Endoscopy Treatments

Ultrasound:

The Haemorrhoid Clinic can provide a complete state of the art diagnostic and interventional ultrasound service. We have access to modern ultrasound machines allowing high quality images to be obtained in all body areas.

What is ultrasound?

High frequency sound waves are used to produce an active picture of the inside of your body. Ultrasound does not use radiation (X rays) and is therefore extremely safe. Although ultrasound is very good at visualizing the solid organs (e.g. liver, kidneys, bladder, aorta) a doppler / duplex ultrasound can evaluate blood vessels. Ultrasound is also very good at directing needles and drains to areas if needed to gain a small sample (biopsy) or drain an abscess / collection (drainage).

Is there any preparation?

We generally ask that you do not eat any solids for 6 hrs and drink plenty of fluids so that you have a full bladder at the time of the scan.  Some ultrasound scans require no preparation at all. The radiology department will advise you prior to your appointment.

What does an Ultrasound involve?

You will be asked to remove some of your clothes and wear a hospital gown. A small ultrasound probe attached to an ultrasound machine is used to obtain the pictures (see picture). We use a small amount of clear jelly to gain the images, which will need to be cleaned off at the end of the procedure.

Endoscopy

Our two state-of-the-art endoscopy suites have the latest equipment available to ensure the fastest and most accurate results, delivering the ultimate care package. Forming an integral component of the Haemorrhoid and Endoscopy Centre, the endoscopy staff provide a one-stop service where consultations, investigations and results are available on the same day.

Our Endoscopy Suite:

Our purpose-built and state-of-the-art Endoscopy Suite sits allow one stop consultation and diagnostic tests if required. As well as being equipped with leading edge endoscopy equipment we also have superb diagnostic support services, Digital X-ray, the very latest CT scanner, MRI and ultrasound as well as a fully CPA accredited pathology service.

Our Endoscopy Suite Features:

• Environment which emphasizes privacy and confidentiality.
• A recovery bay and two procedure rooms.
• Procedures performed are: colonoscopies, gastroscopy, minor anal surgery, and minor procedures under local anaesthetic or sedation.
• Simplified registration check-in procedures, private interviewing and changing facilities and a comfortable recovery room enhancing patient experience.
• Latest endoscopic technology providing high definition image capture.

Conditions treated:

Barretts Oesophagus
Stomach cancer – early and advanced
Oeosphageal cancer
Gastro-intestinal stroma tumours of the upper intestinal tract
Gasto-oesophageal reflux disease (GORD)
Hiatus hernias
Achalasia
Gastroparesis
Bile duct stones
Primary sclerosing cholangitis
Cholangiocarcinoma
Pancreatic cancer
Pancreatic cysts
Colon cancer and polyps
Crohns disease and ulcerative colitis

Contact us today:

To ask a question about endoscopy or to book an appointment, contact our specialist team available Monday – Friday 07:30 am – 17:00 pm. Our gastrointestinal specialists team have a dedicated and caring approach and will seek to find you the earliest appointment possible with the correct specialist for your needs.

Abnormal anal Pap Smear, Dysplasia.

Abnormal anal pap smears, anal dysplasia and anal cancer are all caused by human papilloma virus (HPV).

What is human papilloma virus (HPV)?

HPV is a common virus which can be transmitted sexually. HPV infection may present differently: some HPV types cause warts while other HPV types cause anal and cervical cancer.

Risk factors for HPV:

• Women: history of cervical high grade dysplasia or cervical cancer
• Women and men: HIV infection
• Women and men: history of receptive anal sex.
• Women and men: other HPV related diseases such as warts.
• Women and men: immunosuppression from diseases or from medications.

HPV prevention:

HPV vaccines: they are highly effective in preventing both HPV warts and HPV related cancers when given before becoming sexually active. Practicing safe sex reduces the risk of getting HPV; condoms are partially

protective. Stopping cigarette smoking decreases HPV disease and risk of recurrence. Treating HIV with antiretroviral therapy may reduce the risk of getting anal dysplasia

What is anal dysplasia:

Anal dysplasia is a pre-cancerous condition which occurs when the cells of the lining of the anal canal undergo abnormal changes.  The anal canal is the last few inches of the intestine.  Anal dysplasia may progress from low-grade (low risk) changes to high-grade (high risk) changes before it turns into cancer.

What causes anal cancer?

90% of anal cancers are caused by the HPV. Anal cancer may develop slowly over a period of years.  Anal cancer may occur inside the anal canal where the anus meets the rectum. Or it may develop in the skin just outside of the anal canal opening.  

What are the symptoms of anal cancer?

Sometimes there are no specific symptoms of anal cancer until it is quite advanced. There may or may not be a visible or palpable growth. People may also have anal pain, bleeding and discomfort. These same symptoms can be caused by other benign conditions, like haemorrhoids or anal fissures. This is one of the reasons you should be seen and examined when you have those symptoms, so the correct diagnosis is made. At a minimum, you should have the following examinations:

Digital rectal exam: your provider places a gloved finger in the anal canal to feel for lumps

Routine anoscopy: a visual examination of the anal canal. A short instrument is placed in the anal opening to allow the provider to see the lining of the anal canal.

Diagnosis of anal dysplasia

The diagnosis of anal dysplasia may be made by performing an anal pap smear. Just like a cervical Pap smear, cells are collected from a swab inserted into the anus.  Those cells are then examined by a pathologist looking for pre-cancerous or dysplastic changes.  Male/female patients with any of the following risk factors should have an anal pap smear:

• History of receptive anal sex
• HIV infection.
• History of cervical high grade dysplasia or cervical cancer.
• Other HPV related disease: genital warts.
• Immunosuppression from disease or medications.

Follow-up of anal dysplasia is based on the results of anal Pap smear Results of anal Pap smear may be normal or abnormal. Any description of abnormal anal Pap smear usually triggers a recommendation to perform high resolution anoscopy.

High resolution anoscopy (HRA) uses magnification to obtain a more detailed view of the anal canal. The provider inspects carefully the entire anorectal junction under high magnification. HRA offers the opportunity to both diagnose and treat anal dysplasia. Suspicious or atypical areas can be biopsied, and the lesions may be destroyed in the course the same procedure.

Treatment:

Visible warts are usually treated even if they are not pre-cancerous lesions. There are multiple treatment options. Some include:

• Lesion destruction with electrocautery (heat) or by infra-red coagulation (IRC- intense beam of light).
• Trichloroacetic acid (TCA): the lesion is treated by being touched with acid-soaked cotton.  

After treatment: surveillance

Anal dysplasia can be treated successfully with very close follow up and monitoring. Individuals with low-grade lesions will generally have a repeat HRA in 1 year.  Individuals with high-grade lesions will have a repeat HRA every 3-6 months.  This will continue until there is no further evidence of high-grade dysplasia.

Oesophageal Cancer:

Symptoms of Oesophageal Cancer:

The prime symptoms of oesophageal cancer are difficulty swallowing, persistent indigestion or heartburn, loss of appetite and weight loss. You may also feel pain or discomfort in your upper tummy, chest or back and bring up food soon after eating. Difficulty swallowing, from the cancer narrowing the oesophagus, is the most common of these symptoms. It may feel as though food is getting stuck and swallowing can be uncomfortable or painful.

Diagnosis of Oesophageal Cancer:

Diagnosis is best done with an endoscopy, when a thin, flexible tube with a light and camera is passed into your mouth and down towards the stomach so that a doctor can check for cancer. Small tissue samples – a biopsy –  may be removed for testing. If oesophageal cancer is determined, then further tests such as a CT or ultrasound scan can judge how far the cancer has progressed – measured in stages –  and the appropriate treatment.

