This is an operation for achalasia of the cardia, a condition in which the muscle in the lower oesophagus fails to relax and therefore hinders the passage of food and fluid into the stomach. Treatment with Botox injections or balloon dilatation of the affected part of the oesophagus can be attempted but are often short-lived and surgery is frequently required as a more lasting solution.

Under general anaesthesia, 5 small keyhole incisions are made on the abdomen and laparoscopic instruments are introduced. The lower oesophagus is approached and a lengthwise cut is made in the muscle layer of the lower oesophagus. Care is taken to cut only the muscle layer, leaving the inner lining of the oesophagus intact. As this procedure is often complicated by acid reflux after the operation, a partial or complete fundoplication is also performed at the same time to minimise this.

Intake of food should become more comfortable soon after surgery and a near-normal diet can be maintained.

The spleen is part of the blood filtering process and is involved in both production and destruction of certain types of blood cells. Removal of the spleen is sometimes necessary for certain blood disorders involving red blood cells or platelets, intrinsic problems of the spleen, traumatic injury or if the spleen is enlarged from infective/inflammatory processes.

Splenectomy is often done laparoscopically but may sometimes have to be performed as an open operation. The size of the spleen can be an important factor in this decision which can be made either before the operation or during the procedure. In the laparoscopic approach, you are put under general anaesthesia and 3-4 small cuts on the tummy are used to introduce instruments into the abdomen and release the spleen from its attachments before removing it from the body.

As the spleen is important in fighting infection, not having a spleen might affect immunity and predispose you to certain bacterial infections. To help prevent this, vaccinations are provided a few weeks prior to the operation. Some patients may also need to be on a lifelong prescription of antibiotics following the procedure.

Laparoscopic fundoplication is a keyhole procedure performed for patients with severe acid reflux, Barrett’s oesophagus and symptomatic hiatus hernias that no longer respond to medication. It is done to prevent acid from the stomach travelling the wrong way into the oesophagus. The operation is predominantly laparoscopic although very occasionally, conversion to open surgery may be necessary.

The procedure involves narrowing the defect through which the oesophagus passes into the stomach (called the hiatus) as well as wrapping the upper part of the stomach around the lower oesophagus (the wrap) to recreate the valve at the lower end of the oesophagus. The wrap itself may be complete or partial depending on the circumstances. The operation takes about 1.5 to 2 hours and is carried out under general anaesthesia.

Overnight hospital stay is to be expected, although some patients can go home on the same day. There are restrictions to food intake for the first few weeks after the operation. Sloppy and pureed food is advised for 6 weeks following the operation. Bread and meat are likely to cause the most trouble and are to be avoided. Dietary advice will be provided before you go home. Anti acid medication can be stopped immediately after the procedure.

Laparoscopic bile duct exploration is usually performed at the same time as a laparoscopic cholecystectomy in a certain group of patients. The bile duct is a hollow tube running from the liver to the small bowel and provides a passage for the flow of bile. Stones slipping out of the gall bladder and into the bile duct can cause obstruction and jaundice – a yellowing of the skin and eyes as well as acute pancreatitis. Stones within the bile duct may be detected by investigations performed before the operation or alternatively, with an ultrasound scan performed as part of a laparoscopic cholecystectomy.

The aim of the operation is to remove stones lodged in the common bile duct by making a small cut and passing a camera up and down the duct to visualise the stones before removing them. The opening in the duct is then closed using sutures. A drainage tube is left inside the abdomen at the end of the operation.

As with all laparoscopic procedures, there is a chance this may need to be converted to an open procedure,I if there are technical problems or scar tissue makes the operation difficult.

This operation requires overnight hospital stay for monitoring. Most patients go home the next day although occasionally there can be a small leakage of bile in the drain which settles in a few days. The recovery period is usually the same as that for a cholecystectomy.

An alternative to bile duct exploration is ERCP (Endoscopic retrograde cholangiopancreatography).This is not an operation but involves passing a camera through the mouth and into the small intestine to remove the stones. Sometimes a small cut is made in the muscle of the bile duct to allow the stones to pass, or a plastic tube (stent) is left in place to allow the bile to flow freely. You will be sedated for this, but not fully asleep, and can usually go home on the same day.

Laparoscopic Cholecystectomy is a commonly performed procedure to treat symptoms arising from gallstones as well as to prevent the more serious complications that gallstones can cause.

The laparoscopic (keyhole) approach uses 4 small cuts on the tummy wall to introduce a camera and instruments into the abdomen. The gall bladder is separated from the liver and removed along with the gallstones within it. The whole operation is performed under a general anaesthetic and usually lasts between 1 and 2 hours. It is commonly performed as day case which means that most patients can go home the same day, a few hours after the operation.

While most operations are completed laparoscopically, on occasion it is necessary to carry this out as an open procedure. The decision to do this depends on various factors that the surgeon will discuss with the patient prior to the operation. An open cholecystectomy requires a longer recovery period necessitating a few days stay in hospital. 

Following the operation, walking should be possible later the same day. You should be able to go back to desk-based work in a couple of weeks, although jobs requiring heavy lifting may require a little more time. A normal diet can be resumed soon after the operation.

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