General Surgery

Abdominal aortic aneurysm

An aneurysm occurs when an arterial wall becomes weak and balloons out. The wall therefore becomes very thin and is likely to rupture. The cause of the weakening is related to deposits of cholesterol in the inner part of the artery which causes degeneration and weakening of the artery. Ask your doctor what the mortality rates for abdominal aortic aneurysm operations are at your hospital.

Open surgery is the usual treatment for abdominal aortic aneurysms. The operation is usually successful. Some cases may be suitable for graft treatment. The graft is mounted on a catheter and introduced through a groin artery. It is placed inside the aorta to seal off the aneurysm. Ask what your hospital's success rate is for abdominal aortic aneurysm surgery, in both emergency and elective operations.

If abdominal aortic aneurysms are repaired before they rupture, there is a high overall chance of successful operation and a return to normal life expectancy. Ask your doctor what the risks of surgery are in your particular case.

If an aneurysm is suspected, your GP may refer you to a specialist vascular surgeon for advice. In some areas of the country, people at increased risk of having an abdominal aortic aneurysm are being offered screening by ultrasound scan. Ask either your GP or specialist for an ultrasound scan. This is a painless outpatient test to determine whether an aneurysm is present as well as to measure its size.

Not all aneurysms need surgery. The need for surgery depends on the size of the aneurysm. If it is more than five centimetres in diameter, it is probably safer to repair it than to leave it alone. Ask your doctor how much the aneurysm has enlarged over time and whether this means surgery is necessary.

Smaller aneurysms are usually observed by repeat scanning at six- to 12-monthly intervals, in case they enlarge and become dangerous. This may mean surgery is required. Ask for a clear explanation of the options in your case.

Surgery involves removing the aneurysm and replacing it with an artificial graft which cannot rupture. The operation is done through an abdominal incision. A new method is being developed where an artificial strengthening stent can be placed inside the aneurysm under x-ray control. This will usually prevent rupture and avoid major abdominal surgery. Ask your doctor which of these methods is most suitable for you.

There is nothing you can do about the aneurysm, but improving your general health by taking regular exercise, losing weight and stopping smoking is helpful even if you do not need an operation at present. The most important thing is to keep blood pressure under control in hypertensive patients. Ask your doctor how much exercise you should be doing.

Immediately after the operation, you will be taken to an intensive care or high dependency unit. As the days pass, various tubes will be removed and you will be returned to the normal ward before going home. Ask your doctor how long it will be before you can go home and when you will be able to take up your usual activities again.

There will be a number of tests before you have your operation, if they have not already been done. Both the surgeon and doctor (who will give you the anaesthetic) will visit you. Ask them any questions you still have about your operation.

Varicose veins

Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable and their appearance can be embarrassing. Simply having varicose veins is not a reason for having treatment. Symptoms include aching, discomfort, and heaviness of the legs, which are usually worse at the end of the day. Ask your doctor what sort of treatment, if any, you need.

In a few cases, the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour, sometimes with scarred white areas. Eczema (a red skin rash) can develop. If these changes are allowed to progress, or if the skin is injured, an ulcer may result. Ask your doctor whether your condition is serious. If there are skin changes, ask whether you need to be referred to a specialist or a surgeon.

Varicose veins can sometimes cause phlebitis and bleeding. Phlebitis means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard and tender. Ask your doctor if there is a chance of swelling or bleeding with your condition.

There are three main methods of treatment - support stockings, injections and operation. Ask which is most suitable for your condition, and what each involves.

Being overweight can make varicose veins worse and losing weight can reduce the effects. Ask your doctor or specialist if there is anything you can do to lessen the effects of your condition.

If you need treatment, tests can be carried out to show whether there are important leaky valves allowing blood to flow the wrong way in the veins, and so putting pressure on them. These leaky valves are most common in the groin and behind the knee. Ask your doctor if you need to have any tests.

Specialists use ultrasound machines to examine blood flow in the veins: these 'listen' to the blood flow through the skin. A small hand-held device, called a Doppler machine, is used for this. More detailed scans using a "duplex" scanner (which produces pictures of the veins as well as blood flow information) are needed in some cases, and duplex scans are used on all patients by some specialists. Ask which type of test, if any, is most suitable for you.

Support stockings or tights can be used to treat varicose veins. They can be bought from clothing shops or chemists and there are various different types, or 'classes' of compression. Ask your doctor which type of hosiery is most suitable for you.

Varicose vein surgery

What is the waiting time for surgery? Our data shows that the average waiting time for this procedure is 202 days from the time a patient receives a referral from their GP to an NHS hospital. Waiting times vary, ask your hospital for information on their waiting times.

Does the surgeon specialise in varicose vein stripping? There are 2098 general surgeons on our database. Of these, 170 surgeons have a special interest in varicose veins. For more information on individual surgeons go to our Consultant guide.

How many vein stripping or ligation operations have you carried out? Figures suggest that the more commonly an operation is done the greater the chances of success and the lower the risk of complications. Our statistics show that amongst hospital trusts in England the average number of operations for vein stripping and ligation is 154. There is a great variation in volume from trust to trust with 5 trusts performing over 500 and 2 performing less than 10.

Is endovenous laser treatment (EVLT) available? Newer treatments like EVLT are usually only available privately. A laser fibre is inserted via a quarter-inch incision into the sapheous vein. Guided by duplex ultrasound imaging, the surgeon then threads the laser fibre along the vein to heat and seal it. It can be done under local anaesthetic and patients recover in a few days. Ask the surgeon how he or she carries out the operation.