Treatment of Oesophageal Cancer:

A multi-disciplinary team will recommend a treatment plan which will feature surgery, chemotherapy or radiotherapy. Stage 1-3 is usually treated with surgery but may also require chemotherapy and radiotherapy; Stage 4 is not curable and requires chemotherapy, radiotherapy and other treatments to slow the spread of the cancer. A surgeon can perform an oesophagectomy to remove a section of the oesophagus and then reconnect the remaining section to your stomach. An Endoscopic Mucosal Resection (EMR) which cuts out the tumour with a loop of wire could be recommended. Stents can also be used to hold the oesophagus open to ease swallowing difficulties in advanced cases.

Screening and Surveillance for Colorectal Cancer:

Colorectal cancer is a common malignancy for both men and women.  Screening for colorectal cancer is the process of identifying apparently healthy people who may be at increased risk of developing this disease. Properly done, screening for colorectal cancer saves lives. Removing a pre-cancerous polyp prevents the development of colorectal cancer.  In addition, if found early, colorectal cancer may be cured in up to 90% of cases. Screening is for people without symptoms. Patients who experience rectal bleeding, changes in their bowel habits, abdominal pain, or unexplained weight loss should seek medical attention.

Patients who are considering screening for colorectal cancer need information about:

What is the risk of colorectal cancer:

It is estimated that the lifetime risk of developing colorectal cancer is about 1 in 20. The risk is similar for men and women. Some people are at a slightly higher risk for colorectal cancer due to their personal or family characteristics. Patients who have had prior pre-cancerous polyps or a cancer are at an increased lifetime risk of developing more polyps or another cancer. Close relatives of patients with colorectal cancer OR polyps have a two- to three- fold increased risk of developing colorectal cancer or polyps. Familial Adenomatous Polyposis (FAP) is an uncommon inherited condition which typically causes hundreds of polyps in the colon. Patients with this condition have an almost 100% chance of developing colorectal cancer, usually before age 50. Hereditary Non-Polyposis Colon Cancer (HNPCC) is another uncommon inherited condition, characterized by colorectal cancers in multiple family members. Patients with inflammatory conditions of the colon, such as Crohn’s disease or ulcerative colitis, have an increased risk of colorectal cancer as well. 

What is the benefit of colorectal screening:

Like other serious, common medical problems such as high blood pressure colorectal cancer is considered to be a “silent disease” in its early stages. Up to 90% of these early cancers can be cured, but once symptoms develop, cure rates fall to less than 50%. Unfortunately, not everyone receives proper screening.

What screening tests are available?

Faecal occult blood testing (FOBT) detects very small amounts of blood in stool that may have been shed from a cancer or polyp. The advantages of FOBT are that it is inexpensive and non-invasive; bowel cleansing and sedation are not required. Positive tests require another procedure, typically a colonoscopy. Flexible sigmoidoscopy uses a thin, flexible tubular instrument to give magnified views of a patient’s large intestine.  It allows the doctor to examine the lower third of the colon and the rectum directly and to take samples of abnormal areas for testing in the lab. Flexible sigmoidoscopy has been shown to be highly effective in detecting polyps in the area viewed and is an effective method, especially when paired with FOBT, to reduce colorectal cancer mortality. The main advantages are its short duration, the ability to take samples, and the lack of significant discomfort. Colonoscopy is similar to flexible sigmoidoscopy, but the entire colon is examined. A colonoscope is a long, thin, flexible tubular instrument that provides magnified views of a patient’s large intestine.

Abnormal areas can be sampled or removed completely, depending on their size. Colonoscopy is often considered the “gold-standard” screening test, as it allows for both detection and removal (or sampling) of polyps and cancers. The advantages of colonoscopy are the ability to examine the whole colon and to sample or remove abnormal tissue. Barium enema is an x-ray test that allows examination of the lining of the colon. Computed tomographic colonography uses a CT scan to make images of the lining of the colon that appear similar to views seen during standard colonoscopy. This test usually requires the same type of thorough bowel cleansing needed for colonoscopy.

What are the recommended starting ages and frequency for screening tests?

For average risk individuals, screening should start at age 50. Of the screening methods discussed above, FOBT should be done yearly, along with a flexible sigmoidoscopy every 5 years. Screening should begin earlier in people with a family history of colorectal cancer or polyps.

Surveillance:

Surveillance refers to the process of evaluating patients with a personal history of polyps or cancer.  People who have precancerous polyps completely removed should have a colonoscopy every 3-5 years. Every effort should be made to remove polyps, as there is a significant risk that over time they can progress to an invasive cancer. If a polyp cannot be removed with colonoscopy, surgery to remove that portion of the colon is often needed. Most patients who have a colorectal cancer removed surgically should have a colonoscopy within one year. Patients with ulcerative or Crohn’s colitis for eight or more years should have a colonoscopy with multiple biopsies every 1-2 years.

Stomach Cancers:

Symptoms:

Many symptoms of stomach cancers are similar to less serious conditions with early stage signs being persistent indigestion, heartburn, trapped wind, difficulty swallowing and vomiting. The more advanced signs include blood in your stools, a swelling or lump in the stomach, loss of appetite, weight loss, fatigue, anaemia and jaundice.

Around 90% of stomach cancers appear in people aged over 55.

Diagnosis:

It is easier to treat if diagnosed early and GPs are instructed to check symptoms and examine your stomach for any lumpiness or tenderness and to refer to a specialist for further investigation. A GP should also refer you to a specialist if you have indigestion and weight loss. You may need a blood test or a gastroscopy and biopsy, using a narrow flexible tube to examine the inside of the stomach, and possibly take a small tissue sample for testing

Treatment:

Treatment will vary depending on your general health and how far advanced the cancer has become. The three main treatment options are surgery, chemotherapy and radiotherapy. An operation is usually recommended if the cancer has been detected early and the damaged tissue can be removed. Chemotherapy and radiotherapy are normally prescribed at a later stage to kill cancer cells and arrest tumour growth. Biological treatments, which stimulate the body’s immune system to fight back, are also available It is estimated that a cure is possible in 20-30% of cases.

Capsule Endoscopy

Small Bowel Capsule Endoscopy

Complete endoscopic examination of the small intestine has not been possible until now. Capsule endoscopy provides excellent visualisation of the entire small intestine using a pill-sized, video imaging, wireless capsule. Every capsule contains a camera, light source, batteries and transmitter. During the procedure the patient can move about and over 50,000 colour images are recorded onto a data-recorder worn on a belt around the patient’s waist. The capsule passes through the small intestine as peristalsis occurs and is excreted naturally.

Benefits Capsule Endoscopy

Unlike more traditional investigations, capsule endoscopy avoids exposure to potentially harmful radiation. It is also comfortable and sedation free, as the capsule is easily swallowed by the patient. During the procedure the patient can walk about and relax. Importantly the key findings of multiple clinical trials show that capsule endoscopy is significantly superior for examination of the small intestine for a broad range of indications compared to small bowel enteroclysis and barium follow through, CT, MRI, push enteroscopy and ileoscopy.

Indications for Capsule Endoscopy

The main indications for capsule endoscopy include the investigation of iron deficiency anaemia when obscure gastrointestinal bleeding is suspected, and the diagnosis of early or suspected Crohn’s disease of the small intestine. In addition, capsule endoscopy has a high level of sensitivity for detection of benign and malignant small intestinal tumours; it is helpful in the evaluation of Coeliac disease and other malabsorption disorders that may lead to chronic diarrhoea and weight loss it can identify medication (e.g. NSAID) related small bowel injury and it provides an additional diagnostic facility for small bowel abnormalities requiring further investigation.

