Action Against Heartburn: Gastrointestinal Surgery, Gastro-oesophageal reflux
London Bridge Hospital offers a comprehensive Upper Gastrointestinal (GI) surgical service, specialising in the investigation and treatment of gastro-oesophageal reflux disease (also known as “heartburn”), oesophageal & gastric cancer, gallstones and achalasia.
The group has a particular interest in laparoscopic (“keyhole”) surgery, endoscopy and also performs surgery for other conditions including abdominal hernias.
The London Surgical Group was established by two upper GI surgeons, Mr. Andrew Davies and Mr. James Gossage , with the aim of delivering a high quality, team-based upper GI service to London and the South-East of England.
As well as training in a number of London’s
Conditions we treat
Gastro-oesophageal reflux disease (GORD)
Gastro-oesophageal reflux describes the exposure of the oesophagus to acidic secretions produced by the stomach. Gastro-oesophageal reflux is a common and benign condition with approximately 10% of the population experiencing weekly symptoms of heartburn or regurgitation. However, it can mask more serious underlying conditions if not investigated appropriately. Any patient with new symptoms should be reviewed, especially if associated with any difficulty in swallowing. Investigation usually involves endoscopy and 24 hour acid pH testing. Lifestyle changes are usually the first step of management. Patients often then find acid suppression medication helps. If prolonged medication is not suitable or fails to control the symptoms, then surgery should be considered. Surgery is particularly useful for patients with regurgitation and may be performed using laparoscopic (keyhole) techniques.
The incidence of oesophageal cancer has been steadily rising over the last 10 years. It usually affects the 50-70 year olds age group and is more common in males than females. It is thought to be related to gastro-oesophageal reflux disease and Barrett’s oesophagus. The majority of patients will present with difficulty in swallowing. Any patients with swallowing difficulties or new reflux symptoms should be urgently investigated. Investigation will usually involve endoscopy, CT and PET scanning. Treatment often includes a combination of chemotherapy and surgery, all of which are tailored to the individual.
Gastric cancer usually affects the 50-70 year olds age group and is more common in males than females. The majority of cancers found in the stomach are adenocarcinomas. Patients with new onset dyspepsia (pain, bloating, reflux, belching) should be urgently investigated to exclude gastric cancer. Patients with evidence of weight loss, blood loss (anaemia) or fullness in the upper abdomen should also undergo urgent investigation. Investigation will usually involve endoscopy, CT and PET scanning. Treatment often includes a combination of chemotherapy and surgery, all of which are tailored to the individual.
The gallbladder lies beneath the liver and is responsible for the storage and release of bile, which is produced by the liver. The constituents of bile can vary between individuals and in some can lead to the formation of gallstones. Patients can have pain on eating fatty foods known as ‘biliary colic’ and if recurrent is best treated by removal of the gallbladder. If gallstones are suspected, an ultrasound scan will detect them in the majority of cases. If they are causing symptoms then surgery should be performed to remove the gall bladder. This is performed by keyhole (laparoscopic) surgery in the majority of cases and may be performed as a day-case procedure.
Inguinal (groin) hernias are the most common type of hernia, although there are numerous other types (umbilical, epigastric, femoral and incisional). Hernias, which do not cause symptoms, do not always need to be fixed. Rarely they can present as an emergency with a lump that is painful and irreducible. Surgery may involve open and laparoscopic (keyhole) techniques which will be discussed on an individual basis for the most suitable approach. The surgery can often be performed as a day-case procedure.
Laparoscopic (keyhole) surgery
This is more commonly known as keyhole surgery or minimally invasive surgery. It principally involves the use of a laparoscope which is a long tubular instrument carrying a light source and an optic cable. The instrument is passed into an anaesthetised patient and transmits a picture onto a television screen at the patient’s bedside. The instrument is very narrow so can be passed through a small cut, reducing discomfort and allowing for a faster recovery time. Most procedures can now be performed with the aid of a laparoscope. However, previous operations and certain conditions can make it difficult to develop space in the abdominal cavity to allow good views. In these situations open surgery is often safest.
A Gastroscopy is a detailed camera examination of the oesophagus (gullet), stomach and duodenum. The procedure is performed to evaluate symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing or heartburn. It is the most accurate method of detecting inflammation, ulcers or tumours. The procedure may be performed under local anaesthetic or sedation. The patient is asked to lie on their side as the endoscope is gently passed through the mouth and into the oesophagus, stomach and duodenum. The procedure usually lasts between 10-15 minutes. The endoscope does not interfere with breathing.
The latter is a recently established service designed to offer a one-stop surgical assessment for many general surgical conditions.
Patients can be seen, investigated and pre-assessed for surgery in one visit thus making this process much more time efficient. More complex investigations such as endoscopy, CT and MRI scanning can also be booked in for a later date directly from the clinic. One focus of this service, in line with the national campaign “Action Against Heartburn”, is the appropriate investigation of patients with reflux or heartburn symptoms, particularly those in whom medical therapy has not been effective.
The group can organize and perform all of the necessary investigations and guide the small proportion of patients who need surgery through this process without the need to refer externally.
Appointments may be made by calling Liz Merrington on +44 (0)20 3763 5933 or the GP Liasion Team at London Bridge Hospital on +44(0) 20 7234 2009.
Opening Hours: Out of hours the phone will continue to be answered 24 hours a day
Telephone:020 3763 5933
Fax: 0844 8581122