General Information for Surgery

This section will provide you with information about the most common operations performed in the private sector, that will include summary of the condition, the operation, potential side effects (both short and longterm) and recovery from surgery. The information provided here might not apply fully to your operation, therefore, the surgery will be discussed with you in the clinic and on admission before your surgery.

 

Generally before the operation, you may need to have some blood tests, chest X-Ray and trace for your heart (ECG). High risk patients or longer operations may require a review by the anaesthetist for further assessment. Before your surgery, you need to stay nil by mouth for 6 hours for food and 3 hours for fluids. Also you need to wear special stockings (TEDs) that the ward will provide to minimise the risk of DVT. After operation, you usually receive a Clexane injection under the skin (to thin the blood and reduce the risk of DVT) every night you are in the hospital.

Gallstone (stones within the GB) is a common condition affecting women more than men, with slight familial risk. Consumption of high fatty food for years could predispose to development of gallstones.  Losing weight in a short time (following bariatric surgery) could raise the workload of cholesterol on the GB and precipitate within the GB and form a nidus for gallstone. They are commonly asymptomatic and usually found incidentally by ultrasound scan requested to investigate another condition. They only cause symptoms in about 20% of patients having gallstones.

Reflux symptoms can affect anyone occasionally, but sometimes it becomes a recurrent or persistent problem that needs treatment. Reflux occurs when the stomach acid contents flows back into the gullet, which causes irritation to the lining layer. Most common reflux symptoms include: acidity, heartburn, regurgitation (feeling of fluid or food at the back of the throat), epigastric and retrosternal pain. Non-classical symptoms include respiratory symptoms (cough, asthma attacks, shortness of breath, recurrent chest infection), teeth problems (staining especially affecting the back teeth), upper gastrointestinal bleeding (vomiting blood or passing black stool), taste changes, and dysphagia (difficult swallowing). These symptoms could occur at any time but are particularly worse following meals and on lying down, sometimes waking the patient from sleep. 

Para-oesophageal hernia (POH) could be diagnosed incidentally or after becoming larger in size and symptomatic. It may be associated with reflux symptoms. It usually contains part or all of the stomach, but it may also contain spleen, pancreas, colon or small bowel. It consists of a sac which is a pouch from the abdominal lining (peritoneum) that protrudes into the chest into the posterior mediastinum (space behind the heart). The stomach may twist on itself in a condition called Volvulus. 

Achalasia is a rare condition where there is failure of the lower gullet valve to relax with swallowing and the gullet contractions are uncoordinated, with failure of propagation of the food bolus to transit along the gullet. The patient will suffer from gradual onset of progressive dysphagia (difficulty with swallowing) to food and fluids. It usually takes years to develop and diagnosed late due to gradual onset. It could affect any age, from teenage to elderly patients. Laparoscopic Heller’s Cardiomyotomy is the recommended operation for this condition especially in fit and well patients, usually young ones. Alternatively to surgery, the gastroenterologist may offer endoscopic balloon dilatation, Botox injection or a combination of both. The latter approach is usually advisable for elderly unfit patients. It has less risk but needs to be repeated every 1-2 years. 

Hernia is protrusion of intra-abdominal content (fat or bowel) through a defect or weakness in the abdominal wall. It can affect any age and is more common in men than women. Hernia in children has congenital factor attributing to its development while chronic cough, heavy weight lifting and straining are usually contribute to hernia in adults.

Abdominal wall hernia include epigastric, umbilical/para-umbilical, incisional and other rare hernias that involve the front of the abdomen wall. It may be an incidental finding or symptomatic. As any hernia, the usual way of repair involves using sutures or mesh, but with laparoscopic repair, we almost always repair with special mesh that fixed with clips and sutures to the abdominal wall. 

The appendix is a blind tubular structure that is connected to the first part of the large bowel (caecum) and has little physiological significance. It has a variable position that might affect the presentation if it becomes infected. Inflammation of the appendix (Acute Appendicitis) occurs when the neck of the appendix gets blocked with stool or similar stuff leading to flare up of the bacterial content within the blind tube and development of the clinical features. It usually involves young age group of patients, but may occur at any age.

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