Preparation required for Capsule Endoscopy

Capsule endoscopy is patient friendly and preparation usually involves dietary modification only. On the day before the procedure, lunch is followed by clear fluids and then an overnight fast. The capsule is swallowed by the patient with some water in the morning. Unlike conventional endoscopy, no sedation or analgesia is necessary.

The Oesophageal Capsule

The oesophageal capsule is an alternative investigation for patients with gastrooesophageal reflux symptoms who do not wish to undergo gastroscopy. The capsule is simply swallowed and does not require sedation. It examines the oesophagus for signs of hiatus hernia or acid damage that can lead to inflammation or ulceration (oesophagitis) or the development of Barrett’s oesophagus. The finding of Barrett’s oesophagus is important as this condition is believed to increase the risk of oesophageal cancer. The oesophageal capsule may also be used to identify oesophageal varices in patients with liver disease.

The Colon Capsule

The colon (large bowel) capsule is not yet available for patients. Trials are currently underway to determine its effectiveness. Should these show that the colon capsule accurately detects polyps or bowel cancer, then the colon capsule (which can be swallowed) may be an easy and more convenient way than colonoscopy to check the bowel for these disorders.

Polypectomy

What are polyps?

Polyps are abnormal growths that arise from the cells lining the bowel. Pedunculated polyps are attached to the bowel wall with a stalk, while sessile polyps have a broad base and protrude directly from the lining of the bowel. Whilst most polyps are benign, they often have the potential to become malignant (cancerous) if left untreated.

What are the symptoms of polyps?

Most polyps produce no symptoms and often are found incidentally during endoscopy or imaging of the bowel. However some polyps can produce bleeding, mucosal discharge, alteration in bowel function or rarely abdominal pain.

How are polyps diagnosed?

Diagnosis of colonic polyps is by colonoscopy, flexible sigmoidoscopy or CT-colonography (also known as ‘virtual colonoscopy’).  Research has demonstrated that removal of polyps dramatically reduces the incidence of subsequent colon cancer.

What is polypectomy?

Polypectomy is the medical term for removing polyps. Small polyps can be removed by an instrument called a biopsy forceps, which snips off small pieces of tissue. Larger polyps are usually removed by putting a noose, or snare, around the polyp base and burning through the tissue with an electric current. Neither of these procedures is painful and you will usually not be aware that they are being done. Rarely a polyp is too large to be removed by colonoscopy and requires surgery for removal.  Polypectomy is very safe, but all procedures entail some risks, which you should discuss with your endoscopist. Potential serious complications of polypectomy include bleeding and perforation (creating a hole in the colon), however they are rare. Bleeding can usually be controlled by colonoscopy, during which the bleeding site is cauterized, although surgery is sometimes required. Surgery is usually required for perforation. Other complications have been described but occur much less frequently. You should follow your endoscopist’s instructions carefully following polypectomy, you may be advised to not take certain blood-thinning or anti-inflammatory drugs for a defined period after the polypectomy. In addition, you will be informed about how to find out the results of the tissue analysis of your polyps and if a repeat examination should be performed.

Information on Colonoscopy:

What is a colonoscopy?

A colonoscopy is a procedure that allows the doctor to visually examine the entire lining of the colon and rectum using a colonoscope (a long flexible tube about the thickness of a finger). The colonoscope is inserted into the rectum and gradually advanced through the colon. The doctor is able to carefully examine the lining of the rectum and diagnose colon and rectal problems, perform biopsies, and remove polyps.

Who should have a colonoscopy?

Screening refers to the process of examining otherwise healthy patients in an effort to detect previously undiagnosed colon polyps or cancer. The goal of a screening program is to detect disease at its earliest stages to allow for successful treatment. As part of a colorectal cancer screening program, colonoscopy is routinely recommended to adults starting at age 50. Patients who have a family history of colon or rectal cancer or polyps may be recommended for a colonoscopy earlier and more frequently than those without a family history of cancer. Your doctor may also recommend a colonoscopy to evaluate symptoms such as rectal bleeding, a change in bowel habits, or unexplained abdominal pains.

Colonoscopy may also be recommended for:

• Follow-up examinations for patients who have a history of colon polyps or cancer.
• Patients with acute or chronic anemia.
• Patients with inflammatory bowel disease (e.g., Crohn’s disease or ulcerative colitis).
• Patients with certain familial hereditary conditions such as hereditary nonpolyposis colorectal cancer (also known as Lynch syndrome).

How is a colonoscopy performed?

One or two days prior to the procedure, most patients must complete a bowel “prep”- a prescribed preparation consisting of liquids and/or pills or enema that will cleanse the bowels of stool and other residue. This allows for complete visualization of the bowel surface during the procedure. Your doctor will most likely give you a list of dietary and medication restrictions to adhere to in the days leading up to the procedure. The most important part of the procedure is your completion of the cleansing process as requested by your Dr. During the colonoscopy, most patients receive intravenous sedation to help patients remain comfortable for the duration of the procedure. The colonoscope is inserted via the rectum and advanced to the first portion of the colon, where it is connected to the end of the small intestine. Any polyps or other abnormalities encountered during the colonoscopy will be removed and/or biopsied and sent for analysis. For most patients, the entire procedure takes less than an hour. After the colonoscopy is completed some patients may experience slight discomfort in the form of abdominal cramping and “gas pains,” though this quickly resolves by passing any gas/air that was insufflated during the procedure. It is always important to have the individual who will be taking you home be there to discuss the discharge instructions. Following a colonoscopy, patients usually resume their regular diet. Some restrictions for driving and activity levels apply when intravenous sedation medications are given to sedate patients immediately prior to colonoscopy. These medications affect judgment and coordination for variable amounts of time following the procedure. Most patients are able to resume normal activity the morning following the colonoscopy.

What is a polypectomy?

Polypectomy is the removal of a polyp. During the course of the examination, a polyp may be found. Polyps are abnormal growths of tissue which vary in size from a tiny dot to several inches. If the doctor feels that removal of the polyp is indicated, a wire loop, or snare, will be passed through the colonoscope and the polyp removed from the intestinal wall using an electrical current. If additional polyps are detected, they may be removed as well.

What are the risks of a colonoscopy?

Colonoscopy and polypectomy are associated with very low risk when performed by doctors with special training and experience doing these endoscopic procedures.  One possible complication is perforation, which is a tear through the wall of the bowel that may allow leakage of intestinal fluids. Perforation will usually necessitate hospitalization and often surgery. Another complication is bleeding that may occur from the site of biopsy or polyp removal. It is usually minor and stops on its own. 

What is the benefit of having a colonoscopy?

The doctor can perform a biopsy and remove polyps during the procedure before they turn into cancer. Screening tests can also find colorectal cancer early, when the chance of being cured is good.

What happens after a colonoscopy?

You must make arrangements for someone to drive you home after the procedure. You will not be allowed to drive, take a taxi or bus alone after the procedure. It is recommended that you have a responsible adult with you for 12 hours following your procedure. Even though you may not feel tired, your judgement may be impaired and your reflexes may be slower.

How do I prepare for a colonoscopy?

There are many different colon-cleansing preps.  When you schedule a colonoscopy, the Dr will instruct you as to which prep you should follow. You will be on a clear-liquid diet and drinking laxatives the day prior to your colonoscopy. Please keep this in mind to arrange your work/activity schedule, since you will need to be close to a restroom when you start your laxative preparation.

