If weight loss is essential for you then surgery to achieve weight loss is your best chance of being able to shed some kilos and keep them off. Most people who have tried to lose weight using diet and exercise modification are successful with losing some weight but the majority will regain the weight they have lost within 2 years. Surgery has been proven to provide patients with excellent weight loss which lasts.

What is my BMI (Body Mass Index)? more

Types of surgery:

• Gastric Sleeve
• Gastric Bypass - for weight loss and reflux
• Revision Bariatric surgery

General surgery covers some disorders of the liver and biliary system. The most common of these is pain caused by gallstones. These are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach.

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way.

General surgery covers breast diseases including breast cancer. These conditions are often initially dealt with in a specialised breast clinic which is able to perform a number of investigations (e.g. mammography, ultrasound, needle biopsy) during the initial outpatient clinic visit.

Breast disorders may be noncancerous (benign) or cancerous (malignant) and range from conditions that require no treatment to those that require immediate and major surgery.

Common symptoms of breast disorders include breast pain, lumps and nipple discharge. Investigation of these symptoms by mammography and/or ultrasound may be all that is required for diagnosis but sometimes a needle biopsy may be necessary. This involves inserting a needle into an area of the breast that has been numbed by local anaesthetic and the removal of a small amount of tissue for examination under a microscope.

Breast disorders include:

• fibrocystic disease – benign changes in the breast tissue causes it to become dense or “lumpy”
• fibroadenomas – benign tumours of the breast tissue
• cysts – fluid-filled sacs
• breast infections
• breast cancer.

Many of these conditions do not require surgery and we will work with other specialists to find out the best treatment plan for you.

Breast Cancer Surgery

This may be:

• Simple or Total: all breast tissue, skin and the nipple are surgically removed but the muscles lying under the breast and the lymph nodes are left in place.
• Modified Radical: all breast tissue, skin and the nipple as well as some lymph tissue are surgically removed.
• Partial: the breast lump and a portion of other breast tissue (up to one quarter of the breast) as well as lymph tissue are surgically removed.
• Lumpectomy: the breast lump and surrounding tissue, as well as some lymph tissue, are surgically removed. When combined with radiation treatment, this is known as breast-conserving surgery.

Breast Reconstruction
When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later.

There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice.

Implants
A silicone sack filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 2-5 days.

Flap Reconstruction
A skin flap taken from another part of the body such as your back, stomach or buttocks, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital.

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.

Skin Cancer
New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.
Risk factors for developing skin cancer are:  prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.
 
There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.
 
Basal Cell Carcinoma (BCC)
This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body.  Sometimes BCC’s can ulcerate and scab so it is important not to mistake it for a sore.
BCCs occur more commonly on the face, back of hands and back.  They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.
 
Treatment
Often a BCC can be diagnosed just by its appearance.  In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.
Removal of a BCC will require an appointment with a doctor or surgeon.  It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.
 
Squamous Cell Carcinoma (SCC)
This type of skin cancer also affects areas of the skin that have exposure to the sun.  The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body.  The spreading (metastasising) can potentially be fatal if not successfully treated.
 
A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges.  SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown.  Sometimes it can appear like a recurring ulcer that does not heal.
All SCCs will need to be removed, because of their potential for spread.  The removal and diagnosis is the same as for a BCC.
 
Malignant Melanoma
This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.
A melanoma usually starts as a pigmented growth on normal skin.  They often, but not always, occur on areas that have high sun exposure.  In some cases, a melanoma may develop from existing pigmented moles.
 
What to look for:

• an existing mole that changes colour  (it may be black, dark blue or even red and white)
• the colour pigment may be uneven
• the edges of the mole/freckle may be irregular and have a spreading edge
• the surface of the mole/freckle may be flaky/crusted and raised
• sudden growth of an existing or new mole/freckle
• inflammation and or itchiness surrounding an existing or new mole/freckle.

Treatment
It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.
A biopsy or removal will be carried out depending on the size of the cancer.  Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required.  If the melanoma has spread more surgery may be required to take more of the affected skin.  Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread.
Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).
 
A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

Simple or Total: all breast tissue, skin and the nipple are surgically removed but the muscles lying under the breast and the lymph nodes are left in place.

Modified Radical: all breast tissue, skin and the nipple as well as some lymph tissue are surgically removed.

Partial: the breast lump and a portion of other breast tissue (up to one quarter of the breast) as well as lymph tissue are surgically removed.

Lumpectomy: the breast lump and surrounding tissue, as well as some lymph tissue, are surgically removed. When combined with radiation treatment, this is known as breast-conserving surgery.

Haemorrhoids are a condition where the veins under the lining of the anus are congested and enlarged. Less severe haemorrhoids can be managed with simple treatments such as injection or banding which can be performed in the clinic while larger ones will require surgery.

Haemorrhoid removal:

Haemorrhoidectomy: each haemorrhoid or pile is tied off and then cut away.

Stapled Haemorrhoidectomy: a circular stapling device is used to pull the haemorrhoid tissue back into its normal position.

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.

Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.

There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Basal Cell Carcinoma (BCC):

This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body. Sometimes BCCs can ulcerate and scab so it is important not to mistake it for a sore.

BCCs occur more commonly on the face, back of hands and back. They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.

Treatment:

Often a BCC can be diagnosed just by its appearance. In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.

Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.

Squamous Cell Carcinoma (SCC):

This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated.

A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal.

All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC.

Malignant Melanoma:

This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.

A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles.

What to look for:

• an existing mole that changes colour (it may be black, dark blue or even red and white)
• the colour pigment may be uneven
• the edges of the mole/freckle may be irregular and have a spreading edge
• the surface of the mole/freckle may be flaky/crusted and raised
• sudden growth of an existing or new mole/freckle
• inflammation and or itchiness surrounding an existing or new mole/freckle.

Treatment:

It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.

A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread.

Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).

A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

Skin lesions can be divided into two groups:

• Benign (non-cancerous): e.g. moles, cysts, warts, tags. These may be removed to prevent spreading (warts), stop discomfort if the lesion is being irritated by clothing/jewellery or to improve appearance.
• Malignant (cancerous): basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. Melanoma is a serious skin cancer that can spread to other parts of the body. Urgent removal is recommended.

Surgery to remove skin lesions usually involves an office or outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.

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: involves cutting the spleen free from its attachments and removing it through several small incisions (cuts) in the upper left abdomen.

Open: an incision is made in the upper left abdomen, the diseased or damaged spleen is then separated from its attachments and removed.

This service offers support to people who are overweight or obese to reach and maintain a healthy weight. Weight loss approaches may involve diet and lifestyle changes or weight loss medications, or both may be offered.