The London Day Surgery Centre offers a wide variety of traditional general surgery procedures including:
• Circumcision - new born and adult
• Haemorrhoids and other anal problems
• Hernia repair with non tension mesh - NEW MESH, NO STITCHING, ALMOST NO PAIN
• Ingrowing toe nails
• Varicose Veins
• Vasectomies
• Lumps and Bumps
We also treat all types of skin lumps, polyps, warts cysts, abscesses including skin cancers.
Circumcision
Circumcision is removal of the prepuce, a fold of skin which surrounds the glans (or \'head\') of the penis. This operation is carried out for medical reasons if the prepuce becomes tight or for religious or traditional reasons. We now know that removal of a normal prepuce is not necessary to prevent any diseases.
A prepuce can become tight for congenital reasons, after infections or because of uncommon diseases such as leucoplakia or balanitis xerotica obliterans (ask your doctor or look up on the internet). These diseases can happen to men of any age.
The Operation
Religious or traditional circumcision is best carried out soon after birth, from one week onwards. After three months we, at the London Day Surgery Centre, think a general anaesthetic is needed and paediatric anaesthetics are only allowed at specially registered hospitals in the United Kingdom so we do not do them. For younger babies this is a very straightforward, very safe operation using a Plastibell which protects the glans and tip of the penis during the incision so is commonly carried out at the London Day Surgery Centre.
In older boys, say from teenage onwards, and in men circumcision involves cutting and stitching and is carried out using either local or general anaesthetic. The advantages of local anaesthetic are not having to starve, recovering quickly, not feeling sick and light-headed and remaining in control at all times. The operation takes only a few moments in babies and about twenty minutes in adults. In babies no stitches are needed and in adults dissolvable stitches are used.
Recovery
Babies recover very quickly and mothers usually say they are acting totally normally again by the next morning. Older boys and men should expect to have pain for a few weeks, becoming less day by day, and you will be given painkiller tablets. Your glans (head of the penis) may remain sensitive for three months or so. Rare complications are excessive bleeding, infection and removal of too little or too much skin.
Haemorrhoids
We can deal with most anal problems at The London Day Surgery Centre. Some do not require an operation and some do, under local or general anaesthetic. Patients are able to go home immediately after their treatment or after an hour or so in the recovery area.
Haemorrhoids are not painful until they develop complications. There are two painful anal conditions - thrombosed external haemorrhoid and anal fissure. There are two infective conditions - abscess and fistula-in-ano. Any of these conditions can be confused with haemorrhoids, even by doctors and nurses.
Commonly it is important to exclude other diseases of the intestinal tract by tests, such as a colonoscopy, which we do not do at The London Day Surgery Centre. This will be explained to you, if necessary, and the arrangements for the tests can be made by us.
Piles (the other name for haemorrhoids) are very common and are due to dilatation (swelling) of the normal veins lying just below the skin surface of the anal canal. These veins normally form what are called \'anal cushions\' and being soft and malleable help the sphincter muscle to make a gas tight seal. They distend because humans cause increased pressure within them by straining to pass hard stools, obesity, pregnancy and spending too long sitting on the toilet.
Piles are usually adequately controlled by only an ointment or suppositories. Sometimes, however, they can become more troublesome and then require (surprisingly non-painful) treatment by injection or banding (using a special instrument to apply a tiny elastic band). It is unusual these days to have to carry out a haemorrhoid operation. These local treatments are carried out through a small hollow instrument called a proctoscope which is inserted into the anus and is not painful although some patients find it uncomfortable.
Patients with symptoms suggestive of piles (bleeding, itching, soreness) need an examination of the lower end of the bowel with a lighted tubular instrument called a sigmoidoscope. This requires no anaesthetic or sedation and together with treatment of the piles takes five or ten minutes only. You will be asked to return after about four weeks for a check and it is quite common to require another set of injections or banding. Some patients require three or four and a very few piles never seem to respond completely.