Colostomy formation:

This is an operation to create a stoma or an opening in the colon, which is stitched to the skin. Colostomies can be made with just one end of the bowel stitched to the skin, or with two ends of the bowel stitched to the skin. A bag is fitted to the skin around the colostomy and the patient passes their stools into the bag, which they then empty, and change as required. This operation may be performed on its own, or as part of another operation such as abdominal perineal resection of the rectum or Hartmanns procedure. Colostomies are sometimes recommended prior to chemoradiotherapy for anal cancer or rectal cancer.

What does the operation involve?

This operation can be performed as a laparoscopic /keyhole procedure or an open procedure. To make the colostomy, the surgeon makes a hole through the abdominal wall. If the surgeon is making an ‘end’ colostomy then just the upper end of the colon is stitched to the skin. The other end may have been removed or is simply closed off using staples or stitches and left inside the abdomen. Sometimes the surgeon will form a ‘loop’ colostomy. In this case both the upstream and downstream ends of the colon are stitched to the skin surface.

What are the risks?

There are risks associated with any abdominal operation. Bleeding is very rare in this type of surgery, blood is always available if a transfusion is required. Wound infections can occur in any form of intestinal surgery. Wound infections rarely cause serious problems but may require treatment with antibiotics. As with any form of abdominal surgery the bowel may sometimes take longer than normal to start working, this is known as ileus. Patients may develop abdominal distension and vomiting. If this happens the surgeon will normally recommend a period of bowel rest with continued intravenous fluids and sometimes a tube passed via the nose to the stomach (nasogastric tube). In most cases the obstruction settles spontaneously. Short-term risks include retraction of the colostomy. This is where the stitches between the colon and skin come apart and the colon starts to fall back into the abdomen. In some cases, if the colon falls back too far, an operation to refix the colostomy may be required. Longer-term problems can include narrowing of the colostomy (stenosis), prolapse (when the bowel telescopes out) of the colostomy. Both these complications are uncommon but may require a further operation to correct. Hernias around the colostomy site are quite common. If they become large patients can have problems with fitting their bags. Very rarely a hernia can be a cause of bowel obstruction. Most hernias are quite small and are best not treated but some patients may benefit from a support belt. Larger hernias which are causing problems can be repaired.

What happens after the operation?

After the operation patients will have an intravenous drip, which is normally in place for 24 hours, or until, a normal fluid intake is resumed. A catheter (tube inserted to drain the bladder) may be passed at the time of the procedure and is normally kept in place for 24-48 hours. Patients are allowed to eat and drink as soon as they feel able after the operation (usually the same day). Patients are encouraged to mobilise as soon as possible after the operation. The nurse specialist will show patients how to empty and change their bags so that they can do this independently before they leave hospital. Hospital stay is usually 3-5 days although this may vary. Following discharge from hospital, patients should avoid heavy lifting or increased physical activities for about 6 weeks. Patients can normally resume driving after about 2-4 weeks. A follow up consultation is usually arranged after about two weeks. In some cases the colostomy can be reversed. This would involve another operation, where the surgeon takes away the colostomy and re-joins the bowel. Normally patients are advised to wait at least 3 months, so they are fully recovered, before undergoing a reversal.

Double Balloon Enteroscopy – Imaging the entire small bowel

Double Balloon Enteroscopy (DBE) is an endoscopic technique that allows a specially trained endoscopist to navigate the entire small bowel from either an oral or rectal approach. DBE allows both diagnostic and therapeutic techniques to be performed within the small bowel, avoiding the need of an open surgical procedure. The double-balloon enteroscope features two balloons, one attached to the distal end of the scope and the other attached to a transparent tube sliding over the endoscope. When inflated with air, the balloons can grip sections of the small intestine and “shorten” the small intestine by pleating it over the endoscope. Sequential shortening of the small intestine over the endoscope and advancement of the endoscope enables a comprehensive examination of the entire small intestine.

Endoscopic Anti-reflux Therapy:

Traditional treatments for patients suffering from gastro-oesophageal reflux disease has usually meant taking anti-acid tablets or undergoing invasive surgery. The exciting development of endoscopic anti-reflux therapy now means a 3rd option is now available. These “over the scope” techniques, such as transoral incisionless fundoplication (TIF) using the “Esophyx” device, have several advantages: They are safe.

• Minimally invasive (the procedure is done through the mouth)
• No abdominal scarring.
• Lower complication rate than surgery.
• Patients return to work early.

Transoral incisionless fundoplication (TIF) using the Esophyx device for the treatment of gastro-oesophageal (acid) reflux is now available at our clinic.

What is Flexible Sigmoidoscopy?

A Flexible Sigmoidoscopy is most commonly used to look for bleeding or non-cancerous growths, called polyps, in the colon and is one of the main screening tests for colorectal cancer. It is a common outpatient procedure in which the inside of the lower part of the large intestine (also called the sigmoid or left colon) is examined with a flexible video endoscope. 

What else may be done during the procedure?

During the sigmoidoscopy a biopsy (a sample of the lining of the bowel for closer examination under the microscope) may be taken using tiny biopsy forceps passed through the endoscope. This is a painless procedure. It is also possible to remove small polyps during sigmoidoscopy. Polyps are abnormal projections or growths of tissue, rather like a wart, and certain types of bowel polyps may be at risk of developing into cancer if left. If polyps are found the endoscopist may decide to remove them via pulpectomy during the procedure. It may then be necessary to return for a colonoscopy to examine the whole colon and treat any large or difficult to remove polyps.

Bowel preparation

When you come to the department, a member of staff will explain the test to you and will usually ask you to sign a consent form. This is to ensure that you understand the test and its implications. Your rectum and lower bowels must be empty for the exam to be accurate and complete, but usually there are no diet or fluid restrictions before this procedure. To prepare the bowel for the procedure, an enema will be administered shortly after you arrive in the department by one of the nursing staff. Try to hold the enema for at least five minutes before releasing it. In most cases, sedatives and/or anaesthesia are not necessary. Therefore, you can drive yourself home after the procedure. 

During the procedure:

You will be placed in a comfortable position on your left side and the endoscopist will then pass the sigmoidoscope into the rectum and advance it through the lower colon. You may experience some abdominal cramping and pressure from the air which is introduced into your colon, this is normal and will pass quickly. The procedure usually involves minimal discomfort and takes anywhere from 5-15 minutes.

After the procedure:

You will usually be able to leave the endoscopy department very soon after the test, once you are changed and the results of the procedure have been explained. In most cases a member of staff will be able to tell you the results of the test and you will be given a copy of the endoscopy report to take home. However, if a biopsy sample or polyp was removed for microscopic examination these results may take up to two weeks to process.

What to expect after a Flexible Sigmoidoscopy?

A member of staff will discuss the results of the sigmoidoscopy with you and you will usually receive a copy of the endoscopy report to take home. You may continue to experience mild cramps or gas, but that passes quickly and you can resume normal activities and diet. If you have had any biopsies taken or polyps removed, you may notice small traces of blood coming from your back passage.  If the bleeding persists, becomes more severe or the abdominal pain becomes worse, you should contact either our Dr, your GP or attend you nearest Accident and Emergency Department. You may resume normal medications immediately after your flexible sigmoidoscopy.

Things to report to your doctor:

• Severe pain or vomiting
• Passage or vomiting of blood
• Temperature greater than 38 degrees

Gastroscopy

What is a Gastroscopy?

