General Surgery — Town Hospital

General and laparoscopic surgery at Town Hospital: an overview

The general and laparoscopic surgery department at Town Hospital in the Fifth Settlement, New Cairo, diagnoses and treats conditions that may need an operation. These include gallbladder and bile-duct disease, hernias of different kinds, appendicitis, and conditions around the anus such as piles (haemorrhoids), anal fissure and anal fistula, as well as pilonidal sinus. The department also performs obesity (bariatric) surgery, thyroid and breast surgery, and cancer surgery. Several of these operations are done laparoscopically (keyhole surgery), including gallbladder removal and hernia repair, while open surgery remains an option in cases where the surgeon judges it the right approach.

A general surgeon is on call at the hospital 24 hours a day, the emergency department, radiology and laboratory run around the clock, and the hospital has its own operating theatres and intensive care unit, so a patient can be followed from the first examination to recovery in one place.

Operations performed by the general and laparoscopic surgery department

The right treatment for each patient, surgical or not, is decided by the surgeon after an examination, a review of the tests and imaging, and a discussion of the options with the patient.

Laparoscopic gallbladder removal

Not every gallstone needs an operation: stones that cause no symptoms are often simply monitored. When stones cause repeated attacks of pain in the upper right abdomen, or lead to inflammation of the gallbladder, removing the gallbladder may be advised, and the department performs this operation laparoscopically, through small openings in the abdominal wall. Find out when a gallstone needs an operation, and read the details of laparoscopic gallstone removal.

Bile-duct stones and ERCP

A stone can move from the gallbladder into the main bile duct and block the flow of bile. This causes yellowing of the skin and eyes (jaundice), sometimes with pain, fever or inflammation of the pancreas. The department treats these cases, and the procedures available include ERCP (endoscopic retrograde cholangiopancreatography): an endoscope passed through the mouth into the duodenum, used to remove stones from the bile duct or to place a stent that helps bile drain. The team decides the timing of this procedure, and how it fits with gallbladder removal, case by case. Yellowing of the skin or eyes together with fever, shivering or abdominal pain, or severe upper abdominal pain spreading to the back, needs the emergency department straight away, and any yellowing of the skin or eyes, even without pain, needs a medical assessment without delay.

Appendicitis and abdominal emergencies

Appendicitis is one of the most common reasons for emergency abdominal surgery. The pain may start around the navel, then move to the lower right side of the abdomen and gradually get worse, with loss of appetite, nausea, vomiting or fever. But symptoms do not always follow this pattern, especially in children, pregnant women and older people, so appendicitis cannot be ruled out just because the pain is in a different place or mild at first; any severe or worsening abdominal pain needs urgent medical assessment. In most cases the usual treatment is surgical removal of the appendix, and the department performs this operation as an emergency, day and night. Read about appendicitis symptoms in women and when they are an emergency.

Laparoscopic and open hernia repair

A hernia is a bulge of part of the abdominal contents through a weak spot in the abdominal wall. It usually shows as a swelling in the groin, around the navel or at the site of an old surgical scar, and it gets bigger when standing, coughing or lifting heavy things. In adults a hernia does not heal on its own, although the surgeon may simply monitor some small hernias that cause no symptoms. The department repairs hernias laparoscopically or with open surgery, and the surgeon chooses the approach according to the type and size of the hernia, the patient's general health and any previous operations. A hernia that becomes painful, tense or firm, or that no longer goes back in when it used to, or where the skin over it changes colour, or that comes with sudden severe pain, vomiting or an inability to pass wind or stool, needs the emergency department straight away. Details in Inguinal hernia: causes, symptoms and treatment.

Hiatal hernia

A hiatal hernia happens when part of the stomach slides up through the opening for the oesophagus in the diaphragm. It can cause heartburn, reflux and pain behind the breastbone, or no symptoms at all. Most patients are treated with lifestyle changes and medication prescribed by their doctor. Surgical repair, which the department performs, may be considered when symptoms continue despite treatment, for certain types of hiatal hernia, or when complications appear. The decision is made after the appropriate tests, sometimes together with a gastroenterologist. Severe chest pain, or chest pain with shortness of breath, sweating or pain spreading to the arm or jaw, needs the emergency department straight away because it may come from the heart. Difficulty swallowing, unexplained weight loss or repeated vomiting need a doctor's assessment without delay, and vomiting blood or black stools need an ambulance on 123 straight away, because Town Hospital's emergency department does not receive patients with digestive (GI) bleeding. Read about hiatal hernia symptoms.

Piles, anal fissure and anal fistula

Many cases of piles and anal fissure improve with changes to diet, more fibre and fluids, and better bowel habits, together with a topical treatment chosen by the doctor. Surgery is considered for advanced or long-standing cases that have not responded to conservative treatment. An anal fistula, an abnormal channel between the anal canal and the skin around the anus, usually needs surgery. The department operates on all of these conditions, including laser options in cases the surgeon selects. Bleeding from the back passage always deserves an examination rather than an assumption that it is piles, and heavy bleeding, or bleeding with dizziness or fainting, needs an ambulance on 123 straight away, because Town Hospital's emergency department does not receive patients with digestive (GI) bleeding. Severe pain around the anus with swelling or fever also needs urgent assessment, because it may be an abscess. Read about the symptoms and treatment of piles and anal fissure treatment.

Pilonidal sinus

A pilonidal sinus is an inflamed tract in the skin at the top of the cleft between the buttocks, often linked to hair collecting in the area. It causes pain, swelling and discharge, and it can turn into an abscess. It is common in young adults, and it can come back, sometimes even after treatment, so the surgeon explains how to care for the area afterwards to lower the chance of recurrence. The department performs pilonidal sinus surgery, including laser options in selected cases, and the surgeon chooses the method according to the size of the problem and how often it has recurred. Details in Pilonidal sinus: causes, symptoms and treatment options.

