0161 495 7756
BMI The Alexandra Hospital, Mill Lane, Cheadle SK8 2PX
Mr Anselm Agwunobi provides a comprehensive range of diagnostic and general surgical care procedures. In particular he is a leading expert in hernia surgery and surgery for gallstones and of the gallbladder, along with skin lumps and bumps, with over 25 years experience.
Mr Agwunobi specialises in gastrointestinal surgery, also called the GI tract (a series of hollow organs that form a long continuous passage from the mouth to the anus) and laparoscopic (low-risk, minimally invasive procedures that require only small incisions).
You can find out more about each surgical speciality by selecting and clicking the below:
Colonoscopy is the examination of the large bowel (colon) and rectum to detect any abnormalities. A long, flexible camera with a light on the end is inserted through the back passage (anus). Images are then transmitted to a video monitor for the doctor to view. If an abnormality, such as a polyp, is detected, it will usually be removed at the same time. Tissue samples (biopsy) of abnormal areas of the bowel are sometimes taken and sent for analysis.
Why do I need to have a colonoscopy?
There are a number of reasons why it may be recommended that you undergo a colonoscopy examination. These include:
Preparing for your colonoscopy:
What happens during a colonoscopy?
Colonoscopy is usually done as a day procedure. While in the endoscopy room you will lie on your side. You will be given a sedative to relax through a cannula placed in the back of your hand. You will not be totally asleep.
The colonoscope will be passed through the back passage to begin the inspection of the large bowel. Air will be introduced through the colonoscope to aid full inspection of the bowel. Mr Agwunobi will view the magnified images on a monitor and will be able to identify any abnormality. Most colonoscopies are normal, so try not to worry.
Sometimes we may need to take tissue samples (biopsy) to help confirm a suspected diagnosis. Any colonic polyps, identified during the procedure, are usually removed at the same time.
Colonoscopy examinations usually take approximately 20 -30 minutes.
What happens after the colonoscopy?
You will return to the recovery room, where you will closely monitored until most of the sedative effects have worn off. You will then return to your room with instructions on when you can start eating and drinking again.
Mr Agwunobi will visit you to give you your test results. If you have had any sedatives you may not remember everything and having a relative or a friend present may be useful. We will also write to you to confirm what we have discussed.
If tissue samples were taken the results may take another week to come back, at which time you will be notified. Copies of the test results and any ongoing recommendations will also be sent to your GP.
You will then be ready to go home. Please ensure that you have someone to collect you from the hospital if you have had sedation. Stay at home for the rest of the day to recuperate and do not operate any fine machinery or sign important documents for 24 hours.
Are there any complications associated with colonoscopy?
Complications following colonoscopy are very rare but can sometimes occur. These may be related to the sedatives affecting your breathing and/or oxygen levels in the blood, especially in the elderly and those who have pre-existing heart or lung problems.
Very occasionally, a colonoscopy may cause a small tear in the large bowel or bleeding from the site of a biopsy. If you experience any of the following within 48 hours, please contact your doctor immediately:
Please ensure you consult a healthcare professional before making decisions about your health.
Endoscopy, (sometimes referred to as a Gastroscopy, Colonoscopy or Flexible Sigmoidoscopy), is the general term used for a variety of non-surgical procedures used to examine internal parts of the body. This procedure enables your consultant to identify problems in your gastrointestinal tract and, in some circumstances treat them, without surgery.
The endoscopy procedure allows your surgeon to look at the inside of your body, examined using an instrument called an endoscope. An endoscope is a long, thin, flexible tube that has a light source and camera at one end. Images of the inside of your body are relayed to a television screen.
Who is eligible for Endoscopy?
How do book for Endoscopy?
Contact us using our simple online enquiry form and we will contact you to arrange a suitable appointment.
Please refer to our contraindications to ensure you fit the criteria for this service. We may need to contact you, or your doctor, for additional information.
Contraindications for Endoscopy:
Endoscopy is not suitable for the following groups:
Please contact us if you are unsure about your eligibility and we will advise you.
What happens after my Endoscopy?
Following your endoscopy Mr Agwunobi will visit you and explain the findings. We will also send a report to your GP or referring specialist within 24-48 hours, along with any management recommendations.