A gastroscopy is a test where a doctor looks into the upper part of your gut which consists of the oesophagus (gullet), stomach and duodenum. The operator uses an endoscope to look inside your gut. An endoscope is a thin, flexible, telescope. The endoscope is passed through the mouth, into the oesophagus and down towards the stomach and duodenum. The tip of the endoscope contains a light and a tiny video camera so the operator can see inside your gut. The endoscope also has a ‘side channel’ down which various instruments can pass. The operator may take a small sample (biopsy) from the inside lining of the stomach by using a thin ‘grabbing’ instrument which is passed down a side channel.

Who has a Gastroscopy?

A gastroscopy may be advised if you have symptoms such as recurring indigestion or heartburn, pains in the upper abdomen, repeated vomiting, difficulty swallowing, or other symptoms thought to be coming from the upper gut.

Conditions which can be confirmed or ruled out include:

• Oesophagitis (inflammation of the oesophagus).
• Duodenal and stomach ulcers.
• Duodenitis and gastritis (inflammation of the duodenum and stomach).
• Cancer of the stomach and oesophagus.
• Various other rare conditions.

What happens during a Gastroscopy?

Gastroscopy is usually done as an outpatient ‘day case’. The operator may numb the back of your throat by spraying on some local anaesthetic. You may be given a sedative to help you to relax. The sedative can make you drowsy but it does not ‘put you to sleep’. It is not a general anaesthetic. You lie on your side on a couch. You are asked to put a plastic mouth guard between your teeth. This protects your teeth and stops you biting the endoscope. The operator then gently pushes it further down your oesophagus, and into your stomach and duodenum. The video camera at the tip of the endoscope sends pictures to a screen. The operator watches the screen for abnormalities of the oesophagus, stomach and duodenum. Air is passed down a channel in the endoscope into the stomach to make the stomach lining easier to see. The operator may take one or more biopsies (small samples) of parts of the inside lining of the gut. This is painless. The endoscope is then gently pulled out. A gastroscopy usually takes about 10 minutes. However, you should allow at least two hours for the whole appointment, to prepare, give time for the sedative to work, for the gastroscopy itself, and to recover. A gastroscopy does not usually hurt, but it can be a little uncomfortable.

Preparing for a Gastroscopy

You will get instructions from the Endoscopy Unit before your test. These instructions will commonly include.

• You should not eat for 4-6 hours before the test. The stomach needs to be empty.
• If you have a sedative you will need somebody to accompany you home.

What can I expect after a Gastroscopy?

Most people are ready to go home after resting for half an hour or so. If you have had a sedative – you may take a bit longer to be ready to go home. The sedative will normally make you feel quite pleasant and relaxed. However, you should not drive, operate machinery or drink alcohol for 24 hours after having the sedative. You will need somebody to accompany you home and to stay with you for 24 hours until the effects have fully worn off. Most people are able to resume normal activities after 24 hours. The operator may also tell you what they saw before you leave. However, if you have had a sedative you may not remember afterwards what they said.

Laparoscopic Appendectomy

The appendix is a long narrow tube that attaches to the first part of the colon. It is usually located in the lower right quadrant of the abdominal cavity. Its function, however, is not essential. 

What is a Laparoscopic Appendectomy?

Appendicitis is one of the most common surgical problems. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each 1⁄4 to 1⁄2 inch) while watching an enlarged image of the patient’s internal organs on a television monitor.

Advantages of Laparoscopic:

Quicker recovery, quicker return to bowel function, Less postoperative pain ,May shorten hospital stay, May result in Quicker return to normal activity ,Better cosmetic results.

Are You a Candidate for Laparoscopic Appendectomy?

Although laparoscopic appendectomy has many benefits, it may not be appropriate for some patients. Laparoscopic appendectomy is more difficult to perform if there is advanced infection or the appendix has ruptured. A traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.

How is a Laparoscopic Appendectomy Performed?

Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove the appendix. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions.

What Happens if the Operation Cannot Be Completed by the Laparoscopic Method?

In a small number of patients, the laparoscopic method is not feasible because of the inability to visualize the organs effectively. Factors that may increase the possibility of converting to the “open” procedure may include: Extensive infection and/or abscess, a perforated appendix Obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs, Bleeding problems during the operation

What Complications Can Occur?

As with any operation, there are risks of complications.  

Bleeding, Infection, a leak at the edge of the colon where the appendix was removed, Injury to adjacent organs such as the small intestine, ureter, or bladder. It is important for you to recognize the early signs of possible complications. Contact your surgeon if you have severe abdominal pain, fever, chills or rectal bleeding.

What is laparoscopic cholecystectomy?

The surgery to remove the gallbladder is called a cholecystectomy. A less invasive way to remove the gallbladder is called laparoscopic cholecystectomy. This surgery uses a laparoscope (an instrument used to see the inside of your body) to remove the gallbladder. It is performed through several small incisions rather than through one large incision, usually 4 incisions, each one inch or less in length.

What is a laparoscope and how is it used to remove the gallbladder?

A laparoscope is a small, thin tube that is put into your body through a tiny cut made just below your navel. Your surgeon can then see your gallbladder on a television screen and do the surgery with tools inserted in three other small cuts made in the right upper part of your abdomen. Your gallbladder is then taken out through one of the incisions.

Are there any benefits of laparoscopic cholecystectomy compared with open cholecystectomy?

With laparoscopic cholecystectomy, you may return to work sooner, have less pain after surgery, and have a shorter hospital stay and a shorter recovery time. The incision is much smaller, which makes recovery go quicker. Because the incisions are smaller with laparoscopic cholecystectomy, the pain is less after this operation as after open cholecystectomy.

Is there any reason why I wouldn’t be able to have a laparoscopic cholecystectomy?

If you have previously had multiple abdominal surgery, if you tend to bleed a lot an open surgery may be better for you. Sometimes, your surgeon may begin doing the procedure laparoscopically and then convert to an open procedure.

What are the complications of laparoscopic cholecystectomy?

Complications may include bleeding, infection and injury to the duct that carries bile from your gallbladder to your small intestine. Also, during laparoscopic cholecystectomy, the intestines or major blood vessels may be injured when the instruments are inserted into the abdomen. All of these complications are rare.

What is a hernia?

A hernia is a bulge caused by tissue pushing through the wall of muscle that’s holding it in. Most hernias are abdominal hernias. This means they happen in the belly and groin areas. You may have a hernia if you can feel a soft lump in your belly or groin or in a scar where you had surgery in the past. The lump may go away when you press on it or lie down. It may be painful, especially when you cough, bend over, or lift something heavy. Weakness in the abdominal wall could also result from surgical scars (incisional hernias) or following laparoscopy (port site hernias), or around stomas (when the bowel is brought on to the skin) (parastomal hernias). Hernias are generally repaired in order to avoid the life-threatening complication of strangulation i.e. entrapment of a knuckle of bowel in the defect, causing it to lose its blood supply.

Types of hernias include: Inguinal hernia, Femoral hernia, Umbilical hernia, Incisional hernia, Epigastric hernia, Hiatal hernia.

There are two ways that a hernia repair can be carried out. These are laparoscopic or minimally invasive surgery, or open surgery. 


Keyhole (laparoscopic) surgery (for groin hernias)

The advantage of key hole or minimally invasive surgery is that hernias in both groins can be operated on simultaneously; period of recovery is smaller and incidence of chronic pain is much less compared to an open repair. In the traditional open repair, if one has hernias in both groins, usually one side would be operated on at one time and the other side needs an operation later when the operated side has healed up. The laparoscopic technique is also useful when a hernia has recurred after a previous open repair. However, one sided hernias can also be repaired by this minimally invasive technique. You will usually be able to go home on the same day, but some people stay in hospital overnight if they have other medical problems or if they live alone.