It is common for piles to recur months or years later but this can be lessened by attention to diet and this advice is also available at the London Day Surgery Centre. The important thing is to keep your stools soft by eating plenty of dietary fibre and drinking plenty of water or clear fluid. And you should avoid spending a long time on the toilet.
In this condition a blood clot has formed in the dilated vein which is the pile. This causes a very tender firm lump which is different from the soft swelling, or no noticeable swelling, of an uncomplicated pile.
If left alone most settle in about two weeks but the pain can be immediately relieved by a small operation under a drop of local anaesthetic. A small incision is made over the blood clot and it is squeezed out. You will then need frequent washing, care to keep your stools soft and probably continuing pain killer tablets for another day or so. Sometimes the incision does need repeating two or three days later.
Complications are very rare but you will be given a 24 hour telephone number in case of need. Patients are given a follow up appointment for about four weeks later so that a complete ano-rectal examination can be carried out without causing pain.
Hernias
At the London Day Surgery Centre hernias are performed as day cases. They take less than an hour and can be carried out under local anaesthetic. The advantages of local anaesthetic are not having to starve, recovering quickly, not feeling sick and light-headed and remaining in control at all times. After the operation patients can be up and about straightaway after local anaesthetic but stay in the specialised recovery area for around sixty minutes after a general anaesthetic.
What is a hernia?
A hernia is a lump which occurs when part of the bowel or other abdominal tissue protrudes through an area of weakness in the wall of the abdomen. When this occurs in the groin area it is either an \'inguinal\' hernia or a \'femoral\' hernia but hernias can also occur at or near the umbilicus and in old abdominal scars. We repair all types of abdominal hernia at the London Day Surgery except hiatus hernia which is an Internal hernia.
The Operation
In the repair operation the hernia sac is pushed back through the gap in the muscles into its proper place inside the abdomen and the gap is reinforced by non-tension mesh. This is a sheet of material which looks a bit like nylon curtain but is far stronger. All the skin stitches are absorbable and do not require removal. The mesh remains for ever, becoming tough scar tissue, holding the hernia back.
After the surgery
It will be necessary to rest for a while after the repair and you will be given painkiller tablets as required. You will very soon be encouraged to get out of bed and move about. This may be uncomfortable but it will not cause any damage and it will speed-up your recovery.
You will be able to go home within an hour or so of the end of the operation if it was under a local anaesthetic or from your recovery time, which varies from patient to patient, if you had a general. If you have a general anaesthetic you must have a friend or relative to take you home and stay with you till at least the next morning but you may also wish this after a local.
You will be given a 24 hour telephone number to call if anything worries you with regard to your operation. Routine follow up appointments are not made but the surgeon will telephone you after a few days and again after a few weeks and you can be seen at any time by arrangement.
Recovery
It will be necessary to rest for a while after the repair and you will be given painkiller tablets and, sometimes, suppositories after the operation and to take home to be used as required. You will very soon be encouraged to move about. This may be uncomfortable but it will not cause any damage and it will speed-up your recovery.
You will be able to go home within an hour or so of the end of the operation if it was under a local anaesthetic or from your recovery time, which varies from patient to patient, if you had a general. If you have had a general anaesthetic you must have a friend or relative to take you home and stay with you till at least the next morning but most patients also wish this after a local.
At home you should resume normal activities as and when it feels comfortable to do so. You DO NOT NEED TO HOLD BACK and you will find you are able to do more and more as the days pass after the first day or two. For instance, even lifting weights can be resumed as soon as you find you are comfortable doing so and certainly by two weeks for most people. Most patients are fully recovered and back doing everything they did before the operation by two weeks. There may be some residual bruising and swelling which lasts longer but this will not stop you doing whatever you wish. It often takes three months or so for the scar to become perfectly soft and smooth.
Emergency number & follow up
You will be given a 24 hour telephone number to call if anything worries you with regard to your operation. Routine follow up appointments are not made but the surgeon will telephone you after a few days and again after a few weeks and you can be seen at any time by arrangement. You are allowed to return to the London Day Surgical Centre at no charge (after a telephone call to make an appointment) to have the repair checked if you wish.