If a tissue sample was taken during the endoscopy it will normally take around 5- 7 days to receive the results. We will forward these to your referring clinician, who will discuss the findings with you and advise if any further action is required.
General information regarding Endoscopy:
Please note:
*Please note that this service is available at some, but not all, of our clinic locations and is subject to availability.
Flexible sigmoidoscopy is a tube, the size of a finger, used to examine the lining of the rectum and the left side of the large bowel. The flexible tube has a light and camera at the end to allow the bowel lining to be viewed clearly. Air is usually introduced into the bowel during the examination.
Flexible sigmoidoscopy is used as a diagnostic test for complaints such as passing blood from the back passage and lower abdominal pains, especially in the left lower abdomen.
The bowel needs to be clear of all faecal matter and you will be given a gentle phosphate enema when you arrive for the procedure. You may have sips of water up to two hours before.
What happens during flexible sigmoidoscopy?
The procedure is performed as a day case and can be done either with or without sedation. You will be asked to lie on your left side with your knees drawn up towards your chest. It takes about ten minutes to complete and you may feel a little wind or discomfort as the flexible sigmoidoscope is passed through the left side of the large bowel. This discomfort passes off soon after the procedure.
Flexible sigmoidoscopy can be used to collect tissue samples and to remove colonic polyps, if detected.
What happens after flexible sigmoidoscopy?
Following the procedure you will return to the recovery room for close monitoring, especially if you have had a sedative. You will then go back to your room, where you will be given instructions about eating and drinking and allowed to rest before discharge.
Mr Agwunobi will discuss your test results with you and may arrange a follow up appointment. We will also inform your GP or referring specialist and provide management recommendations. If a biopsy was taken it may take up to seven days for the results to come back, at which point you will be notified.
What happens after flexible sigmoidoscopy?
Following the procedure you will return to the recovery room for close monitoring, especially if you have had a sedative. You will then go back to your room, where you will be given instructions about eating and drinking and allowed to rest before discharge.
Mr Agwunobi will discuss your test results with you and may arrange a follow up appointment. We will also inform your GP or referring specialist and provide management recommendations. If a biopsy was taken it may take up to seven days for the results to come back, at which point you will be notified.
Are there any complications associated with flexible sigmoidoscopy?
Complications following flexible sigmoidoscopy are extremely rare.
Bleeding from the back passage may occur from the site of a biopsy, or the flexible sigmoidoscope may cause a minor tear in the bowel. However, this is very uncommon.
Please ensure you consult a healthcare professional before making decisions about your health.
Gallstones are solid materials, made up of crystallised cholesterol and bile salts. Gallstones can range from the size of a grain of sand to the size of a golf ball.
It is not clear why some people get gallstones, but there are factors that increase your risk, including:
The gallbladder is a small sac, about the size and shape of a pear, which lies under the liver on the right side of the upper abdomen. It is connected to the liver and the bowel through tubes known as the cystic and the common bile ducts. The role of the gallbladder is to store and concentrate bile produced by the liver and release it to aid food digestion.
What are the symptoms of gallstones?
The most common symptom of gallstones is pain, usually in the right upper abdomen. However, it can sometimes feel like a tight band running across the whole area and the pain may also radiate to the back, between the shoulder blades. This is sometimes referred to as “biliary colic” and may be associated with nausea and vomiting. The pain can last from 15 minutes to several hours and attacks of pain may be separated by weeks, months, or even years, with no defined pattern.
Some patients with gallstones experience no symptoms and the stones are only discovered by chance. No treatment is required for silent (asymptomatic) gallstones.
Complications of Gallstones
Gallstone pain occurs when a stone blocks the cystic duct. If this is prolonged then it may cause inflammation and infection of the gallbladder – a condition known as acute cholecystitis. This is usually an emergency and requires hospital admission for pain control and antibiotics, as well as urgent surgery to remove the gallbladder.
Gallstones can also move and lodge in the main bile duct causing an obstruction. This will lead to jaundice, dark urine and skin itching. Some people will also develop a fever and shaking which requires urgent medical attention.