Open surgery

The surgeon makes an approximately 5cm cut in your groin. The inguinal canal (the channel near your bowel) is opened to return the fatty lump or loop of bowel to your abdomen, where it should be. The wall of your abdomen is strengthened by fixing a patch of unabsorbable mesh to it. In an emergency situation, if the hernia has become trapped (strangulated) and part of the bowel damaged, the affected segment may need to be removed and the two ends of healthy bowel re-joined. This is a bigger operation and you may need to stay in hospital for four to five days.

What is a hernia?

A hernia is a bulge caused by tissue pushing through the wall of muscle that’s holding it in. Most hernias are abdominal hernias. This means they happen in the belly and groin areas. You may have a hernia if you can feel a soft lump in your belly or groin or in a scar where you had surgery in the past. The lump may go away when you press on it or lie down. It may be painful, especially when you cough, bend over, or lift something heavy. Weakness in the abdominal wall could also result from surgical scars (incisional hernias) or following laparoscopy (port site hernias), or around stomas (when the bowel is brought on to the skin) (parastomal hernias). Hernias are generally repaired in order to avoid the life-threatening complication of strangulation i.e. entrapment of a knuckle of bowel in the defect, causing it to lose its blood supply.

Types of hernias include: Inguinal hernia, Femoral hernia, Umbilical hernia, Incisional hernia, Epigastric hernia, Hiatal hernia.

There are two ways that a hernia repair can be carried out. These are laparoscopic or minimally invasive surgery, or open surgery. 


Keyhole (laparoscopic) surgery (for groin hernias)

The advantage of key hole or minimally invasive surgery is that hernias in both groins can be operated on simultaneously; period of recovery is smaller and incidence of chronic pain is much less compared to an open repair. In the traditional open repair, if one has hernias in both groins, usually one side would be operated on at one time and the other side needs an operation later when the operated side has healed up. The laparoscopic technique is also useful when a hernia has recurred after a previous open repair. However, one sided hernias can also be repaired by this minimally invasive technique. You will usually be able to go home on the same day, but some people stay in hospital overnight if they have other medical problems or if they live alone.

Open surgery

The surgeon makes an approximately 5cm cut in your groin. The inguinal canal (the channel near your bowel) is opened to return the fatty lump or loop of bowel to your abdomen, where it should be. The wall of your abdomen is strengthened by fixing a patch of unabsorbable mesh to it. In an emergency situation, if the hernia has become trapped (strangulated) and part of the bowel damaged, the affected segment may need to be removed and the two ends of healthy bowel re-joined. This is a bigger operation and you may need to stay in hospital for four to five days.

Left Hemicolectomy:

This leaflet has been designed to help you to understand what to expect when you are having an operation on your large bowel.

What is the Large Bowel (Colon):

The food that we eat travels from the mouth to the stomach where digestion begins. It then travels into the small bowel (ileum) where the nutrients are absorbed and the waste that is left moves into the large bowel (colon). The main function of the large bowel (colon) is to store the waste until we need to go to the toilet. You can live a normal life with part or all of your large bowel removed.

Left Hemicolectomy:

Your Surgeon will have discussed with you why you need to have this operation.

This operation can be performed in one of two ways either by laparoscopic method (keyhole surgery) or by laparotomy (open procedure). The operation involves removing the left side of the large bowel (colon) and joining the two ends together (anastomosis).

The benefits of surgery:

The main benefits are to remove that part of the large bowel affected by disease and to relieve any symptoms you may be experiencing.

Are there any alternatives to surgery?

Your Surgeon will discuss with you any treatment options that may be available to you, depending upon your underlying condition. Surgery is usually recommended as the last treatment option, if all medical treatment has failed or if you have developed a life-threatening condition.

The risks of surgery:

This type of operation is classed as major surgery and as with any form of surgery, carries risks (including risk to life). All operations carry a risk from anaesthetics but this is minimised due to modern techniques.

Listed below are the minor and major risks due to surgery and hospitalisation.

Minor risks – these risks are common:

Urine infection, Chest infection, Wound infection, Nausea and vomiting
Paralytic Ileus (This is when the bowel temporarily stops working and is unable to absorb fluids/food)

Major risks – these risks are rare:

Deep Vein Thrombosis (DVT) Pulmonary Thrombosis (PE) Post-operative haemorrhage
Leak at the anastomosis Wound Dehiscence Abdominal Collection
– blood clot in the leg, blood clot in the lung, bleeding in the abdomen, where the bowel fails to heal at the join – wound opens, abscess in the abdomen

Formation of a stoma

With any surgery on the left part of the large bowel, there is a risk that the join (anastomosis) made by the surgeon, may fail to heal properly during the recovery process. Therefore, to protect this join and allow it to heal, part of the large or small bowel may be brought out onto the surface of the abdominal wall. This is known as a Stoma.

Right Hemicolectomy

This leaflet has been designed to help you to understand what to expect when you are having an operation on your large bowel.

What is the Large Bowel (Colon):

The food that we eat travels from the mouth to the stomach where digestion begins. It then travels into the small bowel (ileum) where the nutrients are absorbed and the waste that is left moves into the large bowel (colon). The main function of the large bowel (colon) is to store the waste until we need to go to the toilet. You can live a normal life with part or all of your large bowel (colon) removed.

Right Hemicolectomy:

Your Surgeon will have discussed with you why you need to have this operation.

This operation can be performed in one of two ways either by laparoscopic method (keyhole surgery) or by laparotomy (open procedure). The operation involves removing the right side of the large bowel (colon) and joining the two ends together (anastomosis).

The benefits of surgery:

The main benefits are to remove that part of the large bowel (colon) affected by disease and to relieve any symptoms you may be experiencing. Your Surgeon will discuss with you your individual benefits from having this operation.

Are there any alternatives to surgery?

Your Surgeon will discuss with you any treatment options that may be available to you, depending upon your underlying condition. Surgery is usually recommended as the last treatment option, if all medical treatment has failed or if you have developed a life-threatening condition.

The risks of surgery:

This type of operation is classed as major surgery and as with any form of surgery, carries risks (including risk to life). All operations carry a risk from anaesthetics but this is minimised due to modern techniques. Listed below are the more common minor and major risks due to surgery and hospitalisation.

Minor risks – these risks are common:

Urine infection, Chest infection, Wound infection, Nausea and vomiting, Paralytic Ileus (This is when the bowel temporarily stops working and is unable to absorb fluids/food) Major risks – these risks are rare:
Deep Vein Thrombosis (DVT) Pulmonary Thrombosis (PE) Post – operative haemorrhage
Leak at the anastomosis Wound Dehiscence Abdominal Collection
– blood clot in the leg, blood clot in the lung, bleeding in the abdomen, where the bowel fails to heal at the join, wound opens, abscess in the abdomen, Injury to the bladder

Small bowel resection:

Small bowel resection is surgery to remove part or all of your small bowel. It is done when part of your small bowel is blocked or diseased. The small bowel is also called the small intestine. Most digestion (breaking down and absorbing nutrients) of the food you eat takes place in the small intestine.

Description:

You will receive general anaesthesia at the time of your surgery. The surgery can be performed laparoscopically or with open surgery.

