Dr Nan Yaw Wong

Symptomatic gallstone is an indication for surgery. There have been attempts in the past to blast the stones with shock wave therapy and also melt the stones using special enzymes, but the recurrence rate was very high. Enzyme therapy is also very expensive and in the long term will cost more than surgery. Laparoscopic gallstone surgery is safe in trained hands and can even be done as a day procedure. Talk to your surgeon about it.

Rubber band ligation is done as an office procedure and without needing any kind of sedation. Through a proctoscope, the applicator ties the rubber band around the pedicle of the haemorrhoids. Up to 3 haemorrhoids can be tied at one sitting. There is some mild discomfort during the procedure but no pain. After the procedure, the patient may experience a sensation of wanting to pass motion, but this is transient and lasts for a couple of hours. Defecation can occur normally after rubber band ligation but some bleeding may occur as the haemorrhoid shrinks and sloughs off after a few days.

Change in stool caliber and consistency can be due to a narrowing in the anus or rectum. Patients who had haemorrhoid surgery done may develop narrowing of the anus and pass narrow caliber stools. The most sinister cause would be a narrowing of the rectum or descending colon due to an inflammatory or malignant process. In older patients, these symptoms should never be taken lightly and a diagnostic colonoscopy would be the obvious next step. At 25 and assuming no family history the odds of it being cancer is low, but not zero.

Based on your age and your 6 years of symptoms, and assuming you have no family history of colorectal cancers, the odds of your symptoms being due to a tumour are low. However, a screening colonoscopy is still your best bet in excluding a potentially serious condition. Discuss with your GP to explore this option. Colonoscopy is still the gold standard and in trained hands a very safe and quick procedure.

As far as possible, surgery should be the first choice to deal with the problem. Stenting is done when the patient is too weak to undergo surgery at the point of presentation. The patient may be dehydrated and have severe electrolyte imbalance due to the obstruction. In good hands, stenting produces good results, and allows both the patient and surgeon to buy time for proper stabilisation and work-up before definitive surgery. For this reason stenting is often called the "bridge to surgery".

Mucus in stool must be taken seriously as certain pre-cancerous polyps known as villous adenoma can secrete large amounts of mucus and come out in the stool. Other possible causes include an infection of the colonic lining. The best and most accurate option is to go through a colonoscopy. Discuss this option with your GP and get a referral as soon as possible.

Anal fissures are classified into acute or chronic. Acute fissure (lasting 8-12 weeks) may be treated conservatively with stool softeners, sitz bath and analgesics. Chronic fissures (more than 3 months) are more stubborn and difficult to heal. Treatment is surgical division of the anal muscles known as Lateral Anal Sphincterotomy. In experienced hands the results are very good with near instant relief of symptoms. Other options include creams and suppositories but these are associated with side effects like headaches.

Colon cancer surgery is complex and requires a team of specialists, nurses and specialised equipment. The average number of days in hospital is 7-10 days after the operation. As the cost depends on the complexity of the case and the technique used, it is difficult to quote a number but it would roughly range from $40,000 to $70,000 all inclusive. Colorectal cancer surgery is Medisave and insurance claimable. It would be best to contact your insurance provider as they are the best persons to answer your policy questions.

Haemorrhoidal disease is common during pregnancy. Most would resolve after delivery but some can remain persistent and refractory to medication. If the haemorrhoids are symptomatic and distressful, surgical excision may be carried out with no compromise to the integrity of the episiotomy wound. If the hemorrhoids are prolapsed, then stapled hemorrhoidectomy is the ideal solution. This can be done as a day procedure and patients are frequently relieved after the operation.

The standard investigation for such a symptom is a gastroscopy. This involves passing a camera down the esophagus into the stomach and ends in the duodenum. The patient is comfortably sedated and does not feel any pain or distress. The whole procedure is about 10 min and is done as a day procedure. Any suspicious lesion can be biopsied and sent for reporting. Should the gastroscopy turn out normal and the symptoms persist, the next step is an ultrasound of the gallbladder to exclude gallstones as a cause of the discomfort.

There are 2 types of colostomy : temporary and permanent. During colorectal cancer surgery, the segment of bowel containing the cancer is removed and healthy bowels are joined back together to form a joint, or what surgeons call an anastomosis. For cancers that are near the anus muscles (so called low tumours), the chance of leakage after the anastomosis is formed is higher than cancers that are further away from the anus (high tumours).