Liver resection (AKA hepatectomy/ hepatic resection) is a complex surgical procedure which is usually indicated for primary or secondary cancers of the liver. This operation is only performed by surgeons with highly specialised training. Surgery is accompanied by a risk of bleeding and potentially other complications such as leakage of bile (a digestive aid produced by the liver). After surgery, patients are usually in hospital for about a week. Dr Srinivasa offers liver resection via both traditional open (a large cut in the belly) and minimally invasive (laparoscopic/ robotic) techniques and can discuss the specifics of the operation and recovery with you if appropriate. Liver ablation is a technique where tumours of the liver are treated with heat energy rather than being cut out. It is used in specific situations and can be done either via an open incision or minimally invasive (laparoscopic/ robotic) approaches. These operations are often day-stay procedures. Liver resection and ablation are also sometimes used in combination with each other.

Surgery of the pancreas is usually reserved for precancerous or cancerous lesions of the pancreas. Some non-cancerous problems of the pancreas can also require surgery. It is major surgery and can be associated with significant risks including the small but finite risk of death. Most people are in hospital for about 1 week but might need to stay for longer. Dr Srinivasa performs major pancreatic surgery regularly and offers open, laparoscopic and robotic pancreatic surgery. He is also often consulted to comment on whether surgery is technically feasible and works with oncologists to provide multidisciplinary cancer care. Depending on the type and stage of cancer, surgery is recommended and a personalised care plan is constructed.

The biliary system consists of tubes that connect the liver to the intestine. The gallbladder is also a part of the biliary system. The commonest biliary operation is removal of the gallbladder- usually for gallstones. However, in complex gallstone disease or cancer of the gallbladder/ bile ducts, more extensive surgery may be required. This can require removal of lymph nodes around the major veins of the body or removal and reconstruction of the biliary system itself. Dr Srinivasa performs complex biliary surgery in his practice and can recommend this if required. Surgery can often be performed either laparoscopically or robotically to optimise recovery.

General surgery covers some disorders of the liver and biliary system. HPB Surgeons specialise in disorders of the liver, pancreas and biliary system and are experts in these matters. The most common biliary problem is pain or other complications (e.g. jaundice) caused by gallstones. These are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach. Dr Srinivasa offers urgent cholecystectomy and does these operations routinely in his practice. HPB surgeons are usually referred not only patients requiring routine cholecystectomy but also more complex cases (e.g. Mirizzi syndrome) due to their subspecialty training.

Laparoscopic: several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon a view of the gallbladder and, by inserting small surgical instruments through the other cuts, the gallbladder can be removed. Open: an abdominal incision is made and the gallbladder removed. Robotic: In some cases (e.g. previously attempted cholecystectomy or incomplete removal of the gallbladder), the superior imaging obtained via the robot and dextrous controls can be used to remove the gallbladder successfully without requiring an open incision

Stomach surgery (AKA Gastric resection/ Gastrectomy) may be necessary for cancerous (e.g. stomach cancer) or non-cancerous problems. This is major surgery with important implications for digestive health and long term recovery. Most patients are in hospital for a week and need close nutritional monitoring both in and out of hospital. Dr Srinivasa will recommend gastrectomy when necessary and liaise with the patient's GP and oncologist to ensure ongoing care. Surgery is often done via laparoscopic or robotic approaches. Note that Dr Srinivasa does not perform gastric surgery for weight loss such as gastric band or bypass surgery but can recommend colleagues who specialise in this area.

Reflux or heartburn can be troubling. It is often caused due to stomach acid irritating the oesophagus and contributing factors can include a hiatus hernia where part of the stomach may be in the chest. If reflux isn't managed by lifestyle measures or medications, surgery can be considered. Reflux surgery (AKA fundoplication) involves wrapping the stomach around the lower oesophagus to create a tighter junction between the oesophagus and stomach and decreasing the likelihood of acid irritation. Surgery is only recommended after reflux is diagnosed using investigations such as endoscopy (a camera test to look at the oesophagus and stomach). Surgery is usually done laparoscopically and most patients are in hospital for 1-2 days. Dr Srinivasa will recommend reflux surgery after careful consultation and investigation if necessary.

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way. The commonest hernias are usually those in the groin (inguinal/ femoral) and hernias that occur after previous surgery (incisional hernias). Dr Srinivasa can repair these via a traditional open or key-hole (laparoscopic) approach. The latter is often associated with faster recovery and return to regular activities. Dr Srinivasa can also offer robotic hernia repair. This is especially suited to incisional hernias as it doesn't require the original scar to be re-opened and is thus associated with less pain and lower risk of swelling (seroma) after surgery. Dr Srinivasa favours the use of biological mesh if mesh is required.

Conditions of the gut dealt with by general surgery include disorders of the oesophagus, stomach, small bowel, large bowel and anus. These range from complex conditions such as ulceration or cancer in the bowel through to fairly minor conditions such as haemorrhoids. Many of the more major conditions such as bowel cancer will require surgery, or sometimes treatment with medication, chemotherapy or radiotherapy.

Removal of the spleen can be required as a planned, elective procedure for certain blood disorders or cancers. This is a complex procedure with a significant risk of bleeding. HPB surgeons have experience removing the spleen, however, as it is often required during surgery on the body or tail of the pancreas. As a result, Dr Srinivasa offers splenectomy in his practice. Laparoscopic: involves cutting the spleen free from its attachments and removing it through several small incisions (cuts) in the upper left abdomen. Open: an incision is made in the upper left abdomen, the diseased or damaged spleen is then separated from its attachments and removed.

Abnormalities of the endocrine system treated by general surgery include disorders of the pancreas and adrenal glands in the abdomen and the thyroid and parathyroid glands in the neck. These are often very complex conditions requiring extensive investigations. If surgery is required it is often quite complicated and will usually mean a stay in hospital for several days or even longer.

Skin conditions dealt with by general surgery include lumps, tumours and other lesions of the skin and underlying tissues. These are often fairly simple conditions that can be dealt with by performing minor operations under local anaesthetic (the area of skin being treated is numbed). Often these procedures are performed as outpatient or day case procedures.