If you have laparoscopic surgery:

• The surgeon makes 3 to 5 small cuts (incisions) in your lower belly. A medical device called a laparoscope is inserted through one of the cuts. The scope is a thin, lighted tube with a camera on the end. It lets the surgeon see inside your belly. Other medical instruments are inserted through the other cuts. Your belly is filled with a harmless gas to expand it. This makes it easy for the surgeon to see and work. The diseased part of your small intestine is located and removed.

Why the Procedure Is Performed

Small bowel resection is used to treat:

• A blockage in the intestine caused by scar tissue or congenital.
• Bleeding, infection, or ulcers caused by inflammation of the small intestine from conditions such as Crohn disease, cancer.

Risks:

Risks for this surgery include:

• Bulging tissue through the incision, called an incisional hernia, Damage to nearby organs in the body, Diarrhoea, Problems with your ileostomy
• Scar tissue that forms in your belly and causes a blockage of your intestines
• Short bowel syndrome (when a large amount of the small intestine needs to be removed), which may lead to problems absorbing important nutrients and vitamins
• Chronic anaemia

After the Procedure:

You will be in the hospital for 3 to 7 days. You may have to stay longer if your surgery was an emergency operation. You also may need to stay longer if a large amount of your small intestine was removed or you develop problems. By the second or third day, you will most likely be able to drink clear liquids. Thicker fluids and then soft foods will be added as your bowel begins to work again. If a large amount of your small intestine was removed, you may need to receive liquid nutrition through a vein (IV) for a period of time.

Laparoscopic Spleen Removal (Splenectomy)

What is the Spleen?

The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria.

How do I know if my spleen should be removed?

There are several reasons why a spleen might need to be removed, and the following list, though not all inclusive, includes the most common reasons.

Auto-immune thrombocytopenia purpura (ITP): This is the most common reason. In this disease, a patient’s platelet count is low because the body makes antibodies to the platelets which cause them to be destroyed in the spleen.

Haemolytic anaemia: In this disease the body makes antibodies to red blood cells which are subsequently destroyed in the spleen.

Hereditary (genetic) conditions: In these patients, the spleen recognizes the red cells as abnormal and may bring them down, possibly requiring splenectomy to improve the symptoms.

Malignancy: Rarely, patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukaemia, require spleen removal

What are the advantages of Laparoscopic Splenectomy?

Individual results may vary depending on your overall condition and health but the usual advantages are: Shorter hospital stay, Less postoperative pain, Quicker return to normal activities, Better cosmetic results, Faster return to a regular routine.

How is Laparoscopic Removal of the Spleen done?

You will be placed under general anaesthesia and be completely asleep. A cannula (hollow tube) is placed into the abdomen by your surgeon and your abdomen will be inflated with carbon dioxide gas. A laparoscope (a tiny telescope) is put through one of the cannulas which projects a video picture of the internal organs and spleen on a television monitor. Several cannulas are placed in different locations on your abdomen to allow your surgeon to place instruments inside your belly to work and remove your spleen. After the spleen is cut from all that it is connected to, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small, but largest incisions.

What happens if the operation cannot be performed or completed by the Laparoscopic Method?

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment.

Laparoscopic Ventral Hernia Repair

Laparoscopic ventral hernia repair is a technique to fix tears or openings in the abdominal wall using small incisions, laparoscopes and a patch (mesh) to reinforce the abdominal wall. It may offer a quicker return to work and normal activities with decreased pain for some patients.

What is a Ventral Hernia?

It usually arises in the abdominal wall where a previous surgical incision was made. In this area the abdominal muscles have weakened; this results in a bulge or a tear. This can allow a loop of intestines or other abdominal contents to push into the sac. If the abdominal contents get stuck within the sac, they can become trapped or “incarcerated.” This could lead to potentially serious problems that might require emergency surgery.

How Do I Know If I Have a Ventral Hernia?

A hernia is usually recognized as a bulge under your skin. Occasionally, it causes no discomfort at all, but you may feel pain when you lift heavy objects, cough, strain during urination or bowel movements. Any continuous or severe discomfort, redness, nausea or vomiting associated with the bulge are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon is recommended.

What Causes a Ventral Hernia?

An incision in your abdominal wall will always be an area of potential weakness. Hernias can develop at these sites due to heavy straining, aging, obesity, injury or following an infection at that site following surgery. Certain activities may increase the likelihood of a hernia including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining.

What are the Advantages of Laparoscopic Ventral Hernia Repair?

Shortened hospital stay, Quicker return to normal activity, Less post-operative pain, Faster return to regular diet, Less wound infections

How is Laparoscopic Ventral Hernia Repair Performed?

Ventral hernias do not go away on their own and may enlarge with time. Surgery is the preferred treatment. A laparoscope is inserted through a cannula (a small hollow tube). The laparoscope and TV camera allow the surgeon to view the hernia from the inside. Other small incisions will be required for other small cannulas for placement of other instruments to remove any scar tissue and to insert a surgical mesh into the abdomen. This mesh is fixed under the hernia defect to the strong tissues of the abdominal wall. It is held in place with special surgical tacks and in many instances, sutures. In a small number of patients the laparoscopic method cannot be performed. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment.

Liver Health

The liver is in the upper right part of the abdomen. The functions of the liver include: storing glycogen (fuel for the body) which is made from sugars; helping to process fats and proteins from digested food; making proteins that are essential for blood to clot (clotting factors); processing many medicines which you may take; helping to remove poisons and toxins from the body. The liver also makes bile which helps to digest fats.

Liver Health Conditions:

Alcohol Related Liver Disease:

Alcohol-related liver disease (ARLD) is where the liver is damaged by drinking too much alcohol. The liver is a complex organ that regulates blood sugar and cholesterol.

Liver Cancer:

This is a cancer that initiates in the cells of the liver called hepatocytes. The exact cause of liver cancer is unknown, but most are associated with liver damage known as cirrhosis.

Fatty Liver Disease:

This is a condition caused by the build-up of fat in cells in the liver. It can be caused by drinking too much alcohol but there are other non-related causes such as obesity, high blood pressure, high cholesterol, type 2 diabetes and smoking.

Hepatitis:

Hepatitis is a viral condition that causes the liver to become inflamed and damaged. The most common types are hepatitis B and C.

Gastric Balloon:

A gastric balloon is a non-surgical, short term weight loss option that creates a feeling of fullness quicker after smaller meals. It reduces your hunger allowing you to control your portion sizes and can be used as a stepping stone on the path to weight loss success. By using dietary advice you can learn healthy eating habits and change your lifestyle so that you can lose weight quickly and keep the pounds off long-term.

1. What is a gastric balloon?
A gastric balloon is a soft silicon balloon that is inserted into your stomach. The balloon partially fills the stomach which leads to a feeling of fullness.

2. What is involved in a gastric balloon procedure?
Whilst deflated the gastric balloon is inserted into your stomach through your mouth and oesophagus. This is done using a thin, flexible tube that has a light and a camera on one end, called an endoscope. You will be given a mild sedative or a “light” anaesthetic for this procedure. The procedure may be uncomfortable but is generally painless. It takes only 15 minutes and you will go home the same day. Normally after six months your gastric balloon is deflated and removed as there is an increased risk of balloon deterioration and perforation after this point.

3. Is a gastric balloon the right option for me?
A gastric balloon is recommended for patients who need to lose weight before an operation to reduce their surgical risk, or it can be used as a stand-alone, non-surgical treatment option for weight management. Weight loss with a gastric balloon can be less and slower than the surgical weight loss options. It is a useful way to lose weight if you don’t meet the criteria for the surgical weight loss procedures

4. The benefits
One major benefit of the gastric balloon is the avoidance of invasive surgery and the risks associated with surgery. As it only takes 15 minutes under a mild sedative you can go home the same day. This in turn means that a gastric balloon is less expensive than many surgical options. It is only temporary, offering support whilst you start to lose weight and become more active.

