Frequently asked questions
Here you can find general answers to the questions asked most often during examinations. An assessment specific to your situation requires an examination.
No. Pancreatic cysts, chronic pancreatitis, autoimmune pancreatitis and certain benign tumours can also appear as a mass in the pancreas. For a definitive assessment, pancreatic protocol imaging and, when necessary, endoscopic ultrasound and biopsy are carried out.
Pancreatic Cancer →If chemotherapy or radiotherapy is to be started, the diagnosis must be confirmed by biopsy. In some patients who appear typical and suitable for immediate surgery on imaging, a biopsy before the operation may not be mandatory. The decision should be made by the multidisciplinary tumour board.
Pancreatic Cancer →No. CA 19-9 can also be raised in bile duct blockage, pancreatitis and various other diseases. In some pancreatic cancers, on the other hand, it may remain normal. On its own it is neither a diagnostic nor a screening test.
Pancreatic Cancer →In patients in whom all of the disease can be removed surgically, there is a possibility of a lasting cure. However, because of the risk of recurrence, surgery is usually combined with chemotherapy. At an advanced stage, treatment aims to control the disease and to extend survival and improve quality of life.
Pancreatic Cancer →Yes. The decision on resectability should be made by a team experienced in pancreatic surgery and radiology. Some locally advanced or borderline resectable tumours can be reassessed after chemotherapy.
However, not every patient becomes operable after treatment.
Pancreatic Cancer →No. The whole stomach is not removed in a Whipple operation. In most techniques the stomach is preserved; in some cases a small part of the outlet of the stomach may be removed.
Pancreatic Cancer →Yes. If the remaining part of the pancreas works adequately, digestion and blood sugar control can continue. Some patients may need pancreatic enzymes or diabetes treatment.
Pancreatic Cancer →Insulin and pancreatic enzymes with every meal are needed for life. Life can be maintained with close follow-up by an experienced diabetes and nutrition team.
Pancreatic Cancer →Chemotherapy after the operation is recommended for most patients whose general condition allows it. The treatment to be used and its duration are determined by whether treatment was given before the operation, the pathology result and the patient’s recovery.
Pancreatic Cancer →The length of treatment varies according to the stage of the disease:
- Chemotherapy before surgery usually lasts a few months.
- Recovery after the operation usually takes a few weeks.
- The total duration of chemotherapy around the operation is usually planned as about six months.
- In metastatic disease, treatment may continue as long as it is beneficial and the side effects are acceptable.
These are approximate durations; the individual treatment plan may differ.
Pancreatic Cancer →First, the cause of the jaundice, any bile duct infection and the resectability of the tumour are assessed. Some patients can be operated on directly, whereas others may first need a biliary stent and chemotherapy.
Pancreatic Cancer →Intestinal stomas, that is, a bag, are not routinely used in pancreatic cancer surgery. One may rarely be needed in very particular and unexpected bowel complications.
Pancreatic Cancer →Pancreatic cancer screening is not recommended for the general population. However, people with a strong family history or certain inherited gene changes can be followed up in programmes designed for high-risk individuals.
Follow-up usually uses pancreatic MRI/MRCP and endoscopic ultrasound. The age at which it starts is determined by the family history and the gene change.
Pancreatic Cancer →Yes. Current NCCN recommendations advise inherited gene testing for all patients diagnosed with pancreatic cancer, even if there is no family history of cancer [1]. The result can affect both treatment and the assessment of family members.
Pancreatic Cancer →A prompt reassessment of the images by an experienced multidisciplinary team can be useful, particularly regarding resectability. However, the assessment should not be unnecessarily prolonged and the planned treatment should not be delayed.