Inflammation of the pancreas (acute pancreatitis) is a potentially life-threatening complication of gallstones. This can occur when a gallstone blocks the common channel of the main bile duct and the pancreatic duct, where they both drain into the bowel (duodenum). This requires urgent hospital admission and management.
How are gallstones diagnosed?
Gallstones are diagnosed by:
How are gallstones treated?
There is generally no need to treat gallstones that are not causing any symptoms. However, patients experiencing pain will probably see their symptoms recur at some point in the future which, in a small minority of cases, can lead to life-threatening complications. Under these circumstances, it is advisable to consider treatment.
The best option is to remove the gallbladder with the stones. This is known as a cholecystectomy and is routinely performed using laparoscopic or keyhole surgery. The operation is performed under general anaesthetic (asleep) and takes about half an hour to complete.
Preparing for a gallbladder operation:
Once you have decided to have your gallbladder removed, we may recommend blood tests to check your liver and kidney function, a blood clotting test and possibly an ECG to check your heart trace (dependent on your age and medical history). You may also need to temporarily stop taking some medications, such as blood thinning drugs. However, the Apple Surgical Clinic team will be able to advise you.
After discussing the pros and cons of your operation we will need you to sign a written consent form to confirm that you are happy to go ahead with the procedure.
You will also receive instructions about reporting to the hospital on the day of your operation and when to stop eating and drinking in preparation for your surgery.
Once at the hospital, you will be taken to your room with its own en-suite facilities. The Apple Surgical Clinic team will admit you and check that everything is in order to proceed with the operation.
What happens during a gallbladder removal operation?
Mr Agwunobi will remove your gallbladder in a procedure known as a laparoscopic cholecystectomy. This will involve making small incisions in your abdomen and inserting a laparoscope, connected to a special camera, giving magnified views of the internal organs.
Tiny, long instruments are used to reach the gallbladder which is then removed from its liver bed. The small skin incisions will be closed with dissolving sutures (stitches), so there is no need for future removal.
You will be asleep throughout the whole procedure (under general anaesthesia) and you won’t feel anything.
Very occasionally it may not be possible to complete the procedure using the keyhole technique and an open cut has to be made to remove the gallbladder. In our practice, this is very rare and over 99% of operations are completed laparoscopically, even in patients who have had previous open abdominal operations.
What to expect after a gallbladder operation:
You will return to the recovery room for close monitoring before being discharged back to your own room. The ward nurses will continue to monitor and support you on the ward to aid your recovery.
You may experience some shoulder tip pain, which can be due to the carbon dioxide gas used during the operation to distend the abdomen. This can irritate the diaphragm, which has the same nerve supply as the shoulders, but it should pass off very quickly.
Adequate pain control will be provided, as well as anti-sickness medications if you feel nauseous.
You may eat and drink a few hours after surgery, starting with small portions.
Most patients are able to go home the same day, although a minority may need to stay in overnight for further monitoring.
You will be discharged home with painkillers to take for 4 – 5 days.
A follow-up appointment will be arranged for you to see Mr Agwubi again in 4 – 6 weeks’ time.
Your skin wounds will be dressed with waterproof dressings so that you can have showers at home. These may be removed after 5 days and the stitches will dissolve themselves.
Full recovery and return to work should take around 7 – 14 days, depending on the type of job you do.
You may be able to drive 7 days after your surgery, or when you feel able to do an emergency stop, but please check with your insurer.
What are potential complications of a gallbladder operation?
Complications are rare and over of 99% of patients have a smooth recovery and see their symptoms resolved.
Very occasionally patients may experience excessive bleeding, infection, injury to the bile duct, or retained stones. These small risks will be discussed with you at your consultation.
Please contact us immediately if you experience any of the following problems during your recovery:
Are there any long-term consequences of not having my gallbladder?
You can live perfectly fine without your gallbladder. Your body will adjust.
In a small minority of patients, there may be an increase in bowel frequency, but this is usually temporary and rarely requires any form of treatment.
Do I need to follow a special diet after my gallbladder operation?
You do not need to follow any special diet after your gallbladder operation. Stick to a healthy, balanced diet as usual, but it may be better to eat smaller portions initially until you are able to manage larger meals.
A hernia is an abnormal protrusion of a loop of intestine, or other internal organs, through a weak area of the abdominal wall.
