Digestive disease surgery: what the specialty covers, conditions treated and what to expect

Digestive disease surgery is an umbrella term rather than a single training pathway. In most hospitals the work is shared between upper gastrointestinal (upper GI) surgeons, who operate on the oesophagus and stomach; hepatobiliary and pancreatic surgeons, who deal with the liver, gallbladder, bile ducts and pancreas; colorectal surgeons, who operate on the large bowel, rectum and anus; and bariatric surgeons, who perform operations for severe obesity. Abdominal wall surgeons repair hernias, and many general surgeons cover several of these areas, especially in smaller hospitals and on emergency rotas.

Each of these surgeons is a consultant who has completed general surgical training and then specialised. They work with gastroenterologists, who diagnose and medically treat digestive disease and perform endoscopy, as well as radiologists, pathologists, dietitians and oncologists. Many operations are now done by keyhole or robot-assisted techniques, but the right approach depends on the condition and the patient.

Where the problem sits in the digestive tract determines who treats it and how.

• Gullet and stomach: reflux that does not respond to medicines, hiatus hernia, achalasia (a swallowing disorder), and oesophageal and stomach cancer. The NHS says treatment for stomach cancer usually includes surgery and chemotherapy, and may include radiotherapy and targeted medicines.

• Gallbladder and bile ducts: gallstones, gallbladder inflammation and stones in the common bile duct. The NHS says stones in the bile duct may be cleared with an endoscopic procedure called ERCP.

• Pancreas: acute pancreatitis, which the NHS says needs urgent hospital treatment and is most commonly caused by gallstones or heavy alcohol use, chronic pancreatitis, cysts and pancreatic tumours.

• Bowel: bowel cancer, diverticular disease, inflammatory bowel disease complications and benign anorectal problems, covered in our colorectal surgery guide.

• Abdominal wall: groin, umbilical, incisional and hiatus hernias. The NHS says some hernias improve on their own but others need surgery.

• Obesity and metabolic disease: bariatric surgery when other measures have not been enough.

The NHS says gallstones are diagnosed by ultrasound and blood tests, and may be found by chance on a scan done for another reason. Acute pancreatitis is usually diagnosed with blood tests and sometimes a CT scan. For persistent reflux that does not respond to medicines, the NHS says a GP may refer you for tests such as gastroscopy, which passes a thin camera down the throat into the stomach, and for tests to check for stomach infection with bacteria that can cause heartburn.

Suspected cancers are investigated with endoscopy, biopsies and cross-sectional imaging such as CT and MRI; further staging scans may follow. For the bowel, the NHS describes colonoscopy as the main test for bowel cancer. For hernias, diagnosis is often by examination, with ultrasound when the picture is unclear.

Gallbladder removal (cholecystectomy) is among the most frequently performed operations in this field. The NHS says people with gallstones may not need treatment if there are no symptoms, but surgery is the main treatment if there are symptoms, complications, or stones in the common bile duct. While waiting, it suggests simple painkillers and a low-fat diet.

Anti-reflux surgery and endoscopic alternatives are reserved for selected people. Surgery for achalasia can be done through the mouth or with keyhole techniques. Oesophageal cancer surgery removes part or, in a few people, most of the gullet, and the NHS says it may also involve removing parts of nearby organs such as the top of the stomach; chemotherapy and radiotherapy are often used alongside.

The NHS describes weight loss surgery as making the stomach smaller so that you eat less. It says surgery may be offered with a BMI of 40 or over, or 35 or over with conditions such as type 2 diabetes or high blood pressure, with lower figures of 37.5 and 32.5 to 37.4 for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean background. Hospital stay is usually 1 to 2 days, recovery about 3 to 4 weeks, and check-ups continue for 2 years. Endoscopic weight loss and revision procedures exist for some patients who prefer to avoid or have already had surgery.

Many hospitals follow enhanced recovery programmes that aim to get patients eating, walking and home sooner after major abdominal surgery. Ask what the unit's plan is.

On the NHS, a GP is the usual starting point. Suspected cancers are referred urgently, and the national standard is a first specialist appointment within two weeks. For most other referrals the standard is treatment within 18 weeks, though waits vary by hospital and procedure. In England, Right to Choose can let you ask for referral to any suitable provider commissioned by the NHS.

The NHS tells people with gallstone pain lasting over 30 minutes to ask for an urgent GP appointment or call NHS 111, and tells people with a hernia and pain, nausea, vomiting or a bloated abdomen to get help from NHS 111, because these can be signs of complications.

Privately, patients are often seen by self-referral or GP letter, then have tests arranged by the surgeon. Policies commonly need pre-authorisation, and cover for weight loss surgery, hernia repair and anti-reflux procedures varies. Cost depends on the operation, whether it is day-case or needs an overnight stay, the surgeon's and anaesthetist's fees, devices such as mesh or staplers, pathology, and follow-up. Ask for an itemised quote and what happens if a complication needs further surgery.

Bring recent scan and endoscopy reports, blood results, and a list of medicines, particularly blood thinners, diabetes medicines and anti-inflammatory painkillers. A short diary of symptoms and triggers helps, such as the timing of gallstone attacks or reflux.

• Ask what the diagnosis is and whether non-operative options remain.

• Ask how often the surgeon performs this operation and what the unit's complication and readmission rates are.

• Ask whether the operation is keyhole, robotic or open, and when it might convert to open.

• Ask about diet, driving, lifting and return to work after surgery.

• For weight loss surgery, ask about long-term vitamin supplements and follow-up arrangements.

The NHS advises calling 999 or going to A&E for sudden severe abdominal pain, pain spreading from the tummy to the back with vomiting, a very high temperature or shivering, or yellow skin or eyes with gallstones; it gives similar advice for bleeding that will not stop, vomiting blood, or sick that looks like coffee grounds. Do not drive yourself. After any abdominal operation, increasing pain, fever, persistent vomiting, a swollen abdomen or a wound that opens warrant a call to the surgical team or NHS 111.