Procedures

This page provides some information about what to expect with a number of different procedures, it does not replace discussing your procedure with a medical professional. This is not an exhaustive list of surgeries offered, and is just a snapshot of some of the more common procedures, here for your reference. Your procedure will be discussed with you fully during your consultation when you will have the chance to ask questions and seek more information.

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Cholecystectomy

Cholecystectomy is most frequently performed using laparoscopic (keyhole) surgery.

The Procedure

For elective surgery, you will be admitted to hospital on the day of your procedure. After coming through the admissions unit, you will be brought to the operating theatre where the anaesthetist will greet you in the anaesthetic bay, a small room right outside the operating theatre.

Next, you will come into the operating theatre and then be administered a general anaesthetic, meaning that you will be unconscious and unaware of anything further until you wake up in the recovery unit.

The surgery involves shaving and cleaning the skin before making four small incisions of 7-15mm (the keyholes). The largest is at your belly button, with the remaining in a row under your right rib cage. The gallbladder is identified and mobilised from the liver where it grows. The bile duct and artery to the gallbladder are clipped with metallic clips and the gallbladder is removed. As part of the procedure, some x-ray dye will be injected into the bile duct, the main plumbing of the gallbladder, and x-rays taken to check for any stones that may have escaped the gallbladder into this plumbing system (choledocholithiasis).

The gallbladder can then be removed in a tiny plastic bag and the wounds closed with dissolving sutures. The gallbladder will routinely be sent for histopathological (under a microscope) analysis by a medical pathologist.

Recovery

In most instances you will be discharged on the same day as your surgery. You should expect to require some simple analgesia after discharge including paracetamol and ibuprofen. A number of people report some shoulder discomfort after keyhole surgery which usually resolves on its own.

The sutures will likely not need to be removed as they will be dissolving. The dressings should stay on for a few days, but you shouldn’t need them after a week or so.

Generally, you will be advised to avoid driving for a few days, strenuous activity for a few weeks and to gradually reintroduce a full diet. Expect to be away from work for about a week, and on desk duties for about 3-4 weeks.

There are no long-term restrictions after gallbladder surgery. You will be able to return to normal function, and whilst some people find that they no longer enjoy certain foods, there is no ongoing prescribed dietary restriction, and most people notice no long term changes.

Follow-up

You will usually be seen about 4 weeks after your surgery to review the pathology of the gallbladder and check that your wounds have healed. This will be a chance to report any issues with your wellbeing generally, particularly with ongoing pain or changes to your diet. Most people feel pretty close to 100% by this visit.

Hiatus Hernia Surgery

Most hiatus hernia surgery is performed laparoscopically (keyhole surgery) and involves returning the contents of the hiatus hernia to the abdominal cavity and then repairing the hernia itself.

The Procedure

You will be admitted to hospital on the day of your procedure. After coming through the admissions unit, you will be brought to the operating theatre where the anaesthetist will greet you in the anaesthetic bay, a small room right outside the operating theatre.

After shaving and cleaning the skin, about 5 small incisions are made to act as the keyholes down which the surgeon places instruments to retract the liver and perform the surgery.

A hiatus hernia usually contains some or all of the stomach, and occasionally other organs such as the liver or colon. The stomach (or other organs) that have slipped through the hernia, are sitting above the diaphragm in the chest, and they are then pulled back down along with the sac, or lining of the hernia itself.

Once the organs are back where they belong the hiatus is repaired by stitching the muscles that surround it together with a series of surgical sutures. Sometimes a piece of mesh is used to reinforce this repair and allow an appropriate amount of scar tissue to form to strengthen the hiatus itself.

After the hernia is repaired a Fundoplication, or gastric wrap, is performed (see Fundoplication – Anti-Reflux Surgery topic). This is because people with hiatus hernias tend to have reflux and the surgery can generate reflux as well. The Fundoplication fixes this and prevents ongoing reflux and reflux symptoms. It is a routine part of a hiatus hernia repair.

Recovery

You will stay in hospital for several days after your surgery. Sometimes there is a little chest pain in the first couple of days, but most people don’t need much pain relief by the time that they go home a few days after surgery. A number of people report some shoulder discomfort after keyhole surgery which usually resolves on its own.

Most patients find that there is immediate resolution of their symptoms with no reflux symptoms the night of their surgery (even for people who normally have their worst reflux at night).