The most obvious symptoms of a hernia are:
Around 4 out of 5 hernias occur in the groin crease (inguinal hernia), but they can also occur through the navel (umbilical hernia), above the navel (para-umbilical or epigastric hernia), below the groin crease (femoral hernia) and through an old surgical incision (incisional hernia).
What causes a hernia?
Hernias usually occur due to natural weakness in the abdominal wall. However, there are some predisposing factors, such as heavy lifting, straining, persistent coughing and carrying excess weight.
Are hernias dangerous?
Abdominal wall hernias are not necessarily dangerous, although they do not get better without surgery. However, they can cause life threatening complications if they cause obstructions or cut off the blood flow, so it may be best to have them surgically repaired.
What is incarceration and strangulation of a hernia?
Abdominal wall hernias can contain a loop of intestine, usually the small intestine, which may become stuck or trapped in the hernia. This is known as incarceration.
Occasionally the loop of intestine is trapped so tightly that its blood supply gets cut off, referred to as strangulation and this can lead to bowel gangrene within 6 hours. If untreated, this can cause bowel perforation, peritonitis and ultimately death.
What are the possible signs and symptoms of hernia strangulation?
Generally, you should be able to gently push a hernia back in.
If you are unable to do this and you develop any of the symptoms below, you must seek immediate medical attention:
How are abdominal wall hernias diagnosed?
Abdominal wall hernias are usually diagnosed based on the history and examination of the individual patient. Other conditions in the groin, such as enlarged lymph glands, undescended testis and abnormally swollen blood vessels, need to be excluded by your GP.
Your doctor may ask you to stand up and cough, as the pressure of coughing helps push out a hernia and appear more obvious.
Occasionally an ultrasound scan, or computed tomography (CT) scan, may be required to help diagnose abdominal wall hernias.
How are abdominal wall hernias treated?
Not all abdominal wall hernias require surgical repair. Hernias through the navel (umbilical hernias) in babies occur because the opening for the umbilical cord did not completely close and some of these may resolve spontaneously. They may just need monitoring.
However, it is normally recommended that adult hernias are repaired surgically, especially if they are causing problems. A mesh material is used to reinforce the weak area of the abdominal wall and reduce the risk of a hernia recurring. This is done using a laparoscopic (keyhole) technique, which allows faster physical recovery, smaller incisions, less pain and can usually be performed as a day case.
Please ensure you consult a healthcare professional before making decisions about your health.
Abdominal pain, or stomach ache, is a common complaint that virtually everyone experiences at some point in their lives. Most of the time it is not due to any underlying condition, however, it is essential to know when abdominal pains may indicate something more serious.
Seek medical help if you experience abdominal pain that is sudden and severe (acute), or has been going on for weeks or months without improvement (chronic).
Abdominal pain can be described as:
If your abdominal pain persists, please seek medical attention, especially if:
What are common causes of abdominal pain?
Conditions that may cause abdominal pain include:
How is abdominal pain assessed?
There are many possible reasons for abdominal pain. If you are referred to us we will need to understand your full medical history and carry out tests to determine the cause.
These might include:
How is abdominal pain managed?
This depends on the underlying cause.
In the majority of cases, there is no serious, underlying illness and the pain is self-limiting. Some problems, such as stomach ulcers and indigestion, can be managed with medications. However, certain conditions, such as appendicitis, an obstructed hernia, or gallstones, will require surgery.
Our medical team will discuss the management plan best suited to you.
Please ensure you consult a healthcare professional before making decisions about your health.
Laparoscopic surgery (also known as minimally invasive, or keyhole surgery) is one the major advances in modern surgical techniques. It involves the use of small incisions in the abdomen (usually less than an inch long) through which long thin instruments can reach and treat the internal organs.
A miniature camera, known as a laparoscope, is passed via one of the small incisions and images of the abdominal organs can then be magnified and viewed on a television monitor. This allows the surgeon to carry out many complex procedures, inside the abdomen, without the need for large cuts.
Laparoscopic surgery has many advantages over traditional open surgery. These can include:
Laparoscopic surgeons have to undergo extensive training to acquire the skills needed to perform complex surgical procedures using the technique. Mr Agwunobi has performed over 3,500 laparoscopic procedures, including on patients who have had previous open abdominal surgery with extensive scarring.
