This is the dilatation or ballooning of a section of the aorta which is the main artery coming out of the heart. An aneurysm usually occurs because of an underlying weakness in the wall of the aorta at that point. Very often you will not have any symptoms from the aneurysm and it may only be discovered through a chest x-ray or CT scan. If the aneurysm begins to get larger or leak, you may experience chest or back pain. If there is a risk of the aneurysm bursting, surgery will be required.

General surgery covers breast diseases including breast cancer. These conditions are often initially dealt with in a specialised breast clinic which is able to perform a number of investigations (e.g. mammography, ultrasound, needle biopsy) during the initial outpatient clinic visit.

You have two carotid arteries, one on either side of your neck, that supply blood to your brain. Carotid artery disease occurs if these arteries become narrowed due to atherosclerosis (a build up of fat and cholesterol deposits on the inner walls of the vessels). If a clot forms in one of the carotid arteries and reduces or stops the flow of blood to part of your brain, it may cause a stroke. You have an increased risk of developing carotid artery disease if you: have a family history of atherosclerosis smoke have high blood pressure (hypertension) have diabetes have coronary artery disease. Treatment may involve lifestyle changes e.g. stopping smoking, exercising more, dietary changes and/or medication. If there is severe narrowing of the arteries, treatment may involve surgery. Surgical treatment: Surgical treatment Carotid Endarterectomy: an incision (cut) is made along the side of the neck, the carotid artery opened and the fatty material (plaque) removed. The artery is closed with a patch. Minimally invasive: a long thin tube (catheter) is inserted through a small incision made in the groin. The catheter is guided to the carotid artery where a balloon attached to the catheter is inflated to clear the blockage or a small metal tube (stent) is put in place to hold the blood vessel open.

The foreskin (flap of skin that covers the tip of the penis) may be removed for cultural, religious or medical reasons.

Abnormalities of the endocrine system treated by general surgery include disorders of the pancreas and adrenal glands in the abdomen and the thyroid and parathyroid glands in the neck. These are often very complex conditions requiring extensive investigations. If surgery is required it is often quite complicated and will usually mean a stay in hospital for several days or even longer.

A fold of tissue (frenum) that attaches to the cheek, lips and/or tongue is surgically removed.

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.

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.

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.

A hydrocoele is a fluid-filled mass that forms in the scrotum. In many cases it will disappear by itself, but sometimes surgery is required to drain the fluid out.

Hyperhidrosis is excessive sweating that may occur over the entire body or only in certain parts, most commonly the face, underarms, palms of the hands and soles of the feet. It may also refer to severe facial blushing. This condition is caused by overactivity of the nerves that carry messages to the affected sweat glands. These nerves are part of the 'sympathetic' nervous system, which means that they are 'involuntary' or not under our conscious control. Treatment may be with medication or, for facial and palm sweating, may involve a surgical procedure known as Endoscopic Thoracic Sympathectomy (ETS). This is a minimally invasive procedure (it does not require a large incision or cut to be made) and involves interrupting the nerves that supply the sweat glands.

Peripheral artery disease refers to the narrowing of arteries outside the heart and brain, usually as the result of atherosclerosis or "hardening of the arteries" (a build up of fatty deposits on the inner wall of arteries). When the arteries become narrowed, the flow of blood to the target organs or tissues is reduced. The arteries commonly affected are those carrying blood to the kidneys, stomach, arms and legs. Peripheral arterial disease often appears first in your legs, with the most common symptom being dull, cramping leg pain that occurs when exercising but stops when you stand still. This is known as "intermittent claudication". Treatment for peripheral arterial disease may involve medication and/or surgery.

Salivary Gland Malfunction Salivary gland malfunction that results in a decrease in saliva production can be caused by conditions such as Parkinson’s disease, depression, HIV infection and chronic pain. Saliva production can also be decreased by certain medications such as some antidepressants, antihistamines and sedatives. Reduced saliva can lead to increased tooth decay and difficulty speaking and swallowing. Good dental care is important in this condition. In some cases, saliva substitutes can be helpful. Salivary Gland Swelling If the duct or tube carrying saliva from the gland to the mouth becomes blocked, the gland will swell. The glands can also swell as the result of mumps, bacterial infections and certain other diseases. If the duct is blocked by a stone, it can sometimes be squeezed or pulled out but may on occasion require surgery to remove it.

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 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.

Vascular ulcers are open wounds on the skin that do not heal or that keep coming back once they do heal. They occur because there is not enough blood being supplied to the skin to heal injuries that may be caused by minor trauma or pressure. Arterial or ischaemic ulcers: are usually the result of atherosclerosis or "hardening of the arteries" (a build up of fatty deposits on the inner wall of arteries). When the arteries become narrowed, the flow of blood to the tissues is reduced. These ulcers are usually found on the toes and edge of the foot and are often very painful. Treatment for arterial ulcers may involve surgery. Venous or stasis ulcers: occur when impaired blood flow in the veins causes pooling of blood in the legs. These ulcers are often associated with varicose veins. Venous ulcers are usually found on the lower leg between the knee and the ankle and the leg is often swollen and discoloured. Compression or pressure bandages are the main treatment for venous ulcers although surgery may be required in some patients.

Undescended testes occur in less than 4% of children, and are more common in premature babies. Many “undescended” testes are simply lying very high in the groin and can be brought down by hand, and some true undescended testes will come down by themselves in the first year of life. After one year, undescended testes always remain so. If not treated there may be problems in adult life with infertility or an increased risk of cancer of the undescended testis. At the appointment, the surgeon will examine your child carefully to see if the testis can be felt in the body. If the testis can be felt, a simple operation under general anaesthetic (putting your child to sleep during the operation) would be performed between 9 and 12 months of age. If the testes cannot be felt, a different type of operation would be performed so that the surgeon can check where the testes are. In some cases, the testes are absent. Both types of surgery involve an overnight stay in hospital.

These are bulging veins that lie just beneath the skin (superficial veins). They occur when the walls of a vein are weak or damaged or if the valves in the vein that normally stop the blood from flowing backwards are impaired, resulting in pooling of the blood and stretched veins. Besides being unattractive, varicose veins can be painful and cause inflammation or ulceration. The following different types of surgery are available if varicose veins require treatment: Sclerotherapy: a tiny needle is used to inject a chemical solution into the vein that causes the vein to collapse. This approach is recommended for small varicose veins or spider veins that typically appear on the upper legs. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. Vein stripping: the varicose veins are cut out and the veins that branch off them are tied off. The cuts (incisions) made in the skin are closed with sutures. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia. Phlebectomy: small cuts (incisions) are made in the leg and the varicose veins are pulled out with a tiny hook-like instrument. The cuts are closed with tape rather than sutures and, once healed, are almost invisible. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia.

Vascular (blood vessel) disorders treated by general surgery include varicose veins, blockages and narrowings in the arteries or abnormal swellings of the arteries (aneurysm). The most common of these conditions facing the general surgeon is varicose veins. This occurs when veins in the legs and thighs become enlarged and twisted. This is often caused by the failure of the one-way valve system in the veins, in which case it can be treated surgically by removing the segments of veins containing the malfunctioning valves as well as those veins which are significantly dilated.