Pancreatic Cancer →You should contact your healthcare team without delay if you have any of the following symptoms:
- Fever and shivering
- New or increasing jaundice
- Persistent vomiting and being unable to take fluids
- Pain that cannot be controlled
- Rapid weight loss
- Black stools or bleeding
- Swelling in one leg
- Sudden shortness of breath or chest pain
- High fever during chemotherapy
Gallbladder stones do not turn directly into cancer. Gallbladder cancer is quite rare. Although long-standing and large stones are thought to possibly increase the risk in connection with chronic inflammation, the vast majority of people with gallstones do not develop cancer.
If irregular thickening of the gallbladder wall, a polyp or a mass is seen on ultrasound, further assessment is needed.
Gallbladder Stones →Usually not. Routine surgery is not recommended for gallstones that cause no symptoms and where imaging shows no other suspicious finding. It may be enough for you to know which complaints should prompt you to see a doctor.
If there is a large stone, a gallbladder polyp, a change in the wall or certain special conditions, the decision is made individually.
Gallbladder Stones →For stones found incidentally in a normal-looking gallbladder that cause no symptoms, regular ultrasound follow-up is not necessary for most patients. If new pain, fever or jaundice develops, a reassessment should be made.
If there is a gallbladder polyp, wall thickening or another suspicious finding, a separate follow-up programme may be needed.
Gallbladder Stones →The size of the stone is one of the criteria used in the assessment, but it is not sufficient on its own. The patient’s symptoms, the number of stones, the appearance of the gallbladder wall, any accompanying polyp or mass and the general state of health are assessed together.
Very small stones can also pass into the bile duct and cause pancreatitis or jaundice. For this reason, a clear-cut distinction such as “a small stone is harmless, a large stone is dangerous” cannot be made.
Gallbladder Stones →Both situations can carry different risks. Small stones can pass more easily into the bile duct and cause pancreatitis or jaundice. Large stones, on the other hand, may be associated with long-term pressure and inflammation.
In the decision on surgery, what matters is not only the number and size of the stones but also the symptoms the patient experiences and any complications that develop.
Gallbladder Stones →A small stone in the gallbladder can pass into the bile duct, but this is not always a good thing. The stone may pass from the duct into the bowel, but it may also block the bile duct or the outlet of the pancreatic duct and cause jaundice, infection or pancreatitis.
Stones that remain inside the gallbladder usually do not disappear completely on their own.
Gallbladder Stones →Biliary sludge is the build-up in the gallbladder of small particles in bile such as cholesterol crystals, bilirubin and calcium salts. A distinct stone has not yet formed, but over time biliary sludge may disappear, stay the same or turn into small stones.
Conditions that can make biliary sludge more likely to form are:
- Prolonged fasting
- Losing weight very quickly
- Rapid weight loss after obesity surgery
- Pregnancy
- Long-term intravenous feeding
- Certain serious illnesses
- The gallbladder not emptying sufficiently
- Use of certain medicines such as ceftriaxone and octreotide
If biliary sludge causes no complaints, immediate surgery or drug treatment is usually not needed. If there is a temporary cause contributing to the formation of sludge, it may disappear on its own once this is corrected. Whether follow-up is needed is determined according to the person’s complaints, blood results and ultrasound findings.
However, biliary sludge is not always harmless. Small crystals can pass into the bile duct and cause:
- Typical gallstone pain
- Inflammation of the gallbladder
- Blockage of the bile duct and jaundice
- Bile duct infection
- Acute pancreatitis
If there is typical gallstone pain together with biliary sludge, or if a problem such as cholecystitis, jaundice or pancreatitis has developed, and the patient is fit for surgery, the definitive treatment is usually laparoscopic removal of the gallbladder. Surgical assessment is particularly important in patients who have had pancreatitis due to biliary sludge, because of the risk of pancreatitis developing again.
Drug treatment to dissolve biliary sludge is not routinely recommended. Medicines containing ursodeoxycholic acid may be considered only in selected patients who are not fit for surgery or who have special circumstances, by decision of the doctor. You should not use “gallstone-dissolving” medicines or herbal products on your own.