Common abdominal procedures
Common abdominal procedures performed using minimally invasive (keyhole) techniques:
Please note that this list is by no means exhaustive. New techniques are being developed by surgeons all the time.
You will have the opportunity to discuss the technique best suited to your condition prior to making any decisions.
Please ensure you consult a healthcare professional before making decisions about your health.
Skin lumps are any areas of abnormally raised skin. The lumps may be hard and rigid, or soft and moveable. Swelling from injury is one common form of skin lump.
Most skin lumps are benign, meaning they’re not cancerous. Skin lumps are generally not dangerous, and usually don’t interfere with your everyday life.
Possible causes of skin lumps
Skin lumps can be caused by a number of health conditions that range in severity. Common types and causes of skin lumps include:
Treatment for skin lumps
Discomfort or pain from lymph node swelling, enlarged salivary glands, or a skin rash caused by a viral illness can be managed. You should try ice packs, baking soda baths, and fever-reducing medication.
Skin lumps caused by injury usually fade on their own as the swelling goes down. Applying an ice pack and elevating the area can reduce inflammation and ease pain.
A skin lump that causes continual pain or is hazardous to your health may require a more invasive medical treatment. Skin lumps that may warrant drainage or surgical removal include:
Most skin lumps aren’t serious. Usually, treatment is only necessary if the lump is bothering you.
You should go to your family GP if you are concerned about a growth on your skin. Your doctor can evaluate the lump and make sure it’s not a symptom of a serious underlying condition which may require surgical intervention.
You will have the opportunity to discuss the technique best suited to your condition prior to making any decisions.
Please ensure you consult a healthcare professional before making decisions about your health.
Upper GI endoscopy or gastroscopy is the examination of the upper gastrointestinal tract (oesophagus, stomach and duodenum) using a specialised long, thin video camera with a light on the end. It is used to diagnose and treat many upper gastrointestinal tract problems.
These can include:
Preparing for Upper GI Endoscopy
You will firstly be assessed by Mr Alsem Agwunobi to ensure you are going to have the procedure for the right reasons and understand what it involves. We will want know your full medical history (any diabetes, heart or lung problems etc.). Please also inform us of all medications that you take, including over the counter remedies and any blood thinning medications.
Upper GI endoscopy is done as a day procedure, either with or without sedation.
If you are having sedation, please ensure you make arrangements for someone to pick you up afterwards because you will not be able to drive yourself home. You should not eat for at least six hours prior to the test to allow better views of the stomach. You may have sips of water up to two hours before.
When you arrive at the hospital you will be checked in at reception and then taken to your room. A member of the Apple Surgical Clinic medical team will visit you in your room and talk you through the procedure once more and obtain your consent (if this had not already been done). You will also be able to ask any further questions.
You will then be admitted by the nursing staff and requested to change into a hospital gown in preparation for your endoscopy.
During the Procedure
Once inside the endoscopy room the team will do everything they can to make you as comfortable and relaxed as possible.
You will have a final check by the team and a local anaesthetic throat spray will be administered to minimise gag reflex. You will be asked to lie on your left side and connected to a machine that monitors your pulse, blood pressure and oxygen levels throughout the procedure. A sedative will be administered to make feel relaxed and a little drowsy (unless you have opted not to have one) and a protective mouthpiece will be inserted to keep your mouth open.
The thin, flexible endoscope is then carefully passed down your throat to examine your upper gastrointestinal tract and assess any abnormalities. During the test it may be necessary to take tissue samples, or biopsies, for further analysis. Some conditions can be treated at the same time, such as stretching a narrow oesophagus, or removing foreign bodies.
During the procedure you should not feel pain, but you may feel a sensation of wind and bloating as air is passed down to get a clear view of your upper GI tract. This quickly passes off as soon as the test is over.
Are there any potential complications of Upper GI Endoscopy?
These are incredibly rare. The vast majority of the time upper GI endoscopy is carried out with no problems at all.
Very rarely the gastroscope can cause a tiny tear in the gullet, but this tends to be when the lumen of the gullet is narrow. Another occasional problem is bleeding from the site where a tissue sample or biopsy has been taken.
