Endoscopy is the passage of a flexible telescope into the intestinal tract to diagnose conditions such as ulcers, polyps or cancerous growth. An endoscopic examination of the oesophagus (swallowing tube), stomach and duodenum is called oesophago-gastro-duodenoscopy (OGD) or gastroscopy. Colonoscopy is endoscopic examination of the entire length of the colon. It is possible to perform localized injections, biopsy of an ulcer or growth and removal of polyps in the stomach or colon via the endoscope. Endoscopy is usually performed under local anaesthetic or intravenous sedation. Patients do not normally have to spend a night in the hospital.
Common conditions such as hernias, appendicitis, growth or strictures involving the small intestine and ulcers of the stomach or duodenum are routinely treated by a general surgeon. A general surgeon also manages other conditions such as breast lumps and thyroid nodules or swellings. These operations, when necessary, are normally performed under general anaesthesia and require hospital stay.
Colon and rectal cancers are common cancers in both males and females. After diagnosing the cancer with a colonoscopic examination, complete removal of the colon or rectal cancer affords the best chance of cure. Other non cancerous conditions such as haemorrhoids, fistula, perianal sinuses and diverticular disease are also under the ambit of colorectal surgery. Major colorectal operations require variable length of hospital stay.
Laparoscopic surgery, also known as keyhole surgery, affords patient a shorter recovery time as compared to an open operation. The most routinely performed laparoscopic surgery includes laparoscopic cholecystectomy (removal of gall bladder) and hernia repair. Other conditions such as stones in the common bile duct, colon cancer and liver cancer can be laparoscopically treated but this is only applicable to a select group of patients.
Gall Bladder Surgery
When laparoscopic cholecystectomy cannot be completed or performed due to abnormal anatomy, severe inflammation, bleeding or fibrous adhesions in the abdominal cavity, conventional open surgery has to be performed. Other gall bladder conditions such as the presence of a large gall bladder polyp, gallstones eroding into the wall of the bile duct and gall bladder cancer are not suitable for laparoscopic surgery. For example, removal of a gall bladder cancer is usually combined with the removal of part of the liver which the gall bladder is attached to.
Bile Duct Surgery
Bile ducts are the tubular structures which carry bile, the liver secretion, into the duodenum. Stones within the bile duct, inflammation of the bile ducts, strictures of the ducts and cancer of the bile ducts (called cholangiocarcinoma) are a few of the conditions which require the expertise of a general surgeon with special training and experience in hepatobiliary and pancreatic surgery.
The pancreas is a deep seated organ in the upper abdomen. It can be affected by the presence of stones within its duct, inflammation and various types of cancerous growth. Chronic inflammation of the pancreas (called chronic pancreatitis) can lead to stricturing of the pancreatic duct and chronic pain. In some patients, relief of the severe chronic pain may be achieved by performing a drainage procedure. This involves the stitching of a length of small intestine to the pancreatic duct. Pancreatic cancer is rare but the best outcome is usually seen in those who can undergo successful complete removal of the cancerous growth.
The liver receives all the blood returning from the organs within the abdominal cavity. It ‘filters’ the blood for bacteria, noxious material in the blood and abnormal cells. Essentially it is acting as the ‘gate-keeper’. The liver is made up of liver cells and bile ducts. Consequently it can develop all the bile duct conditions mentioned above. However the removal of a cholangiocarcinoma here will require the removal of part of the affected liver as well. The two most common types of liver cancer are primary liver cancer (called hepatocellular carcinoma or hepatoma) and secondary liver cancers (these are cancers which have migrated from other organs in the abdomen to the liver, for example, colon cancer). The only chance to cure liver cancer is to perform liver surgery to remove the cancer completely. Liver surgery is complex and requires the expertise of a surgeon who has been well trained and is experienced in hepatobiliary and pancreatic surgery.