A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside.

An inguinal hernia forms when part of the intestine pushes through the abdominal wall, causing a bulge in the groin.

A hiatus hernia is caused by part of the stomach and lower oesophagus bulging through the diaphragm (a sheet of muscle between the chest and the stomach) into the chest. A hiatus hernia can cause a burning feeling in the upper abdomen and chest (heartburn).

Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall (or diaphragm in the case of a hiatus hernia) in some way.

Please click to read more about Hernias

• Laparoscopic Hernia Repair (PDF, 699.3 KB)
• All About Hernias (DOC, 77 KB)
  

  Information about hernias

Over recent years it has become apparent that hernia operations can successfully treat muscular tears in the inguinal canal, called conjoined tendon tears. The operation is performed laparoscopically (keyhole surgery) and is successful in the vast majority of patients. The typical patient is someone with a several-month history of pain in the groin, not responding to physio and other treatment. The pain prevents running and other physical activity especially sport.

I have acquired considerable experience treating this condition over the last 15 years. Please see below for a presentation made to the College of Surgeons meeting in 2005.

• Sportsman's Hernia (PDF, 1.8 MB)
  

  A copy of a presentation made to the College of Surgeons meeting.

Please click here for patient information about the treatment of gallstones.

Please click here for more information about the gallbladder and gallstones.

• All about Gallstones (DOC, 106 KB)
  

  Patient information for treatment of gallstones

This is a procedure which allows the doctor to see inside your large bowel and examine the surfaces directly and take biopsies (samples of tissue) if needed. Treatment of conditions can also be undertaken.

What to expect
The colonoscope is a flexible plastic-coated tube a little thicker than a ballpoint pen which has a tiny camera attached that sends images to a viewing screen. You will be given a sedative (medicine that will make you sleepy but is not a general anaesthetic). The tube is passed into the rectum (bottom) and gently moved along the large bowel. The procedure takes from 10 minutes to 1 hour and your oxygen levels and heart rhythm are monitored throughout.
The procedure is performed in a day stay operating theatre.

Before the procedure
You will need to follow a special diet and take some laxatives (medicine to make you go to the toilet) over the days leading up to the test.

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.

Please click for more information on Colonoscopy

This is a procedure which allows the doctor to see inside your oesophagus, stomach, and the first part of the small intestine (duodenum) and examine the lining directly.

What to expect
The gastroscope is a plastic-coated tube about as thick as a ballpoint pen and is flexible. It has a tiny camera attached that sends images to a viewing screen. During the test you will swallow the tube but the back of your throat is sprayed with anaesthetic so you don't feel this. You will be offered a sedative (medicine that will make you sleepy but is not a general anaesthetic) as well. If the doctor sees any abnormalities they can take a biopsy (a small piece of tissue) to send to the laboratory for testing.
This is not a painful procedure and will be performed at the day stay unit in a theatre suite (operating room) by a specialist doctor with nurses assisting.

Complications from this procedure are very rare but can occur. They include:

• bleeding after a biopsy, if performed
• an allergic reaction to the sedative or throat spray
• perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication).

Before the procedure
You will be asked not to eat anything from midnight the night before and not to take any of your medications on the day of the procedure.

After the procedure
You will stay in the day stay unit until the sedation has worn off which usually takes 1-2 hours. You will be given something to eat or drink before you go home. If you have been sedated, you are not to drive until the following day.

If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks. A report and copies of these are sent to your GP.

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. 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/

Laparoscopic: several small incisions (cuts) are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon a view of the colon (also called bowel or large intestine) and, by inserting small surgical instruments through the other cuts, part or all of the colon can be removed. The two healthy ends of the colon are stitched back together (resected).

Open: an abdominal incision is made and part or all of the colon is removed.

Please click for more information on Colectomy

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.

Gastro-oesophageal Reflux Disease (GERD) 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 GERD is heartburn (a burning feeling in the stomach and chest).
Laparoscopic Nissen Fundiplication is a surgical procedure for GERD 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.

• Laparoscopic Surgery for Reflux (PDF, 1.9 MB)

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.