Obesity (bariatric) surgery

Bariatric surgery is not a quick way to lose weight. It is a treatment option for people with severe obesity that other efforts have not controlled, or obesity that comes with health problems such as type 2 diabetes, high blood pressure or sleep apnoea. Sleeve gastrectomy is one of the most widely known of these operations; after a full assessment the surgeon decides whether the patient is a candidate for surgery and which operation suits them. The department runs a bariatric surgery programme that includes nutritional and psychological follow-up after the operation, because changing eating habits is a core part of long-term treatment. Read more: Bariatric surgery: am I a suitable candidate?

Thyroid surgery

Any new lump in the neck, a lump that grows quickly, persistent hoarseness or difficulty swallowing needs a medical examination without delay, and sudden or worsening difficulty breathing needs the emergency department straight away. Even so, not every thyroid nodule needs surgery; many are benign and only need monitoring once they have been assessed. Surgery is usually considered when the examination or biopsy result is not reassuring, when an enlarged thyroid (goitre) presses on the windpipe or gullet, and in some cases of an overactive thyroid. Before the operation the surgeon explains any follow-up it may need, such as thyroid hormone replacement if the whole gland is removed, and the possible risks, such as effects on the voice or on the calcium level in the blood. After the operation, increasing swelling of the neck or difficulty breathing needs the emergency department straight away, and tingling around the mouth or in the fingers, or muscle cramps, means you should contact the hospital the same day.

Breast surgery

Breast surgery includes removing lumps that the surgeon decides should come out after examination and imaging, taking biopsies, and draining abscesses; in some cases surgery is part of a wider treatment plan. Any new lump in the breast or armpit, puckering or dimpling of the breast skin, a nipple that has newly turned inwards, or a bloody discharge from the nipple needs a medical examination without delay, and self-examination alone is not enough for reassurance, even though most breast lumps are not cancer.

Cancer surgery

Cancer surgery aims to remove the tumour, sometimes with the nearby lymph nodes, or to take a sample to confirm the diagnosis. Surgery is often one part of a wider treatment plan that may include other treatments before or after the operation. The decision is made once the diagnosis is complete, from imaging and biopsies; the surgeon, together with the oncologist and the rest of the treating team, decides whether surgery suits the case and when, and discusses the options clearly with the patient and their family.

When is surgery needed, and when is it not?

A surgical diagnosis does not always mean an immediate operation. Many conditions are first treated without surgery, or simply monitored, for example:

• Gallstones that cause no symptoms, which are monitored in most cases.
• Early piles and anal fissures, which often improve with changes to diet and bowel habits and topical treatment.
• A hiatal hernia with reflux symptoms that treatment keeps under control.
• Some small, painless hernias in adults, which the surgeon may decide to monitor.
• Excess weight where other medically supervised ways of losing weight have not yet been tried.

On the other hand, surgery becomes necessary or urgent when complications develop or conservative treatment fails, as judged by the surgeon after an examination. The following signs need the emergency department straight away, or an ambulance on 123:

• Severe abdominal pain that gets worse or lasts for hours, especially with fever, repeated vomiting or a hard, tender abdomen, and any severe abdominal pain during pregnancy.
• Pain that starts around the navel, then settles in the lower right abdomen and gets worse.
• A hernia that has become painful or tense, or no longer goes back in, or where the skin over it has changed colour.
• Being unable to pass wind or stool, especially with a swollen abdomen or repeated vomiting.
• Yellowing of the skin or eyes with fever, shivering or pain in the upper abdomen.
• Vomiting blood, black stools, heavy bleeding from the back passage, or bleeding with dizziness or fainting: call an ambulance on 123, because Town Hospital's emergency department does not receive patients with digestive (GI) bleeding.

Your care, step by step

• Assessment: care starts with a visit to the general surgery clinic, where the surgeon examines the patient and reviews any previous tests and scans.
• Tests and imaging: the tests and scans the case needs are done in the hospital, including 128-slice CT and a Philips 3 Tesla MRI.
• Decision: the surgeon explains the diagnosis and the options, surgical and non-surgical, with the expected benefits and possible risks of each, and the decision is made together with the patient.
• Surgery: the operation takes place in the hospital's operating theatres after the necessary preparation and pre-anaesthetic assessment, laparoscopically or as open surgery, as the case requires.
• Intensive care: most general surgery operations do not need intensive care, but the hospital has an intensive care unit for patients who need close monitoring after surgery; the team decides this case by case and explains it to the patient beforehand.
• Follow-up: the surgeon follows the wound, the recovery and any tissue results, and explains when the patient can return to normal activity; after bariatric surgery, follow-up includes nutritional and psychological support. Contact the hospital the same day if you develop a fever, redness of the wound or discharge from it; severe or increasing pain, repeated vomiting, yellowing of the skin, shortness of breath or chest pain, a painful swollen leg, bleeding from the wound that does not stop, or a high fever with shivering after the operation needs the emergency department straight away.

The hospital is contracted with 41 payers, and cover for each procedure depends on the payer and the terms of the contract.

Emergency general surgery around the clock

Many surgical conditions come on suddenly, such as appendicitis, acute inflammation of the gallbladder, a strangulated hernia or a blocked bowel. That is why Town Hospital has a general surgeon on call 24 hours a day, working with the emergency department, radiology and laboratory day and night, so a case can be assessed, scanned and a surgical decision made without waiting for the morning; the department also performs emergency appendix removal at night.

If any of the warning signs listed above appear, do not wait for a clinic appointment or take painkillers at home; go straight to the emergency department, or call an ambulance on 123 for signs of bleeding in the digestive tract.