General Surgery Conditions

Anal fissure

Anal fissures are tiny tears in the skin around your anus that can cause bleeding and sharp pain. They can occur when you pass hard stools, if you have constipation or during childbirth.

Usually anal fissures heal on their own reasonably quickly. If you’ve a tear that lasts for six weeks, it’s called a chronic anal fissure. You should see a doctor who may recommend self-help remedies and medications. If these aren’t successful, then surgery will probably be advised.

The most effective treatment for anal fissures is a lateral sphincterotomy. It’s a short and relatively simple operation that takes about 15 minutes. A small cut is made to the ring of muscle surrounding your anal canal (sphincter) whilst you’re under general anaesthetic. It aims to reduce the tension in your anal canal so that your fissure can heal.

Anal fistula

An anal fistula, also known as a fistula-in-ano, is a small tunnel that develops between the skin around your anus and your rectum (back passage). It has an internal opening in your anal canal and an external opening near your anus.

Most often an anal fistula develops due to an abscess in or around your anus. It can also be caused by infection or by bowel conditions, such as Crohn's disease.

Symptoms of an anal fistula are: pus from your anal area, throbbing pain in and around your anus, bleeding around your anal area, diarrhoea, swelling and irritation of the skin around your anus

Anal fistula surgery, or anal fistula repair, is normally advised to close this tunnel. Surgery can be a fistulotomy (a simple operation where the length of the fistula is cut open so that it can heal as a flat scar) or a seton procedure (for more complex fistulas, surgical thread (seton) is placed on the fistula for several weeks to help it heal). Non-surgical options include fibrin glue or a collagen plug that seal and close the fistula.


Haemorrhoids, also known as piles, are swollen veins and muscle inside or around your rectum and anus. They can develop when there’s an increase in pressure in the blood vessels in your anal canal that may be a result of straining on the toilet.

Haemorrhoids don’t always cause symptoms but they can be painful, itchy or sore around your anus, and cause bleeding when you have a bowel movement.

In the first instance self-care measures such as diet and lifestyle changes or medicines may be recommended to relieve the symptoms of haemorrhoids. Banding (placing an elastic band around the piles to cut off the blood supply) or sclerotherapy (injecting with an oily solution to cause the haemorrhoids to shrivel) are non-surgical options.

If these options haven’t worked or your haemorrhoids are severe, surgery may be required. There are a number of surgeries for haemorrhoid treatment. They usually either remove the haemorrhoids (haemorrhoidectomy) or reduce their blood supply so that they shrink.

Hernia repairs

A hernia is a bulge or swelling that develops when a part of your body pushes through a weakness in a muscle or surrounding tissue wall. They can occur anywhere on your body although often they’re found between your chest and hips.

There are many types of hernias. These include: inguinal hernias and femoral hernias (appear on your groin at the top of your inner thigh, caused when fatty tissue or a part of your bowel pokes through), umbilical hernias (fatty tissue or your bowel pushes through your stomach near your navel) and hiatus hernias (your stomach slides upwards into your chest).

Surgery is not always necessary, but if it is advised then the type of operation will be based on the severity of your hernia and its location. Hernia repair surgery can be either keyhole or open surgery. It aims to relieve any pain and return the organs to their correct place.

Lipoma removal

A lipoma is an overgrowth of fat cells that result in a soft, fatty, benign lump forming under your skin. Lipomas can grow anywhere on your body where fat cells are present including: shoulders, neck, chest, back, bottom, thigh and arms.

If a lipoma is small and not causing pain, then it’ll be left alone. Lipomas may cause embarrassment or self-consciousness and you may want the lipoma removed for cosmetic reasons. The removal of lipomas for aesthetic reasons is not available on the NHS but we offer this service at Duchy Hospital.

Removal of lumps and bumps

Lumps and bumps can develop anywhere on your body. Most are harmless or benign such as cysts and skin tags, but it’s advisable to get any new lumps or bumps checked out to identify their cause.

Moles are small coloured spots on your skin that can vary in shape, size and colour. Again most moles are harmless but if you notice any changes in their colour, shape or they develop a skin irritation then you should immediately have them medically assessed.

Lumps, bumps and moles are all skin lesions. If they are malignant (cancerous) then they will need treatment which often involves surgery.

Benign lumps, bumps and moles can be unsightly and cause emotional distress and embarrassment. Their treatment is not routinely offered on the NHS for cosmetic reasons. Here at Duchy Hospital we treat skin lesions for aesthetic and medical reasons.

The removal of skin lesions is normally performed under local anaesthetic. The type of procedure will depend on the size, shape and location of your skin lesion.

Pilonidal sinus

A pilonidal sinus is an abnormal opening in the skin normally around the top of your buttocks. It can occur due to a hair puncturing the skin which then becomes embedded. It may become infected and develop into an abscess which is often extremely painful.

If you’ve an infected pilonidal sinus, surgery will probably be advised. Treatment can involve draining the pilonidal sinus through a small incision, surgically removing it or using fibrin glue to seal it.

Removal of gall bladder

The gallbladder collects and stores a liquid called bile, that helps your body to digest food. It’s a small organ found in the upper right part of your stomach. Your gallbladder isn’t essential to your body so if it becomes diseased or damaged, or most commonly if you have painful gallstones, then your surgeon may be recommended for it to be removed.

Gallstones are small stones in the gallbladder that can develop if you’ve an imbalance in your bile make up. They can be extremely painful and cause vomiting and jaundice. 

Surgery to remove your gallbladder can be performed using keyhole surgery (laparoscopic cholecystectomy) or through open surgery (open cholecystectomy). Both are carried out under general anaesthetic and your surgeon will discuss the most appropriate option for your needs.

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