Sometimes, a special x-ray test is performed on the first or second post-operative day to check that the repair is working and that you can swallow fluids without problems. Once this test is done, you will go onto a fluid diet initially. Your diet will gradually increase from fluids, to puree, soft foods and eventually normal food, over a period of a few weeks.

After keyhole surgery your stitches are usually dissolving and there are some small dressings that are removed in the first week or so.

Follow-up

You will be seen in the office several weeks after your surgery. At this time your diet will be progressed meaning you will be able to eat more normal food and you will be asked about your symptoms. Hopefully by this time you can swallow as normal and your reflux, if you had any, has completely gone.

Fundoplication – Anti-Reflux Surgery

A fundoplication is performed for people with proven gastro-oesophageal reflux that can’t be managed with medication alone. It is also performed as part of a Hiatus Hernia Repair. It is usually performed laparoscopically (keyhole surgery).

The Procedure

After shaving and cleaning the skin, about 5 small incisions are made to act as the keyholes down which the surgeon places instruments to retract the liver and perform the surgery.

Often, the first thing that the surgeon does is repair a Hiatus Hernia if one is present (see Hiatus Hernia Repair topic).

To perform a fundoplication, the surgeon disconnects the upper part of the stomach (the fundus) from the surrounding tissues to ensure that it is mobile enough to wrap around the junction between the oesophagus (food pipe) and the stomach. Sometimes this involves cutting through some of the small blood vessels that run from the fundus towards the spleen.

Once the fundus is able to move freely, it is wrapped around the junction of the oesophagus and stomach and stitched in place there with surgical sutures. It can be wrapped around the front (anterior fundoplication) or the back (posterior fundoplication) and can be wrapped around partially or completely. You surgeon can discuss these finer points with you. In essence, a greater degree of wrap will provide a tighter space for food to pass down and gastric acid to pass up and is therefore more effective, but at greater risk of causing swallowing difficulty. Your surgeon will be able to gauge how tight to make your wrap to get the balance as close to perfect as possible.

Recovery

Most patients find that there is immediate resolution of their symptoms with no reflux symptoms the night of their surgery (even for people who normally have their worst reflux at night).

Your diet will gradually increase from fluids, to puree, soft foods and eventually normal food, over a period of a few weeks.

After keyhole surgery your stitches are usually dissolving and there are some small dressings that are removed in the first week or so.

Follow-up

Gastrectomy

A gastrectomy is performed for the surgical management of gastric (stomach) cancer and occasionally for severe ulcers in an emergency. It involves the removal of the tumour with the stomach itself ensuring that the entire cancer is removed, along with removal of the lymph nodes that would typically be the first place that cancer would spread.

The Procedure

This surgery is either performed using an open technique, meaning the surgeon makes an incision down the middle or across the top of the abdomen, or with laparoscopic (keyhole) surgery.

First the surgeon will check that there is no spread of cancer outside of the stomach and nodes that are being removed. Assuming that this is all ok, the surgeon will proceed to perform the gastrectomy.

The stomach is freed up from all of the blood vessels that deliver blood to it. These arteries need to be carefully controlled by the surgeon to prevent bleeding. The stomach is then disconnected from the first part of the small bowel (duodenum) and from the oesophagus (food pipe). If the tumour is in the bottom part of the stomach, a distal gastrectomy is performed meaning that a short segment of stomach will be left behind at the top. If the tumour is a higher up, a total gastrectomy will be performed, meaning that the entire stomach is removed, and the oesophagus is left in place. Once the stomach is completely disconnected it can be removed.

The lymph nodes are taken out with the stomach. These are found in all of the fatty tissue that surrounds the stomach and the blood vessels that supply it.

The stomach and all of the lymph nodes are sent to the pathologist to examine it under a microscope to provide further information about the tumour.

After removal of the stomach, the small bowel needs to be joined onto the remaining upper part of the stomach (partial gastrectomy) or onto the oesophagus (total gastrectomy) so that food can make it all the way through.

There may be a need to place a plastic tube through your abdominal wall and into the small bowel to deliver liquified feeding solution after wards.

Recovery

Usually following a gastrectomy, you will go to the intensive care unit (ICU). You will wake up with a tube coming out of your nose which keeps the join deflated. There may be a surgical drain coming through the abdominal wall and there may also be a feeding tube coming through the abdominal wall. You will also usually have a catheter in your bladder. You may have a central venous cannula going into one of the big veins in your neck.

Your diet is restricted for the first week or so to allow the join to heal safely. Leaks are a relatively common complication after this surgery, and this helps to minimise the chances and the severity of a leak.

