Skin conditions dealt with by general surgery include lumps, tumours and other lesions of the skin and underlying tissues. These are often fairly simple conditions that can be dealt with by performing minor operations under local anaesthetic (the area of skin being treated is numbed). Often these procedures are performed as outpatient or day case procedures.

Conditions of the gut dealt with by general surgery include disorders of the oesophagus, stomach, small bowel, large bowel and anus. These range from complex conditions such as ulceration or cancer in the bowel through to fairly minor conditions such as haemorrhoids. Many of the more major conditions such as bowel cancer will require surgery, or sometimes treatment with medication, chemotherapy or radiotherapy. Gastro-oesophageal Reflux Disease (GORD) is caused by the backflow (reflux) of food and stomach acid into the oesophagus (the tube that connects the mouth to the stomach) from the stomach. This happens when the valve between the stomach and the lower end of the oesophagus is not working properly. The main symptom of GORD is heartburn (a burning feeling in the stomach and chest). Laparoscopic Nissen Fundiplication is a surgical procedure for GORD that involves wrapping the top part of the stomach (fundus) around the lower end of the oesophagus. The valve between the stomach and the oesophagus is also replaced or repaired. Spleen Removal The spleen is a soft fleshy organ in the upper left abdomen that is involved in the formation and cleansing of blood. It may need to be removed if it becomes enlarged, has a tumour or cyst, or in the presence of certain blood disorders. Laparoscopic Splenectomy involves cutting the spleen free from its attachments and removing it through several small abdominal incisions. Appendicitis The appendix is a small worm-like tube attached to the intestine in the lower right abdomen. If it becomes blocked or infected it can cause appendicitis, which is recognised by pain on the right side of the abdomen, nausea and vomiting. Laparoscopic Appendicectomy is the removal of the appendix using surgical instruments inserted through incisions in the lower right abdomen.

The most common disorder of the liver and biliary system is pain caused by gallstones. These are formed when some of the watery fluid (bile) stored in the gallbladder hardens into pieces of stone-like material. Gallstones may vary from the size of a grain of sand to a golf ball and there may be one or hundreds of stones. Gallstones can cause abdominal pain, fever and vomiting if they block the movement of bile into or out of the gallbladder. Laparoscopic cholecystectomy is the surgical removal of the gallbladder. A laparoscope is inserted into the abdominal cavity at the level of the tummy button. Surgical instruments are inserted through other incisions and the gallbladder removed. The procedure takes about 1 hour to perform under general anaesthetic, and usually will involve an overnight hospital stay. Return to normal physical activities usuallly takes one to 2 weeks.

A hernia exists where part of the abdominal wall muscle is weakened or torn, and the contents of the abdomen push through to the outside. An inguinal or groin hernia forms when part of the intestine pushes through the abdominal wall, causing a bulge in the groin. This bulge is often aggravated by coughing, straining or exercise, or activities involving lifting. A hernia does not mend itself and usually gets worse with time. It can cause discomfort or pain, particularly with physical activity and feels best at rest. Occasionally it can lead to complications, such as strangulation of the intestine which is dangerous and requires emergency treatment. Laparoscopic hernia repair is one of the most commonly performed operations. It involves using surgical instruments to push the hernia back into its original position and repairing the weakness in the abdominal wall with a piece of thin and soft plastic (Prolene) mesh. This mesh becomes part of the abdominal wall giving strength and support and rarely causes any problems in itself. Hernias can recur (come back) but the likelihood of this is low and is in the order of 1 in 50 repairs. The surgery is performed under general anaesthetic, takes about 1 hour to perform, and may be daystay or overnight hospital stay, with review about 1 to 2 weeks later. Recovery may take 1 to 2 weeks. There are no stitches to remove, only the waterproof dressings at 5 days. Driving a car is not advised for 5 days, nor should you lift anything heavy (more than 5kg) for about 3 weeks or do anything strenous as such activities could damage the repair and result in recurrence of a hernia.

Vascular (blood vessel) disorders treated by general surgery include varicose veins, blockages and narrowings in the arteries or abnormal swellings of the arteries (aneurysm). The most common of these conditions facing the general surgeon is varicose veins. This occurs when veins in the legs and thighs become enlarged and twisted. This is often caused by the failure of the one-way valve system in the veins, in which case it can be treated surgically by removing the segments of veins containing the malfunctioning valves as well as those veins which are significantly dilated.

