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.

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 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.

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). Laparoscopic Hernia Repair involves using surgical instruments to push the hernia back into its original position and repairing the weakness in the abdominal wall (or diaphragm in the case of a hiatus hernia).

Gastro-oesophageal Reflux Disease (GERD) occurs when the valve between the stomach and the lower end of the oesophagus is not working properly. Laparoscopic Nissen Fundoplication 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.

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.

Haemorrhoids 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. Colectomy (Bowel Resection) 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. Colostomy An opening is made in the skin of the abdomen (stomach) to allow drainage of stools (faeces) from the colon into a collection bag on the outside. This may be temporary to allow time for healing of the colon or, if the entire colon has been removed, it may be permanent. Rectal Resection Laparoscopic: several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon to view the rectum and, by inserting small surgical instruments through the other cuts, part or all of the rectum can be removed. Open: an abdominal incision is made and part or all of the rectum removed. Colorectal Cancer 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 barium enema – a chalky white substance (barium) and air are pumped into the colon and x-rays are taken biopsy – a small piece of tissue is removed for examination under a microscope Stool blood tests, sigmoidoscopy, colonoscopy and barium enemas are also 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. 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.

Thyroidectomy An incision (cut) is made in the front of and at the base of the neck and part or all of the thyroid gland is removed. Parathyroidectomy An incision (cut) is made in the front of and at the base of the neck and one or more of the parathyroid glands are removed.

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.