Our Procedures

We offer state-of-the-art gastrointestinal cancer screening and diagnoses as well as the latest advances in surgical interventions for oesophageal, gastric and colon cancers. Your treatment will be managed by a team of healthcare professionals known as a multi-disciplinary team (MDT). Members of the MDT will include myself, a clinical oncologist (a specialist in the non-surgical treatment of cancer) and a specialist cancer nurse, among others. Your MDT will recommend what they think is the best treatment for you.

An endoscopic procedure involves the passage of a flexible fibreoptic telescope into the gastrointestinal tract to visualise the lining and in certain situations may allow operations to be performed. If the gullet, stomach and duodenum are to be inspected (gastroscopy) an endoscope about the size of your little finger is passed through the mouth and into each of these organs. For examination of the large bowel (colonoscopy) a longer endoscope is required and this is passed through the back passage around the whole length of the large bowel. This is a longer procedure and is usually performed under sedation however if only the rectum and left side of the colon are required to be visualised a flexible sigmoidoscopy can be performed.

Diagnostic endoscopy is performed as part of the investigation of symptoms and is often performed as part of an ongoing process of investigation.  In general , endoscopic examination allows us to visualise the gastro-intestinal tract and take biopsy specimens for microscopic examination and confirmation of many disease processes.

Upper gastro-intestinal endoscopy (gastroscopy) allows visualisation of the oesophagus, stomach and duodenum and is particularly useful in the investigation of patients with indigestion, swallowing difficulties, upper abdominal pain, vomiting, iron deficiency anaemia and any suggestion of bleeding from the upper GI tract.  

Examination of the lower GI tract is undertaken using a colonoscope  passed via the anus. Patients with symptoms of rectal bleeding, lower abdominal pains and change in bowel habit would be considered for colonoscopy.  Increasingly colonoscopy is being used as part of screening investigations for bowel cancer so that pre-cancerous conditions may be detected and prevented from progressing or alternatively cancers may be detected at an early stage when cure can be considered possible.  Patients who have previously had a bowel cancer or certain types of polyps removed should undergo regular surveillance colonoscopy as they at increased risk of developing further polyps.

In addition to diagnostic procedures both upper and lower GI endoscopes can be used for a variety of therapeutic procedures such as removing polyps and dilatation of narrowed areas within the oesophagus.

Gastrointestinal endoscopy is a very safe procedure but as with all interventions there is a small risk of complications. In most cases these are minor and self limiting. Other complications include bleeding from the site of a biopsy or a tear in the lining of the intestine.

The commonly performed procedures are listed below:

• Gastroscopy
• Bravo capsule endoscopy
• Endoscopic Ultra Sound Scan
• Colonoscopy
• Flexible Sigmoidoscopy

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include: Reduced hemorrhaging, which reduces the chance of needing a blood transfusion. Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring. Requirement for less pain medication.

Although procedure times are usually slightly longer, hospital stay is less, and mostly with a same day discharge which leads to a faster return to everyday living.

The following are the commonly performed laparoscopic procedure are;

• Anti-reflux Surgery
• Laparoscopic Gall Bladder Surgery
• Laparoscopic Hernia Surgery
• Laparoscopic Colonic Surgery
• Diagnostic Laparoscopy and Laproscopic Appendicectomy

Gastro-oesophageal reflux is the presence of stomach contents within the oesophagus (gullet).  A degree of gastro-oesophageal reflux is a normal phenomenon but the protective mechanisms of the oesophagus generally ensure episodes are short lived.  However, the lining of the oesophagus is more easily damaged than that of the stomach and in addition is very sensitive therefore frequent and excessive exposure to gastric secretion may lead to inflammation and symptoms of heartburn. 

Skin and Soft Tissue

This includes many relatively minor procedures in different anatomical locations. In general, surgery is indicated if:

    1.    There is any concern that the lump/mole etc could be a cancer or pre-cancerous lesion.

    2.    There is pain or the lesion is interfering with daily activities.

    3.    There is an obvious cosmetic problem with the lesion.

What are gallstones?

