General Surgery

Laparoscopic inguinal hernia is performed to treat an inguinal or femoral (groin) hernia. It commonly presents as pain or a lump. An groin hernia is a protrusion of abdominal contents through a defect in the layers of the abdominal wall. These can occur secondary to a congenital defect or secondary to a defect developed over time within the abdominal wall. Operative management includes Totally Extra-peritoneal (TEP or laparoscopic) hernia repair or open hernia repair.

Indications
Repair is generally recommended for all patients who are:

• Symptomatic
• Irreducible (unable to be pushed back)
• Contain Bowel
• All femoral hernias

Surgery
Laparoscopic surgery involves 3 small incisions below your umbilicus. The layers of the abdominal wall will be inflated with gas to create space for your surgery to be performed. Surgical instruments will be introduced to assist in reducing your hernia. Your surgeon will then place a mesh in the pre-peritoneal space to cover the defect in the abdominal wall. Your surgeon will close the small cuts with sutures. Approximately 1 in 100 patients will be converted from laparoscopic to an alternate operation. In this circumstance, your operation would convert to either a trans-abdominal approach (within the abdominal cavity) or open surgery. Generally the surgery can be performed as day or overnight surgery.

Risks
May Include: pain, bleeding, recurrence (2-3%), chronic ongoing pain (1%) – may warrant further investigation or treatment.

Indications
Repair is generally recommended for all patients who are:

• Symptomatic
• Irreducible (unable to be pushed back)
• Contain Bowel
• All femoral hernias

Surgery
Surgery is typically performed laparoscopically however occasionally surgery will be converted to an open operation. Surgery involves reducing the hernia contents back into the abdomen. The defect in the abdominal wall is closed and often reinforced with a mesh to reduce the risk of recurrence.

Risks
Can include: pain, bleeding, recurrence of the hernia, injury to abdominal contents including bowel

Indications
Gallstones are the main indication for cholecystectomy. Gallstones can cause a variety of complications including pain, inflammation, infections and pancreatitis. Other rarer indications are gallbladder cancer, gallbladder polyps and acalculous cholecystitis.

Surgery
Surgery will typically be performed laparoscopically through 4 ports. Most patients will be discharged home the same day or the day following surgery. During surgery the gallbladder will be completely removed with clips placed on the ducts and artery supplying the gallbladder. An x-ray will be performed at the time of procedure to assess the bile duct for further stones. These may be removed at the time of theatre if able, otherwise further endoscopic management will be required.

Risks
May include: pain, bleeding, wound infection, bile duct injury (<1%)

Indications
It can be utilised as a diagnostic or therapeutic procedure.

Common diagnostic indications include:

• Investigation of symptoms – difficulty swallowing, abdominal pain, nausea, bloating, bleeding or iron deficiency
• Surveillance of diseases – Barrett’s Oesophagus, achalasia, peptic ulcer disease, gastritis or polyps/tumours.

Therapeutic endoscopy can be utilised for a variety of conditions and involves the treatment of bleeding, tumours, pre-cancerous lesions, strictures or functional problems.

Surgery
Upper endoscopy is typically performed as a day procedure.

Risks
The risks are minimal however commonly symptoms includes nausea and bloating. Less common risks include bleeding (1%) or perforation (0.033%).