Definitions
This section gives a brief description of things that patients have previously asked me to explain in my surgical clinic. Please do use the form on the contact page if there is anything else that you would like included and explained in the definitions list.
The abdomen is the tummy or belly covering the area of the body from the chest down to the groins. The diaphragm forms the roof of the abdomen and the pelvis forms the floor of the abdomen. The abdominal contents include the stomach, small bowel, colon, appendix, rectum, liver, gallbladder, pancreas, kidneys, aorta, bladder, ovaries, uterus and fallopian tubes.
This is an operation were a diseased rectum and anus are removed leaving the patient with a scar where the anus used to be and a permanent end colostomy on the tummy with a bag for collection of faecal material. Can also be called APE (abdomino-perineal excision). The operation is so called because the surgeon operates partly through the front of the tummy (abdomen) and partly through the perineum (the part of the body encompassing the vulva or scrotum, the anus and the coccyx bone) to remove the anorectal excision specimen.
Used to describe a surgical join in the bowel. This can be sutured or stapled using special surgical stapling guns and titanium staples.
This is an operation where a diseased part of the left sided-colon and rectum is removed from an incision in the front of the abdomen and a join or anastomosis is made in the bowel. A temporary stoma or ileostomy may be used to give the join a rest while it heals.
The back passage or small tunnel that faecal material exits out of at the bottom.
This is the largest artery in the body. It takes blood from the heart down through the chest and abdomen to the legs.
This is part of the right colon lying in the right side of the abdomen.
This is a procedure where small plastic bands are placed in to the anus to treat haemorrhoids. No pain relief or sedation is usually required and banding can often take place in the out-patient clinic.
This is a term to describe a dose of laxatives given to a patient to clean out part of the bowel before a procedure is undertaken. It helps in removing faecal material so that it is easier to visualise the part of the bowel being investigated.
The first part of the colon attached to the terminal ileum of the small bowel. The caecum normally lies in the right lower part of the abdomen.
This is one operation used to treat pilonidal sinus disease. It works by flattening out the valley between the buttocks which reduces skin tension and pilonidal sinus pit formation.
This is a procedure where a long thin camera (colonoscope) is inserted in to the anus and moved through the colon and rectum (large bowel) to look for abnormalities. Polyps can also be removed at the same time with instruments that can be passed down the colonoscope. Patients require strong laxatives the day before the test to clean out the bowel so that the inner lining of the colon can be properly viewed. Intravenous sedation and pain relief is given and patients can usually go home the same day as the procedure.
A sub-specialty of general surgery that encompasses disorders of the colon, rectum and anus. Colorectal surgery includes elective and emergency operations and also includes hernia, appendix, pilonidal sinus and small bowel surgery.
An opening of the colon or large bowel on to the front of the abdomen so faecal material can be collected in to a bag.
This is part of the left colon lying in the left side of the abdomen.
Diverticular disease is a very common condition in mature people especially in the Western World. It is thought that people develop diverticular disease because there is not enough bulky moist fibre in their diets. This means that the colon has to squeeze hard to move the food around to the anus and this may result in blow-out bubbles on the surface of the colon and this is diverticular disease, also called diverticulosis. These little bubbles can often be left alone and they do not turn cancerous. Once formed they never go away.
Unfortunately they can sometimes become blocked with a little pellet of faeces or something like a pip and they can then become inflamed. This is called diverticulitis. Diverticulitis can cause abdominal pain, often on the left side of the abdomen, and sometimes this is very severe. It can also cause bleeding from the anus. A course of antibiotics is usually effective in treating diverticulitis.
Rarely the diverticulitis can perforate which can require an emergency operation and stoma bag. If the diverticular disease becomes troublesome and reduces quality of life then an elective operation to remove the diseased segment of colon and join the bowel back together again may prove helpful. This can now be performed by keyhole or laparoscopic surgery.
Patients with diverticular disease are advised to maintain a high fibre and high fluid intake diet. This can be as simple as drinking an extra glass of water in the morning. It is not recommended that you drink the extra water in the evening or you may have to get up during the night to pass urine. An extra apple in the morning can be a good way to add fibre or alternatively snack on prunes, dates or figs during the day. Some say that patients should avoid pips and nuts because these may get stuck in the diverticular bubbles and cause infection but there is no hard evidence to say that this is actually the case.
