The best doctors for gallbladder and gut problems — as 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