If abdominal pain is accompanied by fever, shivering, jaundice, dark urine or persistent vomiting, you should go to a healthcare facility without waiting [6,7].
Gallbladder Stones →Drug treatment may be considered only in selected patients who have small cholesterol stones and are not fit for surgery. The treatment takes a long time and there is a possibility of the stones forming again. For stones that cause symptoms, the definitive and established treatment is usually surgery.
Gallbladder Stones →In standard treatment, it is not only the stones that are removed but the gallbladder that forms them. If the gallbladder is left in place, the likelihood of new stones forming and complaints returning remains.
Gallbladder Stones →Yes. The gallbladder is not an organ that is essential for life. The liver continues to produce bile and the digestive system keeps working. Most patients return to their normal life and usual eating pattern after the operation.
Gallbladder Stones →Today the standard method is laparoscopic, that is, keyhole surgery. In the case of severe inflammation, advanced adhesions, bleeding or anatomical structures that cannot be safely distinguished, the operation may be converted to open surgery.
This change is made for patient safety and does not mean that the operation has failed.
Gallbladder Stones →ERCP is mainly used to remove stones that have passed into the common bile duct. ERCP is not the standard treatment for stones inside the gallbladder.
After the bile duct has been cleared with ERCP, if the patient is fit for surgery, a separate operation may be planned for the gallbladder.
Gallbladder Stones →In some patients, stools may temporarily become softer or the frequency of going to the toilet may increase after the operation. This usually lessens over time.
If there is diarrhoea that lasts a long time, affects daily life or wakes you at night, you should see a doctor so that other causes can be investigated and, if necessary, medicines that bind bile acids can be considered.
Gallbladder Stones →Gallstones can be found during pregnancy, and some stones can be monitored without causing symptoms. If recurrent pain, inflammation of the gallbladder, jaundice or pancreatitis develops, a joint assessment by the obstetrics and gynaecology, general surgery and anaesthesia teams is needed.
When necessary, laparoscopic surgery can also be performed during pregnancy. The decision is made individually, taking into account the stage of pregnancy, the severity of the illness and the condition of the mother and baby.
Gallbladder Stones →In the following situations, go to a healthcare facility without waiting:
- Severe abdominal pain that does not go away within a few hours
- Pain accompanied by fever or shivering
- Yellowing of the eyes or skin
- Dark urine
- Repeated vomiting
- Fainting, marked weakness or confusion
No. A large proportion of masses found by chance in the liver are benign growths such as a haemangioma, FNH or a simple cyst. However, to determine the type of mass, your previous history of cancer, any liver diseases you have and the contrast-enhanced imaging findings should be assessed together [1].
Liver Tumours →A definite diagnosis cannot be made with a blood test alone. Markers such as AFP, CEA and CA 19-9 can help with diagnosis and follow-up in some patients; however, a normal result does not rule out cancer, and a raised result does not definitely mean cancer.
Liver Tumours →No. Some benign masses, and typical HCC in patients with cirrhosis, can be recognised without a biopsy using appropriate contrast-enhanced CT or MRI. If the imaging is not conclusive, or if the biopsy result would change the treatment plan, a tissue sample may be taken.
Liver Tumours →In some patients, yes. For this, the tumour must be technically removable, disease elsewhere in the body must be under control, and enough functioning liver tissue must remain after the operation. The decision should be made individually by a multidisciplinary tumour board.
Liver Tumours →The remaining healthy liver tissue can increase in volume after the operation. However, this does not mean that the removed part re-forms in the same way. The capacity to regenerate can be affected by cirrhosis, damage caused by chemotherapy, fatty liver and other liver diseases.
Liver Tumours →No. Liver metastases may indicate that the disease is at an advanced stage; however, especially with a limited number of metastases from colon and rectal cancer, the disease can be kept under control for a long time in some patients by combining surgery, ablation and drug treatments. In some selected patients, complete surgical removal may be possible [7].
