Treatments

Surgery is considered when diet, medication and structured programmes have not produced a durable result, and when weight is affecting health rather than only appearance. Metabolic surgery goes further: the aim is to change the course of type 2 diabetes as well as reduce weight.

Which operation suits you depends on your weight, your other conditions, whether you have reflux, and how long you have had diabetes. There is no single best operation, and anyone who tells you otherwise before seeing your history is selling something.

The operation is a beginning, not an end. What determines the result is the eating pattern and the follow-up afterwards. We arrange that follow-up remotely once you are home — it is included, not an extra.

These are the complaints people postpone longest, and postponing is what turns a simple problem into a complicated one. Most of them are treatable, and many do not need surgery at all if they are seen early.

Our surgeon's main clinical focus is this area. Several of these procedures are day cases: you are admitted and discharged the same day, which changes what the trip looks like.

Bleeding deserves a separate word. It is most often haemorrhoids or a fissure — but it is also how bowel cancer first announces itself. We will not treat bleeding as a cosmetic problem, and if the assessment points elsewhere we will tell you.

FMT transfers screened gut microbiota from a healthy donor to a patient. Its one firmly established indication is recurrent Clostridioides difficile infection, where the evidence is strong and the success rate high.

Beyond that indication the evidence is early. Research is active in inflammatory bowel disease, irritable bowel syndrome and metabolic conditions, and some findings are promising — but promising is not proven, and we will say so rather than let you travel on a hope.

If you are considering FMT for a condition outside the established indication, ask us directly what the evidence looks like for your situation. You will get an honest answer, even when the honest answer costs us the booking.

A hernia does not close by itself. It usually enlarges slowly, and the reason to repair it electively is to avoid the alternative: strangulation, which is an emergency and a far harder operation.

Repair may be open or laparoscopic, usually with mesh. Bilateral and recurrent hernias are where the laparoscopic approach earns its place. Large and complex abdominal wall hernias need a longer preparation and a longer stay, and we will be explicit about that rather than quote you a three-day trip.

Hiatal hernia is different in character: nothing is visible from outside, and the complaints are reflux, cough and hoarseness. Most are managed with medication first, and surgery is discussed when that fails.