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Description:

An abscess is a collection of pus in any localised space in the body. An anal abscess is one that develops in the tissues around the anus. This is sometimes caused by bacteria lodging in small glands in this area which then becomes infected. As the pus and subsequent pressure increases, the pain increases. Small abscesses can be drained by making an opening through the skin under local anaesthetic. Larger abscesses may need to be drained under general anaesthetic. Hospital admission is needed for such a procedure. Antibiotics may be used to control the spread of the infection, but antibiotics alone will not cure an abscess. Drainage of the pus is always necessary.

An anal fistual is an abnormal track ("tunnel") between the internal lining of the anus and the skin outside the anus and can sometimes excrete pus. Surgery is needed to cure a fistula.

Description:

Carpal tunnel syndrome is a painful disorder of the hand caused by pressure on nerves that run through the wrist. Symptoms include numbness, pins and needles, and pain (particularly at night). Anything that causes swelling inside the wrist can cause carpal tunnel syndrome, including repetitive hand movements, pregnancy and arthritis. Possible treatments include rest, splinting and surgery.

Description:

A circumcision is an operation to cut away the foreskin of the penis. The foreskin is the sleeve of loose skin that covers the end (head) of the penis.

A circumcision may relieve problems such as a tight foreskin that: is causing problems with passing urine and/or causing infections; is causing pain during sexual intercourse.

The procedure takes approx. 20-30 minutes and patients can usually go home on the same day.

Description:

Colonoscopy is a procedure which enables the doctor to see the inside lining of your large bowel. There are a number of reasons why you may need a colonoscopy. The most common reasons are positive FOBT test (usually requested by your GP), blood in stools, change in bowel habits etc. It is performed to rule out a problem in your bowel, or after surgery on the bowel, as a regular check up.

In order for a colonoscopy to be successful, your bowel needs to be prepared. This is a process in which you would follow strict dietary instructions in conjunction with a mild laxative to cleanse the bowel to allow the scope instrument to be inserted. In some cases treatment is possible through the instruments, enabling you to avoid an operation, e.g. removal of polyps.

On the day of the colonoscopy, an anaesthetist will administer a sedative injection to the vein to make you comfortable. Most people sleep through the procedure. The colonoscopy is performed while you lie on your left side. The instrument is inserted through the back passage. Most colonoscopies take between 20 and 45 minutes and you wake up shortly after that. You will stay in hospital for a few hours after your procedure to make sure that you recover from the effects of the anaesthetic.

If a lesion is detected on colonoscopy and requires further surgery, this can be arranged at your post colonoscopy appointment.

Rapid Access Colonoscopy

We can provide your patient with a Rapid Access Colonoscopy provided they meet certain criteria. This is a no gap scheme, operating from Calvary Central Districts Hospital.

Description:

Diverticula are small pouches which bulge out from any hollow structure in the body. Diverticulitis describes the condition which occurs when diverticula become inflamed and painful. Quite often diverticulitis can be managed with a high fibre diet and by increasing vegetables in the diet. A few patients who still experience colicky pain and distension need treatment with drugs (antispasmodics) or peppermint oil. These reduce the spasm in the colon which is often the cause of these symptoms

Description:

Endoscopy of the Upper Gastrointestinal Tract (Upper GI Endoscopy) is performed to evaluate the oesophagus (food pipe), stomach, and duodenum (upper small intestine) for abnormalities. This is done by using a flexible fibreoptic instrument that allows Dr Trehan to directly visualise these organs from the inside. Symptoms which may prompt an endoscopy include difficulty swallowing (dysphagia) or painful swallowing (odynophagia). These symptoms may indicate a narrowing in the oesophagus (known as a stricture), ulceration or inflammation of the oesophagus (oesophagitis).

More commonly, the test is done to search for a cause of blood loss leading to iron-deficiency anaemia (low haemoglobin or blood count). Inflammation of the lining of the stomach (known as gastritis, gastric erosions, erosive gastritis) or duodenum (duodenal erosions or duodenitis) may progress to ulceration - a stomach ulcer or duodenal ulcer. Any of these conditions can cause a slow, unnoticed but steady blood loss, or rarely a severe, dramatic loss of blood that can be life-threatening.

