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 30 minutes. You will spend some time in a recovery unit (probably 1-2 hours) 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. If biopsies are taken for examination, your GP will be sent the results within 2-3 weeks.

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. 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. 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.

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 Treatment Banding: this procedure can be performed in clinic where rubber bands are placed on the haemorrhoids. These will cause the bulk of the haemorrhoid to fall off after a few days Injection: injection with a sclerosing agent (e.g. phenol) is injected into the haemorrhoid causes the blood vessel to harden and fall off Haemorrhoidectomy: reserved for use with external/prolapsed haemorrhoids where each haemorrhoid or pile is ligated off and cut away.

A hernia exists where part of the abdominal wall is weakened and the contents of the abdomen push through to the outside. Common areas including the groin (inguinal or femoral), belly button (umbilical) or following previous abdominal surgery (incisional). Laparoscopic Hernia Repair involves using surgical instruments to push the hernia back into its original position and repairing the weakness in the abdominal wall. Open Hernia Repair are widely used and still remain the gold-standard for the treatment of groin hernias.

General surgery covers some disorders of the liver and biliary system. The most common of these is pain caused by gallstones. Sometimes, some of the watery fluid (bile) stored in the gallbladder hardens into pieces of stone-like material known as gallstones. 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 telescope (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.

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.

There are two types of IBD, ulcerative colitis and Crohn’s disease. In these conditions, the immune system attacks the lining of the colon causing inflammation and ulceration, bleeding and diarrhoea. In ulcerative colitis this only involves the large intestine, whereas in Crohn’s disease areas within the entire intestine can be involved. Both diseases are chronic (long term) with symptoms coming (relapse) and going (remission) over a number of years. Symptoms depend on what part of the intestine is involved but include: abdominal pain diarrhoea with bleeding tiredness fevers infections around the anus (bottom) weight loss can occur if the condition has been present for some time. Diagnosis is made when the symptoms, examination and blood tests suggest inflammatory bowel disease, infection is ruled out, and you undergo a colonoscopy with biopsy. Treatment depends on the severity of the symptoms and what part of the intestine is affected. This usually involves management by a gastroenterologist with support/input from surgeons if required. Medication is aimed at suppressing the immune system, which is harming the lining of the bowel. This is done via oral or intravenous medication as well as medication given as an enema (via the bottom). Other treatments include changes in the diet to optimise nutrition and health. Treatment in some cases requires surgery to remove affected parts of the bowel. For more information see http://crohnsandcolitis.org.nz/

This is cancer that begins in your colon or rectum. Often, it may start as a polyp which is a growth of abnormal tissue on the lining of the colon or rectum. Most people will not have symptoms of colorectal cancer until the disease is at a fairly advanced stage. Then they may experience symptoms such as: change in bowel habit that lasts for more than a few days blood in the stool stomach pain. Tests used to confirm a diagnosis of colorectal cancer include: stool blood test – a sample of stool is tested for traces of blood sigmoidoscopy colonoscopy virtual colonoscopy (CT colonography) biopsy – a small piece of tissue is removed for examination under a microscope These tests are alson used as screening tests to look for colorectal cancer in people without symptoms. If these tests find cancers at an early stage, the chances of successful treatment are much higher than when the cancers are further advanced. Screening tests can also involve the removal of polyps that may become cancerous in the future. In New Zealand, The National Bowel Screening Programme provides screening for eligible 60 to 74 year olds via a stool blood test. For more information please visit https://www.timetoscreen.nz/bowel-screening/ Treatment The choice of treatment depends on your overall health as well as how far advanced the cancer is. This is determined in a process known as ‘staging’ in which the tumour size, lymph node involvement and spread to other organs is assessed. The three main forms of treatment for colorectal cancer are: Surgery – the most common treatment. Surgery may involve ‘Open Surgery’ in which a large incision (cut) is made in your abdomen or ‘Laparoscopic Surgery’ in which several much smaller incisions are made. The section of the colon or rectum with the cancer is removed and the two ends are reconnected. In some cases, a temporary or permanent colostomy may be required to remove body wastes. Chemotherapy – anticancer medicines, either taken by mouth (oral) or injected into a vein (intravenous), can destroy cancer cells and slow tumour growth. Chemotherapy is useful to treat cancers that have spread to other parts of the body and may also be used before or after surgery or in combination with radiation therapy. Radiation Therapy – high energy x-rays are used to destroy cancer cells or shrink tumours. It is often used together with surgery, in some cases to shrink the tumour before surgery, or to destroy any cells that may be left behind after surgery.

Bariatric or weight loss surgery refers to a number of different procedures that can be performed to treat obesity. Procedures fall into three main types: Malabsorptive - these procedures involve bypassing a section of the small intestine thus reducing the amount of food absorbed into the body. Restrictive - these procedures involve reducing the size of the stomach, usually by creating a small pouch at the top of the stomach which limits the amount of food that can be eaten. Malabsorptive/Restrictive Combination - these procedures combine both techniques e.g. gastric bypass surgery in which a small stomach pouch is formed and its outlet connected to part of the small intestine.

Abnormalities of the endocrine system treated by general surgery include disorders of the pancreas and adrenal glands in the abdomen and the thyroid and parathyroid glands in the neck. These are often very complex conditions requiring extensive investigations. If surgery is required it is often quite complicated and will usually mean a stay in hospital for several days or even longer.

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.

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.