Diverticular disease is diagnosed by a colonoscopy or special X-Ray such as barium enema or CT cologram. It is important that patients with worrying abdominal symptoms are investigated properly by a qualified specialist before a diagnosis of diverticular disease is finally given because other conditions such as bowel cancer can give the same symptoms.
This is a patient management plan to enable patients to get better as successfully and quickly as possible after surgery. Before the operation patients are educated on what to expect after surgery and given goals. During the surgery the anaesthetist and surgeon does everything possible to keep surgical trauma and stress to a minimum. After the surgery, patients are encouraged to eat and drink and mobilise as soon as possible. Chest physiotherapy is instituted and the patient is encouraged to take a responsibility in their recovery rather than passively lying in bed. This has been a particular medical culture change in bowel surgery but has brought huge benefits for patients with reduced post-op complications and quicker return to normal activity. There are also large benefits for the local health economy as hospital stay, drug costs and community care costs are markedly reduced.
Fellowship of the Royal College of Surgeons. This is awarded after success in surgical training and formal examinations.
The gallbladder stores bile that is made in the liver. Bile is important for digesting fatty foods so the gallbladder expels its contents in to the bowels after a fatty meal. Sometimes gallstones can crystallise out in the gallbladder and these can cause recurrent abdominal pains and conditions such as pancreatitis. If this happens an operation is usually advised to remove the gallbladder and in most cases this can be done by key hole surgery. The operation is called laparoscopic cholecystectomy. Occasionally it is too technically difficult to perform keyhole surgery and in this instance traditional open surgery is performed via a largte incision in the abdomen.
Most patients never really notice that their gallbladder has gone after surgery as the gallbladder is not essential for healthy gut function.
This is an operation where haemorrhoids are cut out. The procedure can be very painful afterwards and patients often require strong painkillers. Oral laxatives are required as constipation can make the discomfort worse.
This is a surgical procedure where a diseased part of the left-sided colon and rectum is removed. No join or anastomosis is performed and the patient is left with an end colostomy and an internal rectal stump. Sometimes patients can undergo a Reversal of Hartmann’s Operation at a later date to rejoin the bowel.
Hernias are very common in both men and women. They are especially common in the groins and around the belly button (umbilicus). They are essentially holes in the abdominal wall that have developed over time at a weak area in the muscles. Abdominal contents such as fat and bowels can protrude through these holes causing a bulge in the skin. If the fat or bowels are strangled in the hernia then pain and discomfort arises.
With time hernias grow bigger and bigger. They also have the risk of damaging trapped bowel which is very painful and requires emergency surgery. Therefore, when a hernia is discovered and diagnosed, elective surgical repair is usually advised. This can be performed via a traditional open technique but increasingly laparoscopic or keyhole surgical techniques are being used. If you have a hernia, your surgical specialist can give you more information about these techniques and which one would be most suitable.
An opening of the ileum or small bowel on to the front of the abdomen so bowel contents can be collected in to a bag.
This pertains to the region of the groin.
This describes a condition where the inner lining of the bowel can become inflamed for reasons that we do not completely understand. IBD is often subdivided in to Crohn’s Disease, Ulcerative Colitis and Indeterminate Colitis. Most patients require medical therapy with drugs but some require an operation. Laparoscopic or keyhole bowel surgery and an Enhanced Recovery Program can result in smaller wounds and quicker recovery in a significant number of IBD patients.
This is a very common condition where patients can suffer intermittent abdominal pains, bloating and change in bowel habit. It is a benign and self-limiting condition but it is important that other more serious bowel conditions have been excluded by a qualified doctor before the diagnosis of irritable bowel syndrome is made. There are multiple recommended treatments for irritable bowel syndrome but no one treatment is effective for all patients. Sometimes simple headache tablets, anti-diarrhoeals and anti-spasmodic medications help. Sometimes patients find that their bowels are sensitive to certain types of foods and they should try to be a personal detective for food sensitivity. Some of the main culprits are wheat and wheat products, milk and milk products or fruit and fruit juices. Patients can try a one week exclusion diet of a foodstuff that they think might upset them and see if their symptoms disappear in that week. If the symptoms disappear then the patient may need to avoid that foodstuff but if there is no difference in IBS symptoms then it is probably not the excluded foodstuff causing the trouble. There is undoubtedly a brain-gut axis and sometimes concerns in the subconscious can manifest themselves by upset bowels. Some patients find relaxing therapies such as meditation or hypnotherapy useful. Most patients learn to live with their IBS but some particularly afflicted IBS patients may benefit from a diagnostic laparoscopy under general anaesthesia to search for adhesions that can be divided or other rare conditions.