Liver Tumours →Depending on the location of the tumour, a small part of the liver, a segment or a larger portion may be removed. In suitable patients, laparoscopic or robotic methods can be used. For large tumours, tumours close to the blood vessels or multiple tumours, open surgery may be needed. The most important aim is not the name of the method used, but the removal of the tumour with safe margins and the preservation of enough functioning liver tissue.
Liver Tumours →This decision depends on the type of tumour and the pathology result. In HCC, routine drug treatment after surgery is not necessary for every patient. In intrahepatic cholangiocarcinoma and liver metastases, on the other hand, systemic treatment may be given more often before or after the operation. The personal plan is decided by the oncology tumour board.
Liver Tumours →Not all cases can be prevented. Nevertheless, being vaccinated against hepatitis B, having hepatitis B and C infections treated, avoiding excessive alcohol, maintaining a healthy weight, and keeping diabetes and fatty liver disease under control can help to reduce the risk of HCC. For people with cirrhosis or high-risk chronic liver disease, keeping to a regular surveillance programme is important for early diagnosis [3,4].
Liver Tumours →No. The great majority of adrenal masses found by chance are benign. However, to be sure that the mass is benign, its imaging features and the necessary hormone tests should be assessed together.
Adrenal (Suprarenal Gland) Masses →No. In the current approach, the decision is not made on size alone. The internal structure of the mass, its density on CT, whether it secretes hormones, whether it grows and the patient’s general condition are assessed together.
Nevertheless, it is important that masses that are 4 centimetres or larger and have irregular features on imaging are assessed by an experienced team in terms of cancer risk.
Adrenal (Suprarenal Gland) Masses →Most small masses are benign, but size alone is not enough. A small mass may secrete hormones or, rarely, have suspicious imaging features. For this reason, appropriate imaging and hormone assessment should be carried out at least once.
Adrenal (Suprarenal Gland) Masses →Yes. If the adrenal gland on the other side is healthy, it can usually produce the hormones the body needs on its own.
However, if the mass removed was secreting cortisol, the other adrenal gland may work slowly for a while. For this reason, cortisone-containing medicines may need to be taken temporarily.
Adrenal (Suprarenal Gland) Masses →Removal of both adrenal glands is rarely necessary. In such a case, because the body’s own production of cortisol and aldosterone will stop, hormone medicines are taken for life. The patient is taught how to adjust the dose of the medicines during periods of illness, surgery or severe stress.
Adrenal (Suprarenal Gland) Masses →Because in most adrenal masses a biopsy is not needed for the diagnosis, and it cannot always reliably rule out cancer of the adrenal gland. In addition, a biopsy of an unrecognised phaeochromocytoma can lead to dangerous rises in blood pressure.
A biopsy is carried out only in selected patients in whom the result would change the treatment decision, and only after a phaeochromocytoma has been ruled out.
Adrenal (Suprarenal Gland) Masses →No. Some adrenal masses can secrete low levels of hormone without the person noticing any obvious complaint. For this reason, looking only at the symptoms is not enough; hormone tests are carried out in suitable patients.
Adrenal (Suprarenal Gland) Masses →After minimally invasive surgery, most patients can return to desk work within about 2–3 weeks. Those who have had open surgery or who do heavy physical work may need longer. The exact timing depends on the type of operation and the individual speed of recovery.
Adrenal (Suprarenal Gland) Masses →In masses that have definitely benign features on imaging and do not secrete hormones, continual CT or MRI scans are often not necessary. If new symptoms develop, or blood pressure or blood sugar control gets worse, the hormones may be assessed again.
Adrenal (Suprarenal Gland) Masses →Adrenal masses found in children, in young adults and during pregnancy are assessed more quickly and carefully. The imaging method is chosen individually to avoid unnecessary exposure to radiation. During pregnancy, hormone-producing masses can matter for both the mother and the baby, so they should be monitored by an experienced team [1].
