Laparoscopic (or keyhole) surgical procedures are performed through several small cuts (incisions) usually only 5-10mm long, rather than through one large incision.

A long, narrow surgical telescope (laparoscope) that has a tiny camera and light source attached, is inserted through one of the incisions so that the surgeon can view the inside of the body on a TV monitor.

The surgeon then passes specially designed surgical instruments through the other incisions and carries out the procedure using the TV monitor to guide the instruments.

Laparoscopic surgery is usually associated with less blood loss during surgery and less pain and scarring following surgery. In most cases, time spent in hospital is less and overall recovery time from the operation is less than with conventional open surgery.

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.

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.

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.

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.

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:                         

o      abdominal pain

o      diarrhoea with bleeding

o      tiredness

o      fevers

o      infections around the anus (bottom) 

o      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.

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.

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.

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.