BREAST PROBLEMS Patients with worrying symptoms should seek early medical advice.

Breast lumps are often benign but should be seen and assessed by someone able to differentiate benign from malignant conditions. Any uncertain lump is subjected to “Triple Assessment” which includes careful clinical examination, breast imaging (mammogram, ultrasound or MRI scanning) and, if necessary, tissue biopsy.

Breast Pain is usually not associated with cancer, but also requires careful assessment.

Nipple Changes or discharges are usually as a result of benign changes, but require full assessment to exclude underlying problems.

Breast Cancer
Symptoms to be concerned about include changes in the appearance of the breast or nipple or the development of a lump. Many tiny cancers are found on Breast Screening before they can be felt. Surgical treatments for cancer include breast conserving surgery or mastectomy when necessary, with or without immediate reconstruction. Where possible, axillary surgery to assess the lymph glands is carried out using sentinel node biopsy rather than full axillary gland clearance. This has fewer potential complications. Modern adjuvant (backup) treatments, tailored to each patient and their disease, ensure better chances of long term survival after therapy.

Robert Kirby does not deal with cosmetic breast problems, but works closely with plastic surgery colleagues at UHNS and North Staffordshire Nuffield Hospital.



HERNIAS
Hernias are caused by the protrusion of intra-abdominal contents (often containing bowel) though defects in the muscular wall of the abdomen. Hernias can look unpleasant and can be uncomfortable, but the greatest concern is that the bowel may obstruct or strangulate. Hernias can vary in size from less than a walnut to large swellings many inches in diameter. The most common type are inguinal hernias in the groin, but hernias can occur in any region of the abdomen. They can also develop after surgical operations (incisional hernias).

Abdominal wall hernias are repaired with a safe open technique using mesh. Inguinal hernias do not always need surgery if they are small and symptom free, but a (Lichtenstein) tension free mesh repair gives good results when surgery is advised. Most people are comfortable and well enough to go home the same day of their surgery. A new alternative method using preperitoneal mesh was introduced in 2009.
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“Gilmore Groin” Groin pain is often due to muscular or tendon problems. Where full assessment and physiotherapy has not helped the underlying problem, surgery similar to inguinal hernia repair can often relieve the pain, and allow full return to sporting activities.



GASTRO-INTESTINAL PROBLEMS

Robert Kirby is a member of the colo-rectal team and assesses people with abdominal or gastro-enterolological problems as outpatients or, if necessary, as an emergency.

Robert Kirby introduced laparoscopic cholecystectomy for gallstones to North Staffordshire in 1991 and continues to offer this service.

Gallstones can cause problems in a number of ways. They used to be found in Fair (sex), Fat and Forty, but are now one of the most common causes of emergency presentation with abdominal pain in all ages. They may present as biliary colic, a short acting pain that typically comes on after eating a fat containing meal, or acute cholecystitis, which is a severe pain that lasts several days. In this situation it is better to remove the gall bladder to prevent further attacks. Mild biliary colic can sometimes be controlled with a low fat diet.

More severe complications of gallstones include obstructive jaundice and acute pancreatitis.

Crohns Disease is a chronic bowel condition that may require surgery. Robert Kirby deals with this condition with medical gastro-enterology colleagues, and will undertake surgery when medical management is not successful at keeping symptoms of pain, change in bowel habit or subacute bowel obstruction at bay.



Endoscopy
Robert Kirby has a regular endoscopy list and offers a colonoscopy service. Unexplained rectal bleeding is often due to haemorrhoids or other completely benign conditions. Sometimes a colonic polyp is the cause, and removal at colonoscopy can prevent this developing into a bowel cancer at some time in the future..



Medico-legal Reports
Patients are seen at the Nuffield Hospital for assessment of abdominal or breast problems for purposes of providing medico-legal reports.(eg sequelae of trauma/ accidents).