Is microwave treatment available? This is another new treatment. Microwave, also known as radio frequency or VNUS treatment, involves inserting a fine tube into the veins. It causes the affected veins to collapse and shrink. It is available at some hospitals but is not routine treatment.

What are the chances of varicose veins reappearing after treatment? It varies in accordance with the type of treatment and the patient in question. The likelihood of varicose veins reappearing is between 10 and 25 per cent.

What are the chances of improvement with sclerotherapy? With sclerotherapy, the standard outpatient treatment for smaller varicose veins and spider veins, patients can expect a 50 to 90 per cent improvement. For larger veins ultrasound guided foam sclerotherapy is proving effective in moderate cases.

Will the surgery hurt? Either a local or general anaesthetic can be used, depending on your circumstances. Most patients feel only mild discomfort after the surgery. Patients are usually treated in a day.

Will I have a general anaesthetic? Surgery is generally performed under a general anaesthesia. Patients should discuss the options and possible side-effects before surgery.

Who is the anaesthetist and what is their experience? Doctors having operations worry as much about the anaesthetist as the surgeon. If undergoing a general anaesthetic your life is in the anaesthetist's hands even in what is otherwise a routine surgical procedure. You should try and meet the anaesthetist before the operation to check you are indeed fit for general anaesthetic.

Are there intensive care facilities? If things go wrong with a general anaesthetic, you need good intensive care facilities. And the unexpected can happen even in apparently routine surgery, so it is important to know whether there is a facility on site or else how far away one is.

How long will I be in hospital? Best practice is to perform this operation as a day case. You get to go home straight after the operation, something that most patients find more convenient. However, some hospitals are better than others at managing to do this. Our statistics show that the best hospitals treat 90 per cent or more of patients as day cases while the worst treat less than 35 per cent in this way.

Ask what the day case rate is for your surgeon's hospital. A national average of 67 per cent of patients are treated as a day case. Of those not treated as day cases our statistics show that the average length of stay is 2.2 days

Gallstones

People with gallstones don't know they have them until they block the pipes draining the gallbladder, causing inflammation, or move out of the gallbladder and block the pipe leading directly to the intestine, causing jaundice, fever or severe colic. Ask if you need to go to the hospital for further tests after examination by your doctor, or whether you need to go for immediate treatment.

The operation is usually done by keyhole surgery with very small incisions needed in the abdomen. Many patients need only stay in the hospital for one or two nights although they will return for a check up and to have stitches removed. Ask when you will be able to return to work after surgery.

If tests show that your gallstones are stuck in the tubes, the doctor may remove them endoscopically, which means using a special tube passed through the mouth while under sedation. This procedure can remove trapped stones and is called an ERCP. It does not remove your gallbladder.

For some people the surgeon may advise a more traditional operation with a larger cut. This will require a stay of a week or so in the hospital with an antibiotic drip after the operation. Ask which type of treatment is most suitable for you and how much pain there will be both during and after the treatment.

It is possible to dissolve gallstones with medicines but this only works on some patients and the medicines have to be taken for a long time. Ask if this is an option in your case.

Gallstones and diseases of the gallbladder cause serious problems and you must see your doctor. Discuss this with your doctor, and ask how hospital check-ups will be co-ordinated.

A low-fat diet can help which should be as wide ranging and balanced as possible, preferably including steamed or boiled vegetables, fruit, pasta which is oil free, steamed or poached fish or skinless chicken, grilled lean meat, skimmed milk, soya protein such as tofu, brown bread, various types of beans and pulses such as lentils. Ask your doctor or hospital dietician for advice on what you should eat.

You will be advised to avoid alcohol following your operation. Ask your doctor when you will be able to drink alcohol again.

Abdominal hernia

Doctors classify a hernia according to its position in the abdomen. There are essentially five types of hernia, and also the possibility of several types occurring at once. Ask your doctor which type of hernia you have.

There is no sure way of preventing a hernia but there are several ways of reducing the risk, including stopping smoking and tackling hay fever and constipation. Ask your doctor for advice on reducing the risk of a hernia.

The only way of curing a hernia is by surgical repair. There are no drug treatments for the condition. The prospect of having an operation may seem daunting, especially if you have a reducible hernia which is not really causing much discomfort. However, hernias do tend to get worse over time and there is always a risk of developing a serious complication. Ask your doctor what the chances are of developing a 'strangulated hernia' which can be life-threatening.

Hernia surgery is better carried out sooner, rather than later. However, it is important you discuss the different surgical options in detail with your doctor before coming to any decisions. Ask what the risks are in your current state of health of having a hernia operation.

Only about 5% of hernia repairs in the UK are performed under local anaesthetic. The private British Hernia Centre says it carries out more than 90% of all hernias under local anaesthesia but that elsewhere, especially on the NHS, hernias tend to be repaired by the most junior surgeons available. Ask how much experience your surgeon has, how it will be carried out and what sort of anaesthetic will be used.

Elective hernia repair has a high success rate, but the hernia may recur in between one to 20 per cent of cases. Recurrence is more likely with traditional surgery, but also depends upon the type of hernia, any complicating health factor and the surgeon who carries out the procedure. Once a hernia has recurred it does, however, become progressively harder to repair on subsequent occasions. Ask what the success rates are for elective hernia operations at your hospital.

According to the British Hernia Centre, many surgeons in the UK are not sufficiently interested in hernia to treat it as a specialty. Ask if your surgeon is a specialist in hernia repair and how many operations he has carried out before.

You should be able to return to normal - and even play sport - fairly quickly after a hernia operation. Ask how long it will take to return to your normal routine without worrying about the hernia recurring.

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