Prior to having an Upper GI Endoscopy, you would need to be fasted overnight so that the stomach is empty. Mild sedation is given, usually via an intravenous cannula. This will relieve anxiety, make the procedure easier to tolerate, and usually cause amnesia for the event.

During the procedure, Dr Trehan will use a thin, flexible fibreoptic instrument to visualise the inside of the oesophagus, stomach and duodenum. Photographs or even video images may sometimes be taken for future reference, for example to compare with pictures taken after appropriate treatment. If a small biopsy is needed for diagnosing inflammatory bowel disease involving the small bowel, for example, coeliac disease, biopsies from the small bowel beyond the stomach can be taken. Any areas of abnormality may be biopsied during the procedure - this is painless. Tissue obtained from a biopsy is sent to a pathology laboratory for analysis.

After the procedure, specialised nursing staff will care for you during your recovery. Once the effects of anaesthetic have worn off, you will be allowed home - normally on the same day as the procedure.

Description:

Gall stones are formed in the gallbladder and vary in size, shape and colour. The liver manufactures bile which travels down the bile duct. Some of the bile is then directed into the gallbladder and concentrated. In susceptible people, the concentration of bile triggers the formation of crystals that slowly grow to form gall stones. Gall stones can become painful if they lodge themselves in the outlet of the gallbladder as this blocks bile from being released into the stomach. Ultrasound of the abdomen is the standard way of diagnosing gall stones.

If surgery is required, the whole of the gallbladder will be removed rather than just the stones themselves. Removing just the stones from the gallbladder is extremely difficult and much more dangerous than taking out the gallbladder. More importantly, even if you could just have the stones removed safely, they would almost certainly form again in the coming months or years. Also, a diseased gallbladder actually leads to formation of stones and if only the stones are removed, they will recur. It is always advisable to remove the gallbladder for that reason.

Laparoscopic cholecystectomy is the medical term for removing the gallbladder using keyhole surgery. The procedure is performed under a general anaesthetic, with only 4 tiny (less than 1cm) abdominal incisions needed to complete the operation. A telescope with a camera and light source is inserted through one of the tiny incisions so that the gallbladder and surrounding structures can be visualised on a television monitor. The view obtained is very clear and actually magnified to allow precise dissection of the delicate structures surrounding the gallbladder. Special dissecting instruments are inserted through the other incisions to allow the gallbladder to be removed safely. The operation usually takes approx. 90 minutes.

Patients requiring gallbladder surgery are usually admitted to hospital and will require overnight stay.

Description:

Gastro-oesophageal reflux disease or acid reflux is a condition where the stomach acid refluxes or backs up into the oesophagus which is the tube that connects your mouth and stomach. Typical symptoms include heartburn, difficulty or painful swallowing, and regurgitation. Other less common symptoms include stomach or chest pain, bloating, a long-term cough and a chronic sore throat.

An endoscopy may be required for diagnosis as well as biopsy of any abnormal areas seen on the endoscopy

Acid reflux can often be treated very successfully with lifestyle changes, medications or surgery. For further information, please contact your doctor.

Description:

Haemorrhoids consist of various engorged blood vessels covered by the lining of the anal canal. As the haemorrhoid enlarges it bulges into the anal canal and eventually may protrude at the edge of the anus (prolapse). Symptoms include bleeding, lumps, discomfort/pain and itchiness caused by a mucus discharge. Haemorrhoids can be managed conservatively with diet management, medication, non-surgical office procedures, such as, injections or banding of haemorrhoids and in extreme cases, surgical intervention. Please see Dr Trehan to discuss your individual needs.

