Upper Gastrointestinal, 
Hepatobiliary & Pancreas Surgery

Hiatus & Para-oesophageal Hernia including Anti-Reflux Surgery

I manage all forms of hiatal and paraoesophageal including congenital diaphragmatic hernias (Bochdalek/Morgagni). I perform both primary and revisional procedures for recurrent hiatus hernias and work closely with the St George Swallow Centre. Almost always these procedures can be performed minimally-invasively allowing for shorter hospital stays and quicker recovery. However, to ensure that outcomes from this surgery are optimal there are usually a wide variety of preoperative tests required to ensure your surgical suitability. 

Other gastro-oesophageal conditions

There are various conditions within the specialty of Upper GI Surgery that sometimes require a specialist's input. These include peptic ulcer disease, Helicobacter pylori infections, and gastroparesis. Additionally, Upper GI surgeons may be asked to perform procedures such as pyloroplasty and the placement of feeding tubes. As a Consultant Surgeon at St George Hospital, a well-recognised tertiary surgical centre, I have extensive experience in revisional gastro-oesophageal procedures that may occasionally be necessary. Often the investigations require include things such as blood tests, breath-tests, endoscopies and sometimes imaging. Treatments can vary broadly from dietary adjustments, through to anti-acid medication and sometimes even antibiotics. 

Pancreatic cysts

Cysts in the pancreas are commonly found incidentally ("by chance") on imaging such as Ultrasounds or CT scans. They can be the source of much concern due to an association with pancreatic cancer. However, not all cysts in the pancreas are the same, not all cysts can become cancerous and not all hence cysts warrant surgery. In fact, frequently the cysts just have to be thoroughly investigated in the beginning and then in some cases simple observation with regular imaging can result, particularly if deemed low-risk. The work-up, however, can be extensive and involve extra blood tests, imaging with MRI scans, endoscopies with ultrasounds and sometimes also biopsies. Frequently, pancreatic cysts are managed by a multidisciplinary team consisting of an Upper GI/Pancreas Surgeon and a Gastroenterologist and it is important your management is hence at a centre with experience in managing these conditions. 

Abdominal visceral vascular disorders (MALS, SMA syndrome)

Median Arcuate Ligament Syndrome (MALS) and Superior Mesenteric Artery (SMA) Syndrome are rare vascular compression disorders. MALS involves the compression of the coeliac artery by the median arcuate ligament, leading to chronic abdominal pain, weight loss, and other digestive issues. Diagnosis is often confirmed through imaging studies, and treatment may involve surgical release of the ligament. 

SMA Syndrome occurs when the duodenum is compressed between the aorta and the superior mesenteric artery, causing severe nausea, vomiting, and abdominal pain. This condition often requires nutritional support and, in severe cases, surgical intervention to relieve the obstruction.

Both of these disorders are very rare and require extensive work-up. The diagnoses can at times be difficult to achieve and thus experience in managing the nuances of these conditions is essential to ensure patients get the right care. 

Gastro-oesophageal reflux management & oesophageal motility disorders

I have extensive experience in the management of patients with gastro-oesophageal reflux disease (GORD) and it's associated complications (oesophagitis/Barrett's oesophagus). I also manage oesophageal motility disorders such as achalasia in conjunction with other specialists of the St George Swallow Clinic. I perform procedures such as endoscopic dilatations, Heller's Cardiomyotomy etc. for the management of conditions where required. 

Gallstones, gallbladder and bile duct problems

Gallstones and gallbladder related problems are extremely common. In fact, laparoscopic (key-hole) gallbladder surgery is one of the most commonly performed surgical procedures world-wide. Problems arising from gallstones range from abdominal pain and gallbladder inflammation (cholecystitis) to bile duct blockages and infections (cholangitis) and acute pancreatitis. Additionally, bile duct issues, such as scarring (strictures), benign tumors, and cysts, often require surgical intervention. These conditions are some of the most common reasons for consultations in my practice. Unfortunately, effective medical treatments for gallstone-related problems are limited, and surgery is often necessary. However, prior to making any decisions regarding surgery, an in depth consultation is required as gallstones can often be falsely blamed for some symptoms that may lead you to seeking medical attention. Surgery for gallbladder conditions is almost always minimally-invasive. I also offer so-called bikini-line cholecystectomy in the appropriate clinical setting. With this technique the scars are usually hidden below the belly button in the bikini-line. If a previous cesarean section or abdominoplasty has occurred, then many of the incisions can be hidden in this previous scar. Aside from a good cosmetic result, it also can lead to a faster recovery as no incisions are in the upper abdomen and thus pain is usually less.

Acute & chronic pancreatitis and other pancreatic conditions

Pancreatitis is inflammation of the pancreas and can be acute or chronic. Acute pancreatitis occurs suddenly, often caused by gallstones or excessive alcohol use, leading to severe abdominal pain, nausea, and vomiting. It typically requires hospitalisation for management. Chronic pancreatitis is a long-term condition usually resulting from prolonged alcohol use, genetic factors, or autoimmune disorders, characterised by persistent pain, digestive issues, and diabetes. Chronic pancreatitis can lead to permanent pancreatic damage and complications such as pancreatic insufficiency and even pancreatic cancer. Both conditions require medical evaluation and management to prevent serious complications. In some instances surgery may be required to manage these conditions. 

Intestinal failure, enterocutaneous fistulae & surgical feeding access

Intestinal failure is the inability of the intestines to digest food and absorb nutrients and fluids adequately, often leading to severe malnutrition, dehydration, and weight loss. This condition commonly results from extensive surgical removal of the intestines (short bowel syndrome), severe gastrointestinal diseases such as Crohn's disease or radiation enteritis, or congenital defects like necrotising enterocolitis or gastrochesis. Management typically involves parenteral nutrition (intravenous feeding) to maintain nutritional status and prevent complications. In some instances surgical feeding access with feeding tubes may also be required to try and help reduce intravenous feeding requirements. The goal - whenever possible - is to utilise as much of the gut that is present. 

Patients may experience chronic diarrhoea, electrolyte imbalances, and fatigue. Treatment goals include restoring nutrient absorption, optimising hydration, and improving the patient’s quality of life. In some cases, intestinal transplantation may be considered, particularly when other treatments are ineffective. Multidisciplinary care is crucial, involving gastroenterologists, surgeons, dietitians, and other specialists to address the complex needs of these patients.