Gallstones are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach. 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 a view of the gallbladder and, by inserting small surgical instruments through the other cuts, the gallbladder can be removed. Open: an abdominal incision is made and the gallbladder removed.

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 hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way. Hiatus Hernia: Laparoscopic: several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the stomach and lower oesophagus that is bulging into the chest) back into position in the abdominal cavity. The hiatus (opening) in the diaphragm (a sheet of muscle between the chest and stomach) is tightened and the stomach is stitched into place. Open: an abdominal incision is made over the hernia and the hernia is pushed back into position in the abdominal cavity. The hiatus (opening in the diaphragm) is tightened and the stomach is stitched into place. Fundoplication: during the above procedures, the top part of the stomach (fundus) may be secured in position by wrapping it around the oesophagus. Inguinal Hernia: Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position. The weakness in the abdominal wall is repaired. Open: an abdominal incision is made and the hernia is pushed back into position. The weakness in the abdominal wall is repaired. Umbilical Hernia: An incision is made underneath the navel (tummy button) and the hernia (part of the intestine that is bulging through the abdominal wall) is pushed back into the abdominal cavity. The weakness in the abdominal wall is repaired. Incisional Hernia: Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position. Open: an abdominal incision is made and the hernia is pushed back into position.

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.

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. Laparoscopic Gastric Bypass involves bypassing a section of the intestine so that less food is absorbed. 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. Laparoscopic Gastric Banding is a surgical treatment for obesity that involves placing an inflatable cuff around the upper stomach. The cuff can be further inflated or deflated to adjust the volume of food that can be consumed. 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.

A PillCam is a small, capsule-shaped device with a built-in camera that patients swallow. As it moves through the digestive system, it takes thousands of pictures, helping doctors examine areas like the small intestine without the need for surgery. The images are sent to a recorder worn by the patient for approximately 8 hours and the device passes out of the body naturally in a bowel movement.

A flexible tube with a tiny video camera attached (endoscope) is inserted through the mouth into the stomach and small intestine while you are under sedation (you have been given medication to make you drowsy). A smaller tube is then moved through the first tube into the bile duct (the tube that connects your gallbladder and liver to your intestines) through which dye is injected and an x-ray is taken to visualise the ducts. Problems in the bile and pancreatic ducts can be found and treated with this procedure.

Gastroscopy allows examination of the upper part of your digestive tract i.e. oesophagus (food pipe), stomach and duodenum (top section of the small intestine), by passing a gastroscope (long, flexible tube with a camera on the end) through your mouth and down your digestive tract. Images from the camera are displayed on a television monitor. Sometimes a small tissue sample (biopsy) will need to be taken during the procedure for later examination at a laboratory. Gastroscopy may be used to diagnose peptic ulcers, tumours, gastritis etc. Complications from this procedure are very rare but can occur. They include: bleeding if a biopsy is performed; allergic reaction to the sedative or throat spray; perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication). What to expect All endoscopic procedures are viewed as a surgical procedure and generally the same preparation will apply. You will not be able to eat or drink anything for 6 hours before your gastroscopy. When you are ready for the procedure, the back of your throat will be sprayed with anaesthetic. You will also be offered 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 gastroscopy will take approximately 15 minutes, but you will probably sleep for another 30 minutes. You will spend some time in a recovery unit (probably 1-2 hours) to sleep off the sedative and to allow staff to monitor you (take blood pressure readings etc). Because you have been sedated (given medication to make you sleep) it is important that you arrange for someone else to drive you home. If biopsies are taken for examination, your GP will be sent the results within 2-3 weeks.

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.

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.

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)

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.

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.

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: involves cutting the spleen free from its attachments and removing it through several small incisions (cuts) in the upper left abdomen. Open: an incision is made in the upper left abdomen, the diseased or damaged spleen is then separated from its attachments and removed.

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.

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.