Over about a week, the various plastic tubes will gradually be removed, and you will make your way from ICU to the normal ward.

After about a week there is usually an x-ray test where you will drink some x-ray dye to confirm that the join is not leaking, and that fluid passes through normally. After this, you will be gradually allowed to drink fluids, then purees and soft foods in a progressive fashion.

Most people spend about a week to 10 days in hospital and go home without once all of the drains are removed and eating or at least drinking normally.

Follow-up

You will be seen in the office about a month after your surgery. By this time, you will hopefully feel well on the road to complete recovery. There may be a need for further cancer treatment with chemotherapy depending on whether cancer was the reason for your gastrectomy and what the pathologist has found under the microscope.

If you didn’t get the results of the pathology before you left hospital, they will be discussed with you at this visit.

Liver Resection

Surgery for liver tumours is known as liver resection and forms part of the many treatment options available for liver lesions.

The Procedure

This surgery is either performed using an open technique, meaning the surgeon makes an incision down the middle or across the top of the abdomen, or with laparoscopic (keyhole) surgery.

The lesion(s) that need to be removed will be located and then that part of the liver is removed using a variety of techniques to ensure that the lesion is fully removed whilst protecting the remaining liver tissue.

Recovery

Usually following a liver resection you will be taken to the intensive care unit (ICU). There may be a surgical drain coming through the abdominal wall and you will also usually have a catheter in your bladder. You may have a central venous cannula going into one of the big veins in your neck.

Over about a week, the various plastic tubes will gradually be removed, and you will make your way from ICU to the normal ward.

During this period blood tests will be conducted regularly to monitor the health of your remaining liver tissue and your progress overall.

Most people spend about a week to 10 days in hospital and go home without once all of the drains are removed and eating or at least drinking normally.

Follow-up

You will be seen in the office about a month after your surgery. By this time, you will hopefully feel well on the road to complete recovery. There may be a need for further cancer treatment with chemotherapy depending on whether cancer was the reason for your liver resection and what the pathologist has found under the microscope.

If you didn’t get the results of the pathology before you left hospital, they will be discussed with you at this visit.

Pancreatic Surgery

Surgery for pancreatic tumours is known as pancreatic resection. There are several different options available, determined by the type of tumour and its location. Common examples are pancreaticoduodenectomy (Whipple Resection), distal pancreatectomy and total pancreatectomy.

The Procedure

This surgery is usually performed using an open technique, meaning the surgeon makes an incision down the middle or across the top of the abdomen, or with laparoscopic (keyhole) surgery.

The pancreas is located at the back of your abdominal cavity, so most of the surgery is spent safely getting to the pancreas and peeling away all the adjacent organs and vessels. This allows the part of the pancreas which houses the tumour to be removed, whilst protecting the healthy parts and other healthy organs.

Recovery

Usually following a pancreatic resection you will be taken to the intensive care unit (ICU). You will often wake up with a tube coming out of your nose, a surgical drain coming through the abdominal wall and you will also usually have a catheter in your bladder. You may have a central venous cannula going into one of the big veins in your neck.

Over about a week, the various plastic tubes will gradually be removed, and you will make your way from ICU to the normal ward.

During this period blood tests will be conducted regularly to monitor your progress overall.

Most people spend about a week to 10 days in hospital and go home without once all of the drains are removed and eating or at least drinking normally.

Follow-up

You will be seen in the office about a month after your surgery. By this time, you will hopefully feel well on the road to complete recovery. There may be a need for further cancer treatment with chemotherapy depending on whether cancer was the reason for your pancreatic resection and what the pathologist has found under the microscope.

If you didn’t get the results of the pathology before you left hospital, they will be discussed with you at this visit.

Hellers Myotomy

Heller’s myotomy is one of several treatment options for achalasia, along with alternatives like dilatation, injection with muscle relaxants and endoscopic myotomy.

The Procedure

After first shaving and cleaning the skin, the surgery is performed using a laparoscopic (keyhole) technique with 4 or 5 small incisions in the upper abdomen. The lower part of the oesophagus, which is where the problem is, is identified and then the outer muscle of this area is cut with an energy device such as electrocautery.

Recovery

You will usually have a plastic surgical drain coming out of the abdominal wall when you wake up and may also have a tube coming out of your nose which passes down the oesophagus to help it heal without becoming distended.

You will have had an x-ray study while you swallow some dye prior to the surgery as part of the diagnosis of achalasia. This is generally repeated during early recovery to ensure that the dye flows through the lower oesophageal sphincter easily and that there is no leakage.