Adrenal (Suprarenal Gland) Masses →Most cases of gastritis and stomach ulcers do not turn into cancer. Nevertheless, long-standing atrophic gastritis and intestinal metaplasia associated with Helicobacter pylori can increase the risk of stomach cancer over time.
When a stomach ulcer is found, it is important to take biopsies and, if the doctor considers it necessary, to repeat the endoscopy after treatment.
Stomach Cancer →Eradicating Helicobacter pylori with appropriate antibiotics can reduce the risk of stomach cancer. The protective effect is more pronounced when treatment is given before advanced changes develop in the stomach lining.
After treatment, clearance of the bacterium should be confirmed with a breath test, a stool antigen test or another appropriate method.
Stomach Cancer →Not always. Some very early-stage tumours can be removed endoscopically. In locally advanced but resectable disease, on the other hand, the plan is often chemotherapy first, with immunotherapy in addition in suitable patients, followed by surgery and then continuation of treatment.
For this reason, a decision to operate straight away should not be made without adequate staging and an assessment by the oncology tumour board.
Stomach Cancer →No. Depending on the location and extent of the tumour, only part of the stomach may be removed. If the tumour can be removed with safe surgical margins, preserving as much of the stomach as possible may be preferred.
For tumours near the upper part of the stomach or extensive tumours, a total gastrectomy may be needed.
Stomach Cancer →Yes. After a total gastrectomy, the oesophagus is connected to the small intestine and digestion continues.
It is necessary to eat small amounts often, follow the nutritional advice, take B12 supplements and keep up regular check-ups. Although adapting can take time, many patients are able to return to their daily lives.
Stomach Cancer →In suitable patients, the operation can be performed laparoscopically. However, the stage and location of the tumour, previous operations and the surgeon’s experience are important in choosing the method.
More important than the operation being keyhole surgery is that the tumour is removed with safe margins and an adequate lymph node dissection.
Stomach Cancer →The length of treatment varies according to the stage of the disease and the method to be used.
In patients for whom chemotherapy before and after surgery is planned, the whole treatment process usually takes about 4–6 months. Because there are assessments between treatments, preparation for surgery and recovery time after the operation, the overall process may be longer in some patients.
With immunotherapy or treatments for advanced disease, the duration depends on the response to treatment, side effects and the medicine used. For this reason, a definite duration cannot be given in advance for every patient.
Stomach Cancer →In many locally advanced stomach cancers, part of the chemotherapy is given before the operation and the rest after it.
Some patients may have surgery first and receive chemotherapy after the operation depending on the pathology result. The right sequence is determined by the stage of the disease, the patient’s general condition and the nature of the surgery performed.
Stomach Cancer →In suitable patients, chemotherapy before surgery is a planned part of treatment and does not mean that the operation is being unnecessarily delayed.
During this period, the aim is to shrink the tumour and to treat early any microscopic cancer cells that may be present elsewhere in the body. During treatment, the course of the disease is monitored with imaging and clinical assessments.
Stomach Cancer →No. Suitability for immunotherapy depends on the stage of the disease, the treatment being given, characteristics of the tumour such as MSI/MMR and PD-L1, and the licensing conditions of the medicines.
Immunotherapy is a powerful treatment option, but it can cause side effects due to the immune system attacking normal organs. For this reason, it should be given under the supervision of medical oncology.
Stomach Cancer →Stomach cancer is not a single disease. Some tumours may have treatable characteristics such as HER2, PD-L1, MSI/MMR or CLDN18.2.
These tests help to determine which patients may benefit more from targeted therapy or immunotherapy.
Stomach Cancer →In most patients, a return to light daily activities begins within a few weeks. A return to desk work is usually possible within 4–6 weeks. A longer period may be needed in the case of open surgery, complications or heavy physical work.
Adjusting to eating and recovering energy levels may take a few months. Plans for activity and return to work should be based on individual recovery.
Stomach Cancer →The risk may be increased in people who have a first-degree relative with stomach cancer. However, there is no single starting age and interval for endoscopy that applies to everyone.
