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Anal fissures are small tears in the skin around the anus, causing pain and sometimes bleeding during bowel movements.

The mainstay of treatment involves injecting a small amount of muscle relaxant into the muscle of the anal canal, easing tension and allowing the skin to heal. This is an extremely effective treatment and is done as a day stay procedure. In some instances, cutting a small portion of the muscle of the anal canal may be required. This again reduces tension and increases blood flow to the area, which helps the fissure heal. This procedure is usually reserved for fissures that persist despite repeated injections and is known for its high success rate in healing fissures and relieving pain.

An anal fistula is an abnormal tunnel that forms between the inside of the anus and the skin around it. Symptoms such as pain, discomfort, recurrent infections, and drainage of pus or blood typically indicate the need for treatment.

The principle of surgical management is to close the abnormal tunnel and promote healing. Treatment is customised for each individual and often guided by a pre-operative MRI scan. Options include:

• Fistulotomy - surgically opening the tunnel into a flat scar

• Ligation of the Intersphincteric Fistula Tract (LIFT) - closing the tunnel by tying it off

• Rotational/Advancement Flap Repair - a piece of tissue is moved or "advanced" from one area to cover and repair the site of the fistula

An appendicectomy is a surgical procedure to remove the appendix, a small organ attached to the large intestine, which may not have a clear function but can cause problems when inflamed.

Surgery may be appropriate in a private setting if scans have shown something unusual or after an episode of appendicitis, that was treated conservatively. The operation is commonly performed using keyhole surgery (laparoscopy), which involves small incisions through which a tiny camera and surgical tools can be inserted to remove the appendix. This has the advantage of quicker recovery times and less discomfort. It is usually undertaken as a day stay procedure.

Endoscopy is an umbrella term for a medical investigation that uses an endoscope to view the interior surfaces of an organ or tissue. An endoscope is a long, thin, flexible tube equipped with a light and camera at its tip, which transmits images of the inner surfaces of the digestive tract to a monitor.

Endoscopy is a minimally invasive procedure requiring little recovery time.

Colonoscopy

A colonoscopy examines the large intestine and may be recommended for rectal bleeding, persistent abdominal pain, changes in bowel habits or a low blood count. It is also used in the monitoring of colon cancer. More detailed information, including the role of colonoscopy in screening for colorectal cancer, can be found on our Colonoscopy page.

Gastroscopy

A gastroscopy examines the upper digestive system including the oesophagus, stomach and the first part of the small intestine. It may be recommended for persistent stomach pain, difficulty swallowing, ongoing indigestion or where there is suspicion of internal bleeding and/or a low blood count.

The gallbladder is a small organ under the liver that stores bile, a fluid produced by the liver to help digest fats in the food we eat. Gallstones form when substances in the bile harden to form small stones in the gallbladder.

Gallstone issues are characterised by abdominal pain, often triggered by eating fatty foods, as the gallbladder contracts to release bile but is blocked by gallstones. Over time, the frequency and intensity of these attacks can vary, and in some cases, they may lead to more serious complications if not treated. Many people do experience repeated episodes of gallstone issues, especially if the underlying issue of gallstones remains unaddressed.

Surgery to remove the gallbladder (cholecystectomy) is usually done laparoscopically with small incisions, leading to quicker recovery and less pain compared to traditional open surgery. We can live comfortably without a gallbladder because the liver can still produce bile to digest fats, it just flows directly into the intestine instead of being stored.

Haemorrhoids are swollen and inflamed veins around the anus or lower rectum. They can cause discomfort, itching, and bleeding around the anus, especially during bowel movements. There are various treatment options depending on the degree of haemorrhoid including:

• Banding - Recommended for internal haemorrhoids this is a simple, minimally invasive procedure where rubber bands are placed around the base of haemorrhoids, cutting off their blood supply, causing them to shrink and fall off.

• Hemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) - HAL-RAR is a new technique which offers effective treatment for early to moderate haemorrhoids with significantly lower post operative pain than traditional techniques. It utilises ultrasound to identify haemorrhoidal arteries which are then tied off and haemorrhoid tissues lifted back inside the anus.
  For more detailed information please visit https://www.amisurgical.com/ami-hal-rar

• Haemorrhoidectomy - Haemorrhoidectomy is utilised for more significant haemorrhoids, where the haemorrhoid tissue is surgically removed. This procedure offers effective and lasting symptom control.

More in depth information can be found on our Hernia Surgery page.

Hernias occur when an organ or fatty tissue squeezes through a previous surgical incision or other weak spot in the surrounding muscle or connective tissue. They often appear as a noticeable bulge, especially when lifting or bending. They may be symptom-free or accompanied by pain and discomfort. Surgical intervention is considered when they become symptomatic or in asymptomatic cases to prevent complications.

Repair can be performed either laparoscopically or through open surgery, depending on individual factors which will be explored at your consultation.

Your hernia surgery may be covered by ACC if it resulted from a previous operation or an accident. This enables you to have your surgery in a timely manner at Belverdale Hospital. For further information from ACC regarding qualifying criteria please see abdominal wall hernia and incisional hernia. We have experience in guiding clients through the ACC claims process to ensure you receive the care you need without unnecessary delay. Please get in touch if you would like to explore this further.

A hydrocele is a fluid-filled sac around the testicle, causing painless swelling in the scrotum. Surgical repair of a hydrocele is indicated when this swelling becomes large or uncomfortable, or is interfering with your daily activities.

Hydroceles can be repaired via a small incision to drain the accumulated fluid and remove the sac producing the excess fluid, thus preventing it from recurring. The procedure is often done as a same-day surgery, allowing for a relatively quick recovery.

Pilonidal disease is a condition where painful cysts form near the tailbone, right at the top of the buttocks, when hair punctures the skin. These cysts can become infected leading to pain and swelling at the bottom of the spine, redness, and sometimes pus or blood draining from the area. It is not uncommon for people to experience frequent flare-ups or a persistent, mild infection that keeps leaking.

Surgery might be indicated if the cysts keep coming back, are painful, or get infected often. It involves removing the cysts and any infected tissue. This can be done through a simple incision and drainage, or in more severe cases, by removing a larger area of tissue to ensure all the problematic areas are treated. The focus is on healing the area smoothly to minimise the chances of the disease coming back.

Rectal prolapse occurs when part of the rectum, the lower end of the large intestine, slips outside the anus. A rectocele occurs when the bowel bulges through the back wall of the vagina. Both circumstances can cause difficulty with passing a bowel motion (obstructive defecation) and contribute to constipation.

In select individuals, surgical intervention may be indicated. The surgical procedure for rectal prolapse or rectocele typically involves repairing and securing the rectum to its proper position inside the body, which can be done through the abdomen or directly through the rectal area, depending on the severity and specific situation. This helps to restore normal function and relieve symptoms.

More in depth information can be found on our Skin Procedures page

Skin lesions warrant excision if they are unwanted, painful or potentially cancerous. Whether benign or malignant, each requires personalised evaluation and treatment.

Surgery involves carefully cutting out the lesion, often under local anaesthesia, with an emphasis on clear margins, minimal scarring and optimal cosmetic results.

Unfortunately, skin cancers like melanoma, basal cell carcinoma (BCC), and squamous cell carcinomas (SCC) are highly prevalent in New Zealand and demand professional assessment and removal.

Varicose veins can cause aching, discomfort, and swelling in the legs. Surgery is considered when other treatments haven't helped.

Several surgical options exist to remove the affected veins, improving symptoms and appearance.