or 25-30% of total body weight loss and improvement of associated medical diseases such as diabetes, hypertension, sleep apnea and others. Longevity is improved through lower chances of cardiovascular events and many types of cancer. Quality of life is vastly improved. For patients who do not wish to undergo a surgical procedure, the ESG offers an endoscopic alternative. This procedure has produced an average of 18% total body weight loss, but most patients who have had it have not been as severely obese, so the amount of weight lost is not as much since normal weight is more easily achieved. The reported weight loss at five years has remained as good as at one year, so the procedure appears durable. UVA began its experience in 2019, and have had good results to date. The procedure is done endoscopically as an outpatient. Peroperative assessment, counseling, and postoperative follow-up are all part of the program. A multidiscipline team is involved including RDs, MDs, and RNs. Currently insurance is not yet covering the procedure, so it is available on a cash pay basis which includes all costs for preoperative and postoperative visits for one year. We believe this procedure will continue to evolve and improve, soon be insurance covered, and likely be a very popular alternative for patients desiring treatment for their obesity-related medical problems in the future. For more information on the program and procedure, please call 434 924-2121.

While laparoscopic surgery is no longer an innovation in surgery, it would not do justice to the fact that when this revolutionary technique of performing abdominal surgery was beginning, it was the University of Virginia Department of Surgery that was one of the leading academic medical centers embracing and promoting the technology. The first laparoscopic gallbladder surgery in the U.S. was done in 1989, and by February 1990 surgeons at the University of Virginia, led by Dr. Schirmer, adopted laparoscopic surgery for performing this then radically different way of performing access for abdominal operations. The institution then dedicated much time to teaching surgeons in the state the techniques of laparoscopic surgery for the next several years, while simultaneously using laparoscopic approaches to performing hernia surgery, appendectomy, bowel surgery, gastric surgery, antireflux surgery, adrenalectomy, and splenectomy all within the next five years. Bariatric surgery followed in 1999 and certain pancreas and liver procedures after that. This track record as a leading department in the field of minimally invasive surgery is worthy of mention. Members of the Department of Surgery continue to adopt new techniques in performing operative procedures that can produce a more rapid and secure recovery for our patients.

The Early Recovery After Surgery (ERAS) program has resulted in significant changes in the perioperative management of patient analgesia, fluids, oral intake, ambulation, and narcotic use that it has generated a significant body of clinical outcomes and research. Further improvements in these areas are constantly being sought by new trials. There is active participation and leadership among our faculty in these efforts on a regional and national basis, particularly Dr. Hedrick

The 35 year experience of this program has been accompanied by the recording of outcomes for the many thousands of procedures done during this time period. Long-term results as well as the effect of these operative procedures on the subsequent development of various medical conditions including cardiovascular disease, breast cancer, osteoporosis and bone disease, have all been investigated and reported. The various successes and failures of different operative techniques, so important to their continued use or abandonment in favor of more superior procedures, have also been a major component of such outcomes research and reporting over the years.

A number of the members of the Division of General Surgery have contributed to the literature on surgical infections and their treatment. All members of the Colon and Rectal Surgery Program have been active in this area of research, as has Dr. Hallowell. This major complication after surgery continues to merit the focus and attention given to reducing its deleterious effect on patient recovery after surgery.