Bile is produced in the liver and is a mixture of the byproducts of metabolism and important components for digestion. Bile contains cholesterol, bile salts and waste products like bilirubin.  In general some of these components are very soluble (bile salts) and others are difficult to keep in solution (i.e. breakdown products of fats and cholesterol). The balance of soluble products to insoluble products partially determines an individual’s liability to form gallstones. There are two basic types of gallstone.

Problems with rectum and anal canal are common. The most common include haemorrhoids, fissures and fistulas, abscesses; all of these are benign but may cause considerable discomfort.  Symptoms of more serious diseases such as inflammatory bowel disease, colonic and anal cancer may be similar to those of the more common benign diseases therefore seeing your doctor about problems in this area is important.

What are the common symptoms of  ano-rectal disease?

The most common symptoms are:

• Rectal bleeding
• Pain
• Discharge
• Itching (Puritis ani)

Rectal bleeding is always abnormal.  In most cases it will be due to benign conditions but it may also be a symptom of colonic cancer or other serious disease therefore it is important that medical attention is sought at an early stage.  Although the pattern of bleeding may point to the site of bleeding it is not possible from history alone to determine the cause of bleeding and an examination is required. Many patients will feel reassured that they have undergone a screening test that are normal i.e. have submitted stool samples for testing of microscopic blood. It is important to note that even if these were normal and a patient has rectal bleeding this should be investigated as negative tests only indicate there was no bleeding at the time the test was taken.

Pain

Pain in or around the anus is usually a symptom of diseases at the anal margin – most commonly a fissure or an abscess. Rarely an anal cancer may present with pain.

An anal fissure is a crack in the skin at the anal margin – most commonly it occurs at the 6 o’clock position and may be associated with a small skin tag which is easily felt.  The most common symptom is pain related to passing stool.  Anal fissures may be associated with fresh rectal bleeding and often relate to constipation. Treatment is most often possible with local ointments but if this is not successful injection with Botox or surgery (sphincterotomy) may be required. 

An abscess is a collection of pus, often under pressure and is extremely painful until it is drained by surgery.  In this region abscesses are classified according to their position - the commonest are:  ischio-rectal and perianal.  An ischiorectal and periananl abscess may be secondary to a connection between the anal canal and the external skin (Fistula-in-ano). To prevent a further abscess developing this will require treatment in its own right once the abscess has been drained.  

Discharge

An abnormal discharge from the anus may relate to diseases of the bowel producing excess mucous, haemorrhoids or rectal prolapse or a fistula in ano.  Mucous (or slime) is normally produced by the bowel lining however any inflammation may lead to excess mucous production which is apparent as a discharge.  Some growths of the rectum such as polyps and tumours may produce large qualities of mucous.  

Incontinence

Incontinence of stool is much more common than most people think; probably because most sufferers are embarrassed and reluctant to come forwards with the problem.  It should also be remembered that there are different degrees of continence and some patients may experience a mild discharge that they are unable to control while others have faecal soiling.  In general the causes of incontinence can be divided into:

• Problems with the bowel causing excess stool i.e. if there is excessive diarrheoa.
• Weakness of the anal sphincter mechanism possibly from previous injury – the most common relating to child birth.
• Problems with perception i.e. if a patient is unaware that there is stool in the rectum they may become incontinent – this may relate to chronic conditions affecting sensation.
• Initial investigations will be to ensure that there is no underlying bowel disease and a sigmoidoscopy will be required.  Further investigation may require measurement of the strength and fuctionng of the anal muscles.

Peri-anal itching (Purities Ani)

Again this is a relatively common condition and it may relate to problems with the bowel resulting in diarrhoea and /or discharge which irritates the skin around the anus.  Any problems encountered with cleaning the area around the anus may lead to an itch – this is most commonly encountered in patients with peri anal skin tags which may make cleaning after a stool difficult.  Alternatively it may be due to irritation of the surrounding skin from an unrelated cause i.e. skin conditions such as dermatitis.

Herniae of the abdominal wall represent common surgical complaints which are often troublesome and interfere with a patient’s work and daily routine. The most up-to-date minimally invasive techniques are utilised to ensure that patients with herniae are offered effective treatment with the aim of optimising their post operative recovery.