5. What are the risks?
Most people don’t experience any complications at all, but you should be aware of the risks. Bleeding or perforation can occur as a result of injury during the balloon insertion or removal. Gastric discomfort, nausea and vomiting are common for the first few days following balloon placement but rarely continue in the longer term. You may get a sense of heaviness in the abdomen, abdominal and/or back pain, gastro-oesophageal reflux (where stomach acid leaks out of the stomach) or indigestion. Although rare, leakage or deflation of the balloon could occur.

Gastric Band Surgery:

This is a common type of weight loss surgery that is carried out. A general anaesthetic is needed. During gastric band surgery, a special band is placed around the upper part of your stomach, essentially dividing your stomach into two. When you eat, food passes from your gullet (oesophagus) into the part of your stomach above the band. Because this upper section is smaller than the size that your whole stomach was previously, you will need to eat less than before to feel full. After eating, the food then gradually passes through to the section of your stomach below the band and is digested as normal. Gastric bands are designed so that their position can be adjusted after the surgery and so the amount of food that you are able to eat can be changed. The band is connected to a special port under your skin to allow this adjustment. Adjustments may be needed in the first few months after your surgery so that the setting that is best for you can be found. These adjustments can usually be made quickly in an outpatient clinic and you do not need another general anaesthetic or operation. Another advantage of gastric band surgery is that is can usually be carried out using laparoscopic surgery. This means a quicker recovery time afterwards. This surgery is also reversible. The band can be removed at a later date if required. However, there would then be a risk that you might put the weight back on. Gastric band surgery is generally one of the safest types of surgery for weight loss. However, the surgery does still carry some risks and complications. Sometimes a gastric band can slip out of place or it may wear through (erode) the wall of your stomach and become ineffective. A gastric band may also wear out and need replacing at a later date. However, these problems do not happen in everyone. If they do occur, another operation may be needed to replace the band.

What is Oesophageal Dilatation?

It is a procedure to widen the narrowing in your oesophagus. The first step is an endoscopy which you probably have experienced at an earlier date, but the procedure will take a few minutes longer as it is a little more than an inspection. The doctor will pass a slim flexible tube with a light on into your gullet (oesophagus) until it reaches the narrowing. In some patients a balloon dilator is used which is inserted into your gullet to the point of the narrowing and is then gently inflated to stretch your gullet. In other patients, a fine wire is passed through the endoscope into your stomach through the narrowing. The endoscope will then be removed leaving the wire in your gullet. The doctor will then pass the dilator over the wire and down to the narrowing. Firm but gentle pressure is used to push the dilator through the narrowing; this procedure is repeated using larger dilators until the narrowed area has been adequately stretched. 

Why Do I need Oesophageal Dilatation?

You have probably been troubled by some symptoms, which have led to your doctor advising you to have treatment called an oesophageal dilatation to stretch the narrowing (stricture) in your gullet (oesophagus). This will help relieve the swallowing difficulties you are experiencing. 

Can there be any complications or risks?

Perforation of the gullet:

Oesophageal Dilatation carries a risk of perforation (hole) of the gullet. In most circumstances the risk is 1%.  If this occurs, you may feel a pain in your chest or back, be short of breath and feel generally clammy and unwell.

Where will the test be performed?

Oesophageal dilatation is mostly performed in the Endoscopy Department. Specially trained doctors and nurses work here and are very experienced in performing oesophageal dilatation and in the care it involves.

Do I need sedation?

Yes. People have sedation to keep them comfortable while the doctor carries out the procedure. Sedation is given through a flexible needle in the back of your hand or arm. It makes you feel sleepy and relaxed but does not put you to sleep. 

Will I ever need an Oesophageal Dilatation again?

Yes, it is possible this procedure may have to be repeated periodically to enable food to pass down your gullet to your stomach.

Oesophageal stent procedure:

In an oesophageal stent procedure, a tube is placed in your oesophagus to keep open a blocked area. The tube helps you swallow solids and liquids. Your oesophagus is the muscular tube connecting the back of your mouth to your stomach. Many health problems can partly block a portion of your oesophagus. An oesophageal stent can help reopen your blocked oesophagus and ease symptoms. The procedure might take place under general anaesthesia or conscious sedation. If it takes place under general anaesthesia, you will sleep through the procedure and feel no pain. During the procedure, the surgeon places a long, thin tube (catheter) down the back of your mouth and into your oesophagus. Next, the surgeon places a folded-up hollow tube (stent) over the catheter in the correct position across the blockage. The stent expands against the walls of your oesophagus, giving support. Then the surgeon removes the catheter and leaves the stent in place.

Why might I need an oesophageal stent procedure?

You might need an oesophageal stent for a number of health problems. Traditionally, healthcare providers have most often used oesophageal stents to treat oesophageal cancer.

But these stents are also used to treat:

• Cancer of the stomach, narrowing of the oesophagus from an ulcer, Narrowing of the oesophagus from radiation treatment, A hole in the oesophagus

Oesophageal stent procedures are relatively safe. But they do sometimes cause problems later.

These might include:

• Pain in the oesophagus, Bleeding (usually mild), New hole in the oesophagus (rare)
• Movement of the stent, Tumour growth into the stent, Gastro-oesophageal reflux (GERD or heartburn)

Minimally invasive surgery:

Innovative Treatment Options Using Minimally Invasive Techniques

• Endoscopic and laparoscopic assisted surgery
• Use of robotics
• Transanal endoscopic microsurgery (TEM)
• Transanal minimally invasive surgery (TAMIS)

What is minimally invasive surgery?

This surgery involves making 2-3 smaller incisions approximately 0.5cm in length and one slightly larger incision (4-5cm).  Several types of minimally invasive surgery exist:

• Laparoscopic assisted surgery – This surgery involves the use of small ports that are inserted through the abdominal wall.  Fine instruments are passed through a channel in these ports to perform the surgery.  
• Robotically assisted surgery – This type of surgery is most commonly performed for tumours located in the sigmoid or rectum. This involves the use of surgeon-guided, robotic arms that help perform precise dissection with enhanced visualization.

What are the benefits of minimally invasive surgery?

• Smaller incisions
• Less post-operative pain
• Decreased use of pain medication
• Shorter hospital stay

What is TEM and TAMIS?

Transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) are similar techniques that allow surgeons to remove benign polyps and early stage cancers without the use of invasive surgery.

More about TEM

Developed in the 1980s, TEM was created  to enable surgeons to remove polyps and tumors in the  rectum using a port placed through the rectum and a microscopic lens.  This technology has demonstrated precise excision of polyps and tumors with preservation of anal sphincter muscle control.

More about TAMIS

TAMIS was developed in 2009 and has been utilized for the same indications as TEM.

What is the difference between TEM and TAMIS?

The primary difference between the two techniques is that a resterilized, reusable port is used for TEM, while a disposable port is used for TAMIS.

What are the benefits of TEM and TAMIS?

Many benefits have been noted for patients undergoing TEM and TAMIS: no visible incisions, decreased postoperative pain, faster recovery, and a shorter hospital stay. Some patients will even be discharged home the day of surgery.

Not all patients are candidates for minimally invasive surgery due to prior surgical history, overall fitness for surgery, and stage of cancer.  Discuss with your surgeon if you are a candidate for minimally invasive surgery and which approach is appropriate for you.