What happens after the procedure?
You will return to the recovery room where you will closely monitored until most of the effects of the sedative have worn off. You will then go back to your room with instructions on when to start eating and drinking again. Mr Agwunobi will visit you to give you the results of the test.
Results of tissue samples may take another week to come back, at which time we will notify you. Copies of the test results and any ongoing recommendations will also be sent to your GP.
You will then be ready to go home. Please ensure you have someone to collect you from the hospital if you have had sedation. Stay at home for the rest of the day to recuperate and do not operate any fine machinery for 24 hours.
Please ensure you consult a healthcare professional before making decisions about your health.
What Is an Appendicectomy?
An appendicectomy is the surgical removal of the appendix. It’s a common emergency surgery that’s performed to treat appendicitis, an inflammatory condition of the appendix.
The appendix is a small, tube-shaped pouch attached to your large intestine. It’s located in the lower right side of your abdomen. The exact purpose of the appendix isn’t known. However, it’s believed that it may help us recover from diarrhoea, inflammation, and infections of the small and large intestines. These may sound like important functions, but the body can still function properly without an appendix.
When the appendix becomes inflamed and swollen, bacteria can quickly multiply inside the organ and lead to the formation of pus. This buildup of bacteria and pus can cause pain around the belly button that spreads to the lower right section of the abdomen. Walking or coughing can make the pain worse. You may also experience nausea, vomiting, and diarrhea.
It’s important to seek treatment right away if you’re having symptoms of appendicitis. When the condition goes untreated, the appendix can burst (perforated appendix) and release bacteria and other harmful substances into the abdominal cavity. This can be life-threatening, and will lead to a longer hospital stay.
What is an Appendicectomy?
An Appendicectomy is the standard treatment for appendicitis. It’s crucial to remove the appendix right away, before the appendix can rupture. Once an appendectomy is performed, most people recover quickly and without complications.
Why Is an Appendicectomy Performed?
An appendicectomy is often done to remove the appendix when an infection has made it inflamed and swollen. This condition is known as appendicitis. The infection may occur when the opening of the appendix becomes clogged with bacteria and stool. This causes your appendix to become swollen and inflamed.
The easiest and quickest way to treat appendicitis is to remove the appendix. Your appendix could burst if appendicitis isn’t treated immediately and effectively. If the appendix ruptures, the bacteria and fecal particles within the organ can spread into your abdomen. This may lead to a serious infection called peritonitis. You can also develop an abscess if your appendix ruptures. Both are life-threatening situations that require immediate surgery.
Symptoms of appendicitis include:
Although pain from appendicitis typically occurs in the lower right side of the abdomen, pregnant women may have pain in the upper right side of the abdomen. This is because the appendix is higher during pregnancy.
What Are the Risks of an Appendicectomy?
An appendicectomy is a fairly simple and common procedure. However, there are some risks associated with the surgery, including:
It’s important to note that the risks of an appendicectomy are much less severe than the risks associated with untreated appendicitis. An appendectomy needs to be done immediately to prevent abscesses and peritonitis from developing.
How Do I Prepare for an appendicectomy?
You will need to avoid eating and drinking for at least eight hours before the appendectomy. It’s also important to tell your doctor about any prescription or over-the-counter medications you’re taking. Your doctor will tell you how they should be used before and after the procedure.
You should also tell your doctor if you:
You should also arrange for a family member or friend to drive you home after the procedure. An appendectomy is often performed using general anesthesia, which can make you drowsy and unable to drive for several hours after surgery.
Once you’re at the hospital, your doctor will ask you about your medical history and perform a physical examination. During the exam, your doctor will gently push against your abdomen to pinpoint the source of your abdominal pain.
Your doctor may order blood tests and imaging tests if appendicitis is caught early. However, these tests may not be performed if your doctor believes an emergency appendectomy is necessary.
Before the appendicectomy, you’ll be hooked up to an IV so you can receive fluids and medication. You’ll likely be put under general anesthesia, which means you’ll be asleep during surgery. In some cases, you’ll be given local anesthesia instead. A local anesthetic numbs the area, so even though you’ll be awake during the surgery, you won’t feel any pain.