Complications
Infections are rare at The London Day Surgery Centre and all patients are given a dose of prophylactic antibiotic at the time of surgery (you will be asked if you have any allergies). When they do occur they are treated with antibiotics but occasionally the mesh has to be removed surgically.
Bruising of the wound area and into the scrotum is common but clears up without any special treatment in nearly every case. Rarely it is necessary to re-operate to stop bleeding.
A few patients develop a fluid collection between the mesh and the muscles, called a seroma, which is never a major problem but sometimes needs to be drawn off using a needle and syringe. and it can be easily aspirated if necessary.
An uncommon but troublesome complication of all hernia repairs is a persisting groin pain and treatment of this is, of course, also available. Usually simple pain killers are sufficient but stronger tablets can be prescribed, the area can be injected (just as is a \'tennis elbow\' or painful joint) and occasionally a nerve needs to be cut and frozen at another operation.
Finally, you need to know that there is a recurrence rate of between 1% and 2% of all hernia repairs whoever is carrying them out and whatever method is used; it is far lower than it used to be before the modern non-tension mesh operation.
Ingrowing Toenails
This is a painful condition of, usually, the big toe but any toes can be affected. If treatment with antibiotics and care with hygiene has not worked a small operation is usually needed. It is often first worth trying to brush up and down in the gutter at the side of the nail every time you wash your feet.
The condition is due to infection at the side of the nail where it is embedded in the toe. This causes inflammation, a part of which is swelling of the soft tissues. This causes the soft tissue to spread over the edge of the nail and gives the impression of the nail having \'grown into\' the tissue whereas what has happened is that the tissue has grown over the nail.
The Operation
The operation is carried out under ring block local anaesthetic (although a general is available at The London Day Surgery Centre). A needle is inserted at the base of the toe and local anaesthetic solution is injected all round the toe so that the whole toe goes numb. After fifteen minutes or so the anaesthetic will have worked and a thin sliver of the side of the nail can be removed together with cleaning out of all the infected tissue. A dressing is applied and you are given full instructions about future care, change of dressings and regular foot bathing. The nail will regrow normally over a period of a few months and you should keep the area clean and, maybe, brush in the side gutter once tenderness has completely settled.
Recovery
You will be able to go home straight afterwards or stay with us for a cup of tea or coffee or soft drink and a biscuit. Most patients have only a little pain once the local has worn off and you may need paracetamol or ibuprofen or similar tablets for a short while. We may give you a short course of antibiotics as well. Complications are rare but you will be given a 24 hour telephone number in case of need. Follow up appointments are not usually needed but can be made if necessary.
Sometimes this condition recurs and then another operation is used which leaves the nail permanently less wide. As well as a sliver of nail being removed a wedge of the nail bed underlying it and, especially, under the hidden part at the cuticle is removed. Stitches are then needed and these are removed after about ten days. This operation, using the same ring block local anaesthetic, takes fifteen to twenty minutes. Prescribed pain relief will manage any discomfort after the local anaesthetic has worn off.
Lumps and Bumps
The sorts of lesions which can be removed at The London Day Surgery Centre are skin tags, warts & verucas, cysts, moles, milia, naevi, polyps, lipomas (soft fatty lumps under the skin), abscesses and skin cancers.
Removing small skin lesions like cysts, moles, abscesses and lipomas is very straightforward. It takes only ten or fifteen minutes for most of these minor operations which are usually carried out under local anaesthetic. General anaesthetics are also available at the London Day Surgery Centre if needed.
After a small needle prick to insert the local an incision is made over or round the lump or blemish and it is removed. Sutures to close the skin are often of the absorbable type placed just under the skin so you will not have to have stitches removed. You will be able to go home straight afterwards or stay with us for a cup of tea or coffee or soft drink and a biscuit. Most patients have very little or no pain once the local has worn off but you may need a paracetamol or ibuprofen or similar tablet for a short while.