Description:

The palm of the hand contains a deep layer of tissue called the palmar fascia, which extends across the palm to the fingers. Dupuytren's contracture is a shortening and thickening of the palm's tissue that gradually causes clawing of the fingers as they are pulled towards the palm. There are various treatments for Dupuytren’s contracture.

njection of corticosteroids into the fascia sometimes can help in mild cases. These medications reduce any localised tenderness and may help to delay subsequent thickening of the tissue. However, chances of recurrence are more after corticosteroids injection rather than definitive surgery.

Surgery - depending on the severity of the condition, surgery options may include: cutting the fascia bands through small incisions in the palm; removing the thickened fascia; removing the fascia and associated skin, and using a skin graft to seal the palm; or in severe cases amputation of an affected finger, if the contracture has returned so many times that corrective surgery is no longer possible.

Description:

A hernia (or 'rupture') occurs where there is a weakness in the wall of the abdomen. As a result, some of the contents within the abdomen can then push through (bulge) under the skin. Normally, the front of the abdomen has several layers comprising skin, then fat, then muscles, which all keep the guts (intestines) and internal tissues in place. If, for any reason, there is a weak point in the muscles, then part of the intestines can push through. You can then feel a soft lump or swelling under the skin.

There are different types of hernia depending on its location, Inguinal hernia (usually in males, groin area); Femoral hernia (usually in females, lower groin area); Incisional hernia (from previous surgery at site of scar or wound); Umbilical hernia (near the belly button); Paraumbilical hernia (above or below belly button).

A hernia can be fixed by a small operation. A hernia repair is one of the most common operations performed by surgeons. It is very common for people to have their hernia repaired as a day case so that there is no need to stay overnight in hospital. A hernia can either be repaired under a local or a general anaesthetic. This will depend on the actual type of operation needed.

The type of operation will depend on the type of hernia that you have. There are now various different ways of repairing a hernia, which will depend on many factors. For example, the type of hernia, the size of the hernia, your general health. Dr Trehan will be able to discuss the type of operation with you in more detail.

Description:

A hydrocoele is a collection of fluid in the scrotum. Hydrocoeles are normally painless. Large hydrocoeles may cause discomfort because of their size. Walking or sexual activity may become uncomfortable if you have a very large hydrocoele. Quite often, a hydrocoele can be left alone without any surgical intervention.

Surgery may, however, be recommended if your hydrocoele is large or uncomfortable. The operation for a hydrocoele involves making a very small cut in the scrotum or lower tummy (abdominal) wall. The fluid is then drained from around the testicle (testis). The passage between the abdomen and the scrotum will also be sealed off so the fluid cannot re-form in the future. This is a minor operation and is performed as a day case.

Description:

An ingrown toenail develops when the sides of the toenail grow into the surrounding skin.

There are several things you can do yourself to treat mild ingrown toenails and prevent them from getting worse, including: practise good foot hygiene; trim the nail straight across; gently push the skin away from the nail using a cotton bud (using a small amount of olive oil to soften the skin); wear comfortable shoes that are not too tight and provide space around your toes; and painkillers, such as paracetamol, can be used to help relieve any pain.

Surgery may be recommended in cases where an ingrown toenail is more severe. This may involve either removing a section of the affected toenail or removing the whole nail. Surgery usually takes 20-30 minutes and can be performed under a local anaesthetic. Following surgery, you should rest your foot and keep it raised for 1-2 days. The bandage can be removed 2 days after having nail surgery.

Description:

Lymph nodes are small balls of tissue that are part of the body's immune system. The nodes produce and harbor infection-fighting white blood cells (lymphocytes) that attack both infectious agents and cancer cells. Cancer, infection, and some other diseases can change the appearance of lymph nodes. For that reason, your doctor may ask a surgeon to remove lymph nodes, to be examined microscopically for evidence of these problems.

Usually, one or more entire lymph nodes are removed and examined under the microscope by a pathologist. On occasion, the doctor does a needle biopsy to remove a portion of a lymph node to see whether a cancer already diagnosed has spread to that point. Many lymph nodes, such as those in your neck, armpits, and groin, are found close to the surface of the skin. These can all be reached through an incision in the skin.