You will be able to drink fluids when you are discharged and will gradually reintroduce normal diet over a period of time.

Follow-up

Your will be seen in the office several weeks after your surgery. At this time your diet will be progressed meaning you will be able to eat more normal food, and you will be asked some questions about your symptoms. Hopefully by this time you can swallow as normal, and your symptoms will have resolved.

Appendicectomy

Appendicectomy, as it is known here in Australia, or ‘appendectomy’ in the United States, is the gold standard of treatment for Acute Appendicitis.

The Procedure

This operation is nearly always performed as an emergency, meaning usually you will have been admitted through the hospital Emergency Department.

Once the decision is made to proceed to surgery, you will be booked on the emergency operating list and join the queue of people waiting for emergency surgery. Generally the aim will be for you to have surgery that day or early the following morning, depending on the time you present.

When it is your turn, you will be brought to the operating theatre where the anaesthetist will greet you in the anaesthetic bay, a small room right outside the operating theatre.

After shaving and cleaning the skin, the surgery involves making three small incisions (keyholes) at your belly button, and two further incisions lower down on your abdomen, in the middle and the left side. These provide the access ports for the camera and instruments required for the appendix to be removed.

The next part of the operation involves confirming the diagnosis. If appendicitis is found, the appendix, which is a worm-shaped extension coming off the first part of the large bowel, is removed by dividing its blood supply, tying a loop of surgical suture around its base and the cutting it off the bowel.

The appendix is then removed in a little plastic bag. Any pus or infected fluid is washed away, and the wounds are closed with dissolving sutures.

Recovery

In most instances you will be discharged on the day after your surgery. You should expect to require some simple analgesia after discharge including paracetamol and ibuprofen. A number of people report some shoulder discomfort after keyhole surgery which usually resolves on its own.

The sutures will likely not need to be removed as they will be dissolving. The dressings should stay on for a few days, but you shouldn’t need them after a week or so.

Generally, you will be advised to avoid driving for a few days, strenuous activity for a few weeks and to gradually reintroduce a full diet. Expect to be away from work or school for about a week, and on desk duties for about 3-4 weeks.

There are no long-term restrictions after appendicectomy. You will be able to return to normal function, and whilst some people find that they no longer enjoy certain foods, there is no ongoing prescribed dietary restriction.

Follow-up

You will usually be seen about 4 weeks after your surgery to review the pathology of the appendix and check that your wounds have healed. This will be a chance to report any issues with your wellbeing generally, particularly with ongoing pain or changes to your diet. Most people feel pretty close to 100% by this visit.

Hernia Repair

Repair of an Abdominal Wall Hernia is the gold standard of treatment. No alternative will lead to definitive correction of the problem. Repair is recommended in certain types of hernias and when hernias are symptomatic.

The Procedure

The surgery involves shaving and cleaning the skin before making either a small incision over the area of the hernia or several keyhole incisions slightly further away. The decision to use an open or keyhole surgery will be made based on a variety of factors and on an individual basis. Both approaches are generally very effective and have advantages and disadvantages compared to each other. These decisions will be made with you in the pre-operative consultation and then confirmed at the time of surgery.

Every hernia is different, but the general principles of the repair are to return the contents of any hernia to where they belong, i.e. back into the abdominal cavity and to then close or cover the defect with sutures or a piece of mesh.

There are lots of different types of mesh and the selection of whether mesh is required at all and what type to use will be determined by the location, size and type of the hernia.

For inguinal (groin) hernias, mesh is routinely placed to reduce the chances of hernia recurrence.

Recovery

The sutures will likely not need to be removed as they will be dissolving. The dressings should stay on for a few days, but you shouldn’t need them after a week or so.

Specific discharge and recovery instructions will vary based on the type of hernia and the type of repair.

Follow-up

You will usually be seen about 4 weeks after your surgery to check that your wounds have healed, and that the hernia repair has been successful. This will be a chance to report any issues with your wellbeing generally, particularly with ongoing pain or persistent symptoms. Most people feel pretty close to 100% by this visit and it is a good chance to be cleared back to full activity.

Pilonidal Surgery

Surgery for pilonidal disease varies based on whether the presentation is an emergency with acute infection or more elective with longer term or recurrent symptoms.

The Procedure

Emergency cases of pilonidal abscess are managed in the hospital, and you would usually be admitted through the Emergency Department for intravenous antibiotics whilst you await your operation. When coming in for an elective excision of the diseased skin, you would be admitted through the elective admissions unit.