Usually you will only need simple adhesive plaster type dressings for a few days and full instructions will be given. Normal washing, showering, bathing is encouraged after 12 hours. Complications are very rare but you will be given a 24 hour telephone number in case of need. Follow up appointments are not usually needed but can be made if necessary.
Most lesions which are removed are sent to the laboratory for microscope examination and you will be telephoned with the result about one week later.
Skin Tags - Short wave diathermy is a method which uses a heated needle to cauterise or remove a lesion. It is quick, and painless.
The approx cost is £150 this depends on amount to be treated.
Milia – Small pearl like spots which remain on the skin for months and sometimes years. They can be removed easily and painlessly with a fine needle which makes a pathway for its extraction.
The approx cost is £50 depending on area to be treated.
Warts/Verucas – These often disappear after one or two treatments of N-Lite laser. This is a quick and painless procedure.
The approx cost is £50 depending on area to be treated
Vasectomy
The operation is a minor surgical procedure which is carried out as a day case at the London Day Surgery Centre, during which the tubes (called the vas deferens) that carry sperm are sealed to prevent sperm getting into the ejaculated fluid. It is a safe, simple and effective procedure which has been carried out on almost one fifth of UK men reproductive age.
The Operation
The operation therefore produces sterility and is irreversible. It can be carried out under general or local anaesthesia and local is preferred by most men. The vas deferens tubes, one on each side, which carry the sperm are cut and tied back. It is a safe, simple and effective procedure which is commonly carried out.
After a small needle prick to insert the local a small incision is made in the middle of the scrotum just below the penis. The vas deferens on each side is divided, a one centimetre portion excised and the ends turned back and ligated. An absorbable suture is used, hidden under the skin, so there are no stitches to remove. The operation takes about half an hour and you will be able to go home straight afterwards; or stay with us for a cup of tea or coffee or a soft drink and a biscuit.
Recovery
Usually you will only need simple adhesive plaster type dressings for a few days and full instructions will be given. Normal washing, showering, bathing is encouraged after 12 hours. Complications are rare but you will be given a 24 hour telephone number in case of need. Follow up appointments are not usually needed but you will be contacted by telephone after a few days to check all is well and at about four weeks after the operation you will be reminded that you need a sperm count to check it has been successful. This can be carried out at any medical laboratory or hospital you wish.
Pain and tenderness is to be expected for the first day or so, gradually subsiding over a week or two. There may be some swelling and bruising to see but this, too, will soon go.
Normal exercise and sexual relations should be resumed as soon as it is comfortable to do so; there is no reason to delay if you feel all right. But you must continue using contraception until the remaining sperm \'downstream\' from the vasectomy site have been ejaculated or have died; this can take a month or more.
You will require a semen sample test at about one month after the vasectomy and this will be repeated if there are still sperms remaining. You are not sterile until azoospermia (the complete absence of sperms) has been confirmed by the laboratory.
Potential risks of vasectomy
There are some risks which you should know about. They are given in the table which is from a study of many thousands of vasectomies (NS Awsare et al \'Complications of vasectomy\' Annals of the Royal College of Surgeons of England 2005;87:406-410) and you can see that they are not common. Testicular cancer, prostate cancer, kidney stones and hardening of the arteries (atheroma) never occur due to vasectomy.
infection - 3.5% (treated with antibiotics but can take a few weeks to clear)
haematoma - 2% (a large bruise which can take a few weeks to clear)
orchalgia 2 - 15% (a continuing testis pain)
fistula - case reports only (i.e. very very rare)
sperm granuloma - 10% (a small, sometimes tender, lump where the vas has been cut)
anti-sperm antibodies - 60% (this is why reversing operations are so often unsuccessful)
recanalisation - 0.05% (a failure rate of 5 in 10,000 operations)
failure rate - 2% if a negative sperm count test has not been done
| 