Gastroscopy allows examination of the upper part of your digestive tract i.e. oesophagus (food pipe), stomach and duodenum (top section of the small intestine), by passing a gastroscope (long, flexible tube with a camera on the end) through your mouth and down your digestive tract. Images from the camera are displayed on a television monitor. Sometimes a small tissue sample (biopsy) will need to be taken during the procedure for later examination at a laboratory. Gastroscopy may be used to diagnose peptic ulcers, tumours, gastritis etc. Complications from this procedure are very rare but can occur. They include: bleeding if a biopsy is performed; allergic reaction to the sedative or throat spray; perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication). What to expect All endoscopic procedures are viewed as a surgical procedure and generally the same preparation will apply. You will not be able to eat or drink anything for 6 hours before your gastroscopy. When you are ready for the procedure, the back of your throat will be sprayed with anaesthetic. You will also be offered medication (a sedative) to make you go into a light sleep. This will be given by an injection into a vein in your arm or hand. The gastroscopy will take approximately 15 minutes, but you will probably sleep for another 15 minutes. You will spend some time in a recovery unit (probably 1 hour) to sleep off the sedative and to allow staff to monitor you (take blood pressure readings etc). Because you have been sedated (given medication to make you sleep) it is important that you arrange for someone else to drive you home. Dr Sussman will come and speak to you once you are awake to go over the findings . If biopsies are taken for examination, your GP will be sent the results within 2-3 weeks. You may also be reviewed by Dr Sussman following the procedure to discuss these results.

Colonoscopy is the examination of your colon (large bowel) using a colonoscope (long, flexible tube with a camera on the end). The colonoscope is passed into your rectum (bottom) and then moved slowly along the entire colon, while images from the camera are displayed on a television monitor. The procedure takes from 10 minutes to an hour. Sometimes a small tissue sample (biopsy) will need to be taken during the procedure for later examination at a laboratory. A colonoscopy may help diagnose conditions such as polyps (small growths of tissue projecting into the bowel), tumours, ulcerative colitis (inflammation of the colon) and diverticulitis (inflammation of sacs that form on the walls of the colon). Colonoscopy may also be used to remove polyps in the colon (this is called a polypectomy). Risks of a colonoscopy are rare but include: bleeding if a biopsy is performed; allergic reaction to the sedative; perforation (tearing) of the bowel wall. These are very uncommon (less than 1 in 1500 procedures) but are serious if they do occur and may result in the need for emergency surgery. What to expect It is important that the bowel is completely empty before the procedure takes place. This means that you will only be able to have liquids on the day before, and will probably have to take some oral laxative medication (to make you go to the toilet more). When you are ready for the procedure, you will be given medication (a sedative) to make you go into a light sleep. This will be given by an injection into a vein in your arm or hand. The colonoscopy will usually take 15 – 30 minutes, but you will probably sleep for another 30 minutes. Because you have been sedated (given medication to make you sleep) it is important that you arrange for someone else to drive you home. Some patients may experience discomfort after the procedure, due to air remaining in the colon. Dr Sussman will discuss the findings with you on the day, and may arrange to see you a week or two later to discuss any biopsy results.

This is a condition which generally affects teenagers and young adults, but may occur at any age. Although more common in men it does occur in women too. It is often though not always seen in hairier individuals and may run in families. It usually presents with pain or discomfort and possibly swelling or a pus-like discharge affecting the natal cleft area (between the buttock cheeks) of the lower back. A Pilonidal Sinus is a cavity under the skin which may have a few openings visible on the skin surface in the midline of the natal cleft or just off the midline. These openings may have a few hairs protruding from them and may also discharge pus/blood stained fluid. The cavity itself can be quite large (several centimetres) and is often full of hair. The exact cause of these sinuses is not clear. The acute episode may settle with antibiotics, but surgery is required in most people to prevent recurrent problems. Many operations have been described to deal with this problem. The surgery involves cutting out the cavity and overlying skin openings. This can leave a sizeable defect which is at times left open to heal with daily dressings required over a period of weeks to months. The hole can be closed directly by pulling the edges together, but often this is under tension and in about 30% the sinus may recur. My preference in most people is to remove the sinus and close the resultant defect/"hole" with a flap of skin and tissue from the adjacent buttock. In my experience this will give the best result with the lowest likelihood of recurrent or ongoing problems. It is a more complex operation to perform but worthwhile in view of the superior results. The most common operation I perform is called a Karydakis procedure and on occasion I will perform a modified Limberg Procedure. It takes about 90 minutes to perform under general anaesthetic. A small plastic tube drain is left in place and removed on the ward just prior to discharge home the next day. Skin stitches are removed at 7 to 9 days at a follow-up visit. It is not a particularly painful procedure but strenuous physical activity must be avoided for at least 1 month after surgery to ensure good healing of the wound.