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).

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.

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.

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.

A range of surgical procedures may be performed on the liver, most involving removal of part of the liver. Surgery is most commonly required for primary liver cancer and metastatic cancer, like colorectal cancer, but sometimes for pre-cancerous lesions.

Types of surgery include:

• Whipple procedure: for lesions in the head of the pancreas
• Distal pancreatectomy: for lesions in the tail or body of the pancreas
• Total pancreatectomy

Surgery may involve open surgery or laparscopic/key-hole surgery

A range of surgical procedures may be performed on the pancreas, most involving removal of part of the pancreas. Surgery is most commonly required for pancreatic cancer but sometimes for pre-cancerous lesions.

Types of surgery include:

• Whipple procedure: for lesions in the head of the pancreas
• Distal pancreatectomy: for lesions in the tail or body of the pancreas
• Total pancreatectomy

Surgery may involve:

• A single large cut in the stomach (open)
• Using a tiny camera and tools inserted through several small cuts in the stomach (laparoscopic)
• Robotic arms used by the surgeon to help make the surgery more precise (robot-assisted)

Service types: Bariatric surgery procedures.

Laparoscopic Gastric Sleeve and Laparoscopic Gastric Bypass surgery

Gastro-oesophageal Reflux Disease (GORD) GORD 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 GORD is heartburn (a burning feeling in the stomach and chest).

Laparoscopic Nissen Fundiplication is a surgical procedure for GORD 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.

Cirrhosis is the term used to describe a diseased liver that has been badly scarred, usually due to many years of injury. Many people who have developed cirrhosis have no symptoms or have only fatigue, which is very common. However, as the cirrhosis progresses, symptoms often develop as the liver is no longer able to perform its normal functions.

Symptoms include:

• swollen legs and an enlarged abdomen
• easy bruising and bleeding
• frequent bacterial infections
• malnutrition, especially muscle wasting in the temples and upper arms
• jaundice (a yellow tinge to the skin and eyes)

Cirrhosis is diagnosed using a number of tests including: blood tests, ultrasound scans and a biopsy of the liver.

Treatment options depend on the severity of damage to the liver and include dietary changes and avoidance of substances such as alcohol that can further damage the liver. Medication may be given to prevent complications and treat symptoms of liver failure. There is no cure other than liver transplantation.

The best way to establish what type of liver disease is present and the extent of the disease, is a biopsy. It is usually performed by inserting a needle into the liver through the skin and taking a small sample of liver tissue. Examination of the sample under the microscope can demonstrate what damage or what type of disease is present. Before your doctor does this procedure, they will check whether or not you are at increased risk of bleeding by doing blood tests. Following the procedure, you will need to be monitored for several hours before you are discharged to go home.

The spleen is a soft fleshy organ in the upper left abdomen that is involved in the formation and cleansing of blood. It may need to be removed if it becomes enlarged, has a tumour or cyst, or in the presence of certain blood disorders.

Laparoscopic Splenectomy involves cutting the spleen free from its attachments and removing it through several small abdominal incisions.

Conditions managed include benign functioning or malignant lesions of the adrenal glands. 
Surgery offered includes: laparoscopic total or partial adrenalectomy, or open adrenalectomy depending on the size and whether surrounding organs are involved.

Skin conditions dealt with include lumps, tumours, cysts 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.

Laparoscopic: several small incisions (cuts) are made in the lower right abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) in inserted. This allows the surgeon a view of the appendix and, by inserting small surgical instruments through the other cuts, the appendix can be removed.

Open: an incision is made in the lower right abdomen and the appendix removed.

Laparoscopic Gastric Sleeve and Laparoscopic Gastric Bypass surgery

Partial: the diseased part of the stomach is removed and the remaining section is reattached to the oesophagus (food pipe) or small intestine.

Total: all of the stomach is removed and the oesophagus is attached directly to the small intestine.

This service offers support to people who are overweight or obese to reach and maintain a healthy weight. Weight loss approaches may involve diet and lifestyle changes or weight loss medications, or both may be offered.

Skin lesions can be divided into two groups:

• Benign (non-cancerous): e.g. moles, cysts, warts, tags. These may be removed to prevent spreading (warts), stop discomfort if the lesion is being irritated by clothing/jewellery or to improve appearance.
• Malignant (cancerous): basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. Melanoma is a serious skin cancer that can spread to other parts of the body. Urgent removal is recommended.

Surgery to remove skin lesions usually involves an office or outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.

Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.

There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Basal Cell Carcinoma (BCC):

This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body. Sometimes BCCs can ulcerate and scab so it is important not to mistake it for a sore.

BCCs occur more commonly on the face, back of hands and back. They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.

Treatment:

Often a BCC can be diagnosed just by its appearance. In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.

Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.

Squamous Cell Carcinoma (SCC):

This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated.

A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal.

All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC.

Malignant Melanoma:

This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.

A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles.

What to look for:

• an existing mole that changes colour (it may be black, dark blue or even red and white)
• the colour pigment may be uneven
• the edges of the mole/freckle may be irregular and have a spreading edge
• the surface of the mole/freckle may be flaky/crusted and raised
• sudden growth of an existing or new mole/freckle
• inflammation and or itchiness surrounding an existing or new mole/freckle.

Treatment:

It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.

A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread.

Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).

A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

Peptic ulcers are sores or eroded areas that form in the lining of the digestive tract. They usually occur in the stomach (gastric ulcer) or in the duodenum (duodenal ulcer), which is the first part of the small intestine.

People with peptic ulcers can have a wide variety of symptoms and signs, can be completely symptom-free or, much less commonly, can develop potentially life-threatening complications such as bleeding. Signs and symptoms of ulcers include:

• pain / burning or discomfort (usually in the upper abdomen)
• bloating
• an early sense of fullness with eating
• lack of appetite
• nausea
• vomiting
• bleeding, which is made apparent by blood in the stool, either in noticeable or microscopic amounts (very brisk bleeding will result in black and tarry stools that smell bad)

Smoking, alcohol, anti-inflammatory medication and aspirin increase the risk of developing ulcers. Psychological stress and dietary factors (once thought to be the cause of ulcers) do not appear to have a major role in their development.

Helicobacter pylori, a bacteria that is frequently found in the stomach is a major cause of stomach ulcers. If this is found you will be given a course of antibiotics.

Diagnosis is made by the history, examination and sometimes blood tests. You may be asked to have a gastroscopy (see above) to clarify the diagnosis and aid with treatment.

Treatment consists of medication to reduce the amount of acid in the stomach which aids in the healing of ulcers and avoidance of things that cause ulcers in the first place.

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.