BEST SURGEONS FOR GUT AND GALLBLADDER OPS

Chosen by fellow doctors

WHaT are the hallmarks of a good doctor? Technical expertise and skill, of course — but someone who understands you, someone you trust, is also vital. Indeed, research shows that a good relationship with your doctor can improve the chances of a successful outcome.

but how do you find a specialist who fits the bill? That’s where this unique series of guides, which has been running every day this week in the Mail, can help.

We’ve identified the country’s top consultants — as judged by their peers. We’ve canvassed the views of more than 260 consultants across seven specialties from around the country and asked them this very simple, but key, question: If your own nearest and dearest were to need treatment in your field, to whom would you refer them — and why?

The consultants who earned the most votes from their peers are the ones who made it into our guides — though patients should bear in mind that this is not a scientific study.

and, of course, there are many superb specialists all over the country who didn’t make it on to our list, but who spend every day transforming patients’ lives.

To help you make informed decisions about your care, we’ve also talked to experts about the latest thinking on treatment. Today, in the final part of our series, we focus on gallbladder surgery and treatment for inflammatory bowel disease.

THE RISING TIDE OF GALLSTONES

Gallbladder surgery is one of the most common elective procedures in the NHS, with 72,000 gallbladder removal operations — cholecystectomies — carried out every year.

Gallbladder problems are also the most common cause of emergency hospital admissions for people with abdominal pain. at the root of it all: gallstones. an estimated 15 per cent of the UK’s adult population have gallstones, although treatment becomes necessary only if the stones announce their presence with intense pain.

The gallbladder itself is a pearshaped organ that lies under the liver in the upper right side of the abdomen. Its role is to store bile, a solution made in the liver that helps break down fats.

bile is continually secreted by the liver, passing through a series of ducts which join up to form a larger channel called the common bile duct. The gallbladder is linked to this channel by another duct, the cystic duct.

The gallbladder holds the bile until food has passed through the stomach, at which point the gallbladder contracts. This empties the bile into the small intestine to mix with the food. Gallstones form if there is an imbalance in the chemical make-up of bile. In most cases, this is because there is too much cholesterol — a waxy substance, made by the liver, which then crystallises.

When the gallbladder squeezes bile into the small intestine to aid digestion, any tiny crystals will usually be expelled with it. The severe pain associated with gallstones is triggered by a stone getting trapped in the neck of the gallbladder.

More people than ever are now afflicted by gallstones and this is largely down to obesity, says Steve ryder, a consultant hepatologist at Queen’s Medical Centre in Nottingham and trustee to the british liver Trust.

because gallstones tend to recur, these days they are treated by removing the entire gallbladder. The gold- standard method of doing this is keyhole surgery because it is at least as safe as open surgery, less painful and less invasive, so patients can return to normal life faster.

For a young, slim and otherwise healthy patient, cholecystectomy can be a day- case procedure and they are usually back to normal in a week. but for older, overweight patients it can be more challenging.

Open surgery is only performed in a minority of cases where keyhole surgery is not suitable (for example, due to previous abdominal surgery because of scar tissue). It needs a bigger incision and the patient takes longer to recover.

after the gallbladder is removed, bile passes from the liver down the bile duct continuously into the intestine. This doesn’t normally cause problems, though some patients experience wind and gas.

acute cholecystitis — inflammation of the gallbladder, usually caused by a stone getting trapped in the bile duct — is a medical emergency and guidelines from the National Institute for Health and Care excellence (NICe) recommend cholecystectomy within seven days.

Whether the procedure is urgent or elective, though, demand far outstrips supply.

Two branches of general surgery cover gallbladder conditions — upper gastrointestinal (upper GI) and hepato-pancreatico-biliary (HPb) surgeons, and there are only 250 of these altogether in the UK.

as a result, ‘ the majority of gallbladder removals are not done by trained HPb or upper GI surgeons’, says Hassan Malik, an HPb surgeon at aintree University Hospital in liverpool.

Patients living close to an NHS teaching hospital are likely to get an upper GI surgeon, but cholecystectomy in a local district hospital is more likely to be done by a colorectal surgeon.

While the experts have reservations about this, they say the most vital safeguard for patients is having a surgeon who does enough cholecystectomies a year to become proficient at them.

The benchmark number is about 50 a year, according to richard Hardwick, an upper GI surgeon at addenbrooke’s Hospital in Cambridge and Spire Cambridge lea Hospital.

but, critically, surgeons should also know their own limitations so they can call for expert help or safely cut short the procedure if they run into unexpected

difficulties. ‘I recently had a call from a surgeon in a district hospital about this situation exactly,’ says Professor Peter Lodge, an HPB surgeon at St James’s University Hospital in Leeds.

‘I dropped everything and went straight there to help them finish — in this scenario, the only priority is making the patient safe.’

The major fear in cholecystectomy is cutting the bile duct instead of the cystic duct.

‘This can be a life-threatening disaster,’ says Mr Hardwick, who is also president of the Association of Upper GI Surgeons of Great Britain and Ireland. ‘If the bile duct has been clipped and obstructed, then bile from the liver can’t drain to the gut — and that situation is not compatible with life. The patient will become bright yellow, be very unwell and go into acute liver failure.’