Regardless, when your turn for surgery comes, you will be brought to the operating theatre where the anaesthetist will greet you in the anaesthetic bay, a small room right outside the operating theatre.

After positioning you either on your side or face down on the operating table, the area is shaved and cleaned before surgical drapes are placed around the area.

In acute infections, the abscess is simply opened and cleaned out, then left open with a dressing packing the wound to keep it clean during recovery.

In elective resections of the disease, the affected area of skin is removed and then the wound is closed using one of several options. The goal of any of these options is to close the wound, minimising the need for stitches in the midline to maximise the chance of the wound healing. A local flap is often used.

Recovery

You can usually go home either on the same day or the following day. You need to keep the area clean and dry for the first couple of weeks to allow the wound to heal. These are high risk wounds due to their location and the tension that closure (for elective resections) places on the skin.

Pain is usually not too bad and you will be given tablets at home to help.

Follow-up

Typically you will be seen in the office 4-6 weeks post-operatively with the goal being that by this time the wounds will be fully healed. If you had an emergency incision and drainage, this will be the chance to discuss whether elective excision of the remaining tissue is worth considering.

Long term, you should expect to make a full recovery and have no ongoing restrictions relating to the procedure you have had.

Gastroscopy

A gastroscopy is performed for a number of reasons including investigation of upper gastrointestinal bleeding, difficulty swallowing and reflux.

The Procedure

You will be admitted to the hospital through the admissions unit on the day of your procedure. After this, you will be brought through to either the endoscopy room, or to the anaesthetic bay if your gastroscopy is being done in an operating theatre.

The anaesthetist will explain their plan for sedation, usually opting for anaesthesia that allows you to breathe for yourself but remain fully unaware of the procedure itself.

A gastroscopy involves passage of a special camera, called an endoscope, through your mouth, down the oesophagus (food pipe or gullet) into the stomach and then into the first part of the small bowel (the duodenum). Along the way all of the lining of these organs can be examined and biopsied if appropriate or required.

A number of interventions can be performed during the procedure depending on what is found and the reason for your gastroscopy.

Recovery

You will wake up in the recovery room and be able to go home on the same day. Usually, some results will be able to be given to you on the same day, but others, such as biopsies will take longer.

You can’t drive for at least 24 hours after the sedation, so someone will need to take you home, but there is generally no other recovery.

Follow-up

You won’t always need further follow up, but if biopsies were taken you might need to come back to be seen in the office a few weeks later. Depending on the reason for the gastroscopy, you may need a follow up examination at a pre-determined interval.

ERCP – Endoscopic Retrograde Cholangiopancreatography

Endoscopic Retrograde Cholangiopancreatography is certainly a mouthful, so it is know surprise that this procedure tends to be known by its acronym, ERCP. This is a procedure done to access the bile duct, the main tube connecting the liver to the bowel, to diagnose and treat various causes of duct obstruction.

Usually, the reason for an ERCP is either pain or jaundice associated with blockage from gallstones and/or strictures.

The Procedure

The anaesthetist will explain their plan for sedation, usually opting for anaesthesia that allows you to breathe for yourself but remain fully unaware of the procedure itself.

A ERCP involves passage of a special camera, called an duodenoscope, through your mouth, down the oesophagus (food pipe or gullet) through the stomach and then into the first part of the small bowel (the duodenum). At this stage the opening of the bile duct into the bowel can be identified and a tiny wire passed from the camera into the bile duct to perform interventions within the duct itself.

Options for intervention include cutting the sphincter muscle to allow gallstones to come out, stretching strictures or scars that are causing narrowing and biopsies of any abnormal areas within the ducts.

Sometimes a stent is placed to keep the duct open and allow the bile to drain out if jaundice is a problem.

Recovery

You will wake up in the recovery room and usually be able to go home on the same day. Some results will be able to be given to you on the same day, but others, such as biopsies will take longer.

You can’t drive for at least 24 hours after the sedation, so someone will need to take you home, but there is generally no other recovery.

Follow-up

Depending on the problem for which you had the ERCP you may need to have a second procedure booked for follow up. This is particularly important after some kinds of stents and other temporary interventions.

In other circumstances, no follow up is required at all and you will be discharged back to the care of your GP.

When gallstones are the problem, ERCP is often combined with Cholecystectomy which can happen either prior to or after the ERCP, and occasionally at the same time. If you need a cholecystectomy after your ERCP, arrangement for this can be made before you leave hospital or at the post-operative visit in the office.