When lymph nodes beneath the skin are biopsied, you lie on an examination table. If needed, the procedure can be done under general anaesthetic or very superficial nodes can be excised under local anaesthetic. Next, the doctor makes a small incision in the skin and the tissue just beneath it until he or she can see the lymph node and cut it out. After the procedure, the area is covered with a bandage. You'll usually be able to go home within several hours.

Description:

A pilonoidal sinus is an infected tract which commonly contains hairs. It occurs under the skin between the buttocks (the natal cleft) a short distance above the back passage (anus). The tract may discharge pus from time to time on to the skin. There are a variety of treatments for pilonoidal sinus depending on the severity of the condition.

Treatments include clearing the affected area of hairs (by shaving, etc) and to keep the area clean with good personal hygiene; using antibiotics for infections or, for persistant symptoms, surgery is advised which usually entails excision of the area and coverage with a skin flap.

Description:

A polyp is a small growth, attached to the bowel wall, which can occasionally become a cancer. If polyps are found (usually during a colonoscopy) they are usually removed at the time of examination. Most polyps can be burnt off by placing a wire snare around the base and applying an electric current. If a polyp is removed you will be advised to avoid heavy lifting, straining and to avoid aspirin and arthritis medications for a period of 2 weeks to reduce the risk of bleeding or perforation of the bowel.

Description:

Specialists can usually diagnose 90% of all skin lesions by their appearance and by the use of dermatoscopy (a special magnifying lens using polarizing light). All skin lesions removed are sent to the pathologist for analysis and examination by microscope. The pathologist can offer an accurate diagnosis in 99% of cases. It is therefore very important that you follow up the results of the pathology by contacting Dr Trehan or your general practitioner. 10% of skin lesions which were initially thought to be benign may actually be malignant (cancerous) requiring further treatment.

Description:

Appendicitis occurs when the appendix is blocked and becomes infected due to an invasion of intestinal bacteria. If appendicitis is left untreated, it may cause the appendix to rupture (burst). If the appendix ruptures, the infected contents flow into the abdominal cavity. This can cause a much more serious medical emergency known as peritonitis, which is inflammation of the membranes lining the abdominal wall and organs.

Without prompt treatment, peritonitis can be life threatening. Surgery to remove an appendix can either be done as an "Open" or "Laparoscopic" (or keyhole) appendicectomy. The type of operation you have will depend on how severe your appendicitis is. Once the appendix is accessed, the blood vessels that supply it are clamped and the appendix is cut and removed. You should be able to leave hospital 1-2 days after the operation.

Description:

A vasectomy is a method of contraception. It is an operation whereby the tubes that carry sperm from a man's testicles to the penis are cut, blocked or sealed. This prevents sperm from reaching the seminal fluid (semen), which is ejaculated from the penis during sex. There will be no sperm in the semen, so a woman's egg can't be fertilised.

A vasectomy is usually carried out under local anaesthetic, and takes about 15 minutes. During a vasectomy, the skin of your scrotum is numbed with local anaesthetic. The doctor makes two small incisions (cuts), about 1cm long, on each side of your scrotum. The incisions allow your surgeon to access the tubes that carry sperm out of your testicles.

These tubes are known as vas deferens. Each tube is cut and a small section removed. The ends of the tubes are then closed, either by tying them or sealing them using diathermy (an instrument that heats to a very high temperature). The incisions are stitched, usually using dissolvable stitches, which will disappear naturally within about a week. Following the procedure, you will require a semen analysis after 3 months to demonstrate that there are no sperms in the semen. This can be organised by Dr Trehan or your General Practitioner.

A vasectomy has no effect on sex drive or ability to enjoy sex. You will still have erections and ejaculate normally. The only difference is that your semen will not contain sperm.

Description:

If a malignant lesion is detected on your colonoscopy and requires a resection of a part of your large bowel (also called a hemicolectomy), your admission to hospital and subsequent surgery can be arranged by Dr Trehan.