Less severe and far more common is a bile duct leak, which occurs because of a leak from the cystic duct stump.

Yet accurately identifying the correct duct in a horribly inflamed gallbladder in a complex area of the anatomy can be challenging, even for experts.

So when the stakes are this high, how do you line up a gallbladder surgeon who can safely and expertly carry out your operation?

To identify the very best, we canvassed the views of around 40 leading HPB and upper GI surgeons from around the country.

Here are the ones they nominated, with comments explaining why.

GALLBLADDER SURGEONS RATED BY THEIR PEERS PROFESSOR GILES TOOGOOD

St James’s University Hospital in Leeds

WHAT THEY SAY ABOUT HIM: The former county cricketer is ‘internationally renowned and one of the best surgeons I have ever seen operate’, according to one of his peers. ‘ He is also very personable and approachable.’

Adds another: ‘He doesn’t do anything unnecessary. Every move he makes has a purpose — he gets where he needs to in the abdomen without making things bleed.’

PRIVATE: Nuffield Health Leeds Hospital, Spire Leeds and Methley Park Hospitals.

ANDREW SMITH

St James’s University Hospital in Leeds WHAT THEY SAY ABOUT

HIM: ‘He’s an amazingly caring individual and an extremely good surgeon. He is always in the hospital and he’s exactly the sort of person you’d want to care for your wife or mother,’ reveals one of his peers.

PRIVATE: Spire Leeds Hospital, Nuffield Health Leeds Hospital.

IAIN CAMERON

Nottingham University Hospitals WHAT THEY SAY ABOUT HIM: ‘An excellent surgeon, extremely sensible and reliable and safe and wonderful with his patients,’ says one. ‘I would be very happy to have my closest relatives to be cared for by him,’ says another. PRIVATE: BMI The Park Hospital in Nottingham.

SIMON DEXTER

St James’s University Hospital in Leeds WHAT THEY SAY ABOUT HIM: ‘Very deft, he is an exceptionally talented keyhole surgeon,’ says one of his contemporaries. ‘He has great technical skills and economy of movement — the less unnecessary touching and moving of tissues, the better, as tissues bruise easily. He has to be one of the leaders in this country.’

PRIVATE: Spire Leeds Hospital, Nuffield Health Leeds Hospital.

KRISHNA MENON

King’s College Hospital in London WHAT THEY SAYABOUT HIM: According to one surgeon: ‘He’s probably the best laparoscopic [keyhole] surgeon in the country. He is meticulous and pays great attention to detail, but he is also very caring of his patients. PRIVATE: Bupa Cromwell Hospital in London, London Bridge Hospital, The London Clinic.

PROFESSOR DEREK MANAS

Freeman Hospital in Newcastle WHAT THEY SAY ABOUT

HIM: ‘Technically topnotch and highly regarded’, is the verdict of one of his peers. ‘He is adept at both keyhole and open surgery so if the operation was very challenging, he’d take it in his stride and convert to an open procedure.’

PRIVATE: Professor Manas does not work privately.

RICHARD HARDWICK

Addenbrooke’s Hospital in Cambridge WHAT THEY SAY ABOUT HIM: ‘I’ve seen him operate and he’s outstanding technically and does a huge amount for his patients — I’d be happy

to have any of my family operated on by him,’ reveals one of his peers.

PRIVAT E : Spire Cambridge Lea Hospital.

family operated on by of his peers. ire Cambridge

PETER SEDMAN

Castle Hill Hospital in Cottingham WHAT THEY SAY ABOUT HIM: ‘ he is kind, assured, has sound clinical judgment and is very skilled technically,’ says one of those who nominated him. ‘ he is also very approachable and immensely supportive of his patients,’ says another. PRIVATE: Spire hull and east Riding hospital.

HASSAN MALIK

Aintree University Hospital in Liverpool WHAT THEY SAY ABOUT

HIM: ‘A quite exceptional quality liver surgeon: he is accustomed to doing very complex liver surgery and handles challenging gallbladder surgery with great skill,’ is the verdict of one of his peers.

PRIVATE: Aintree University hospital (private care).

MARK PETERSON

Northern General Hospital in Sheffield WHAT THEY SAY ABOUT

HIM: ‘he trained with me and was the best trainee I have ever had,’ says one fellow surgeon. Adds another: ‘he is personable, calm and has very good thought processes. he is good at changing tactics in surgery if necessary.’ PRIVATE: Claremont Private hospital in Sheffield.

MARK TAYLOR

Mater Infirmorum Hospital in Belfast WHAT THEY SAY

ABOUT HIM: ‘A sensible and very experienced surgeon,’ was the opinion of one of his contemporaries. PRIVATE: Mater Infirmorum hospital (private care) and Ulster Independent Clinic, Belfast.

ZAK RAHMAN

Royal Free Hospital in London WHAT THEY SAY

ABOUT HIM: ‘An extremely bright and very good surgeon who is also reliable and sensible — and this quality should never be underestimated.’

PRIVATE: Royal Free hospital (private care).