This term describes a modern surgical technique where long cameras and instruments are inserted in to the abdomen to perform operations that were traditionally performed by hand through large incisions. The laparoscopic technique is the same as keyhole surgery or minimally invasive surgery.
This is a keyhole operation to remove the gallbladder.
This is an operation for patients with an anal fissure who have not healed with special creams. The internal anal sphincter is cut to reduce painful spasm at the anus and to allow increased blood supply for healing.
This is an operation where the diseased left side of the colon is removed. The bowel is usually rejoined by an anastomosis..
Minor surgery encompasses small operations that often require only local anaesthetic. Minor surgery operations are usually performed as a daycase procedure. Most minor surgery is carried out on the skin for lumps or bumps and skin abnormalities. Modern sutures now offer the advantage of being dissolvable and minimising skin scarring reactions.
Other forms of minor surgery include banding treatments for haemorrhoids that are commonly carried out in the out-patient clinic.
In the UK and Ireland, and sometimes in Australia and New Zealand, qualified surgeons take the title of ‘Mr’, ‘Miss’, ‘Mrs’ or ‘Ms’ rather than ‘Dr’. This tradition arose before 1800 A.D. when physicians were by definition doctors who held a University medical degree (MD), whereas surgeons seldom had any formal qualifications. Surgeons often worked as assistants to physicians visiting patients at their homes. Hospital surgical practice became increasingly more important in the 18th and 19th centuries and the wealthiest and most famous medics became surgeons rather than physicians. After the founding of the Royal College of Surgeons of London in 1800 A.D. surgeons gained a formal medical qualification on membership of the college (MRCS). However, surgeons were now so proud to be distinguished from physicians that the title of ‘Mr’ had become a badge of honour. Although surgeons in 1730 A.D. had no right to be called ‘Dr’, hospital surgeons in 1830 A.D. had no wish to be. This tradition has lasted till the present day and sometimes acts as a great source of confusion for patients and foreign doctors!
A powerful oral laxative.
An overgrowth of the inner skin lining of the bowel or anus. Polyps can be tiny or very large. They can also be benign or malignant. Sometimes polyps run in families but we think that most are caused by environmental damage causing different genetic mutations in the lining of the bowel as people age. Most polyps give no symptoms at all but sometimes they can cause anaemia, bleeding or interruption to the normal flow of faeces.
Excision of a polyp.
After surgery.
Before surgery.
The rectum is at the end of the colon or large bowel and lies in the pelvis. It stores faecal material just before opening of the bowels. It is attached to the top of the anus.
This is an operation where part of the terminal ileum and right side of the colon is removed for diseased bowel. The bowel is usually joined back together again forming an anastomosis or join.
This describes a thread or plastic sling that is sometimes used in anal fistula surgery. The thread prevents painful build-up of fluids around the anus and allows the fistula to discharge infected materials out of the body. Sometimes patients require a long term seton suture. Apart from having a little thread hanging out of the bottom, patients can use and clean their anus as normal.
This is an operation where the diseased sigmoid colon in the left lower abdomen is removed. The bowel is usually rejoined with an anastomosis.
An opening of the bowel on to the front surface of the abdomen to enable bowel contents to be collected in a bag.
The end of the small bowel attaching on to the caecum of the large bowel.
This is the middle part of the colon or large bowel lying across the upper abdomen.
What can general surgeons do for skin complaints
All qualified general surgeons should be able to offer patients simple operations to deal with common skin disorders such as moles, warts, lipomas, sebaceous cysts, skin tags, abscesses, unsightly scars and navels and problem nails. These operations are frequently carried out under a local anaesthetic.