The number of family members diagnosed with cancer, their ages at diagnosis, the pathological type of the cancer and the person’s Helicobacter pylori status should be assessed together. Particularly if stomach cancer has occurred in more than one family member or at a young age, genetic counselling and a personalised endoscopy programme may be considered.
Stomach Cancer →It is not possible to prevent all stomach cancers. Nevertheless, measures that may help reduce the risk include:
- Not smoking
- Having Helicobacter pylori infection treated appropriately
- Limiting very salty and processed foods
- Eating a balanced diet rich in vegetables and fruit
- Maintaining a healthy weight
- Having a doctor’s assessment if there is a family history
- Having warning symptoms investigated without delay
Mild and infrequent complaints can improve with lifestyle changes. When excess weight, eating late or certain triggering habits are corrected, symptoms can decrease markedly.
Frequently recurring complaints that affect sleep or daily life require assessment and treatment.
Gastro-oesophageal Reflux Disease →No. Reflux is the backflow of stomach contents into the oesophagus. Gastritis, on the other hand, is inflammation of the inner lining of the stomach.
The symptoms can be similar, and the two conditions can be present in the same person at the same time. To distinguish them clearly, a clinical assessment and, if necessary, an endoscopy are carried out.
Gastro-oesophageal Reflux Disease →Not every patient does. In mild reflux without damage to the oesophagus, the medicine can be reduced, stopped or taken as needed.
Long-term treatment may be needed in patients with severe oesophagitis, Barrett’s oesophagus, or an ulcer or narrowing due to reflux. The aim is to use the lowest effective dose possible.
Gastro-oesophageal Reflux Disease →Proton pump inhibitors should generally be taken 30–60 minutes before a meal. If taken once a day, they are usually taken before breakfast; if taken twice a day, before breakfast and the evening meal.
Because the way of taking them may vary depending on the type of medicine, the prescription and the doctor’s advice should be followed.
Gastro-oesophageal Reflux Disease →Current scientific evidence does not show that proton pump inhibitors used for an appropriate reason directly cause cancer.
These medicines should not be used unnecessarily, but they also should not be stopped without the doctor’s advice just because of frightening information found on the internet.
Gastro-oesophageal Reflux Disease →Many patients can stop their reflux medicine after surgery. However, some patients may need to take medication again over time.
Surgery is not a guarantee that medication will never be needed again for life. The main aim of surgery is to improve reflux control and quality of life.
Gastro-oesophageal Reflux Disease →On its own, it is not enough. First, objective tests should show that the complaints really are caused by reflux, and the likelihood of the patient benefiting from surgery should be assessed.
Surgery may be considered in suitable patients whose reflux has been clearly proven, who need long-term medication and who prefer surgery with an understanding of its benefits and risks.
Gastro-oesophageal Reflux Disease →The possible risks are:
- Bleeding and infection
- Injury to the oesophagus, stomach or surrounding organs
- Temporary or permanent difficulty swallowing
- Wind and bloating
- Difficulty belching or vomiting
- Recurrence of the hernia or the reflux
- The need for a further procedure
The likelihood of these risks varies according to the patient’s anatomy, accompanying illnesses and the surgeon’s experience.
Gastro-oesophageal Reflux Disease →Reflux is not a disease that turns directly into cancer. However, long-term reflux can lead in some patients to a cellular change called Barrett’s oesophagus. Only a small proportion of people with Barrett’s oesophagus develop oesophageal cancer over time.
Not every reflux patient develops Barrett’s, and not every Barrett’s patient develops cancer. If Barrett’s is found, a suitable follow-up programme is prepared according to the biopsy result.
Gastro-oesophageal Reflux Disease →No. Routine endoscopy at regular intervals is not necessary for every patient whose symptoms are well controlled and who does not have Barrett’s oesophagus or significant damage to the oesophagus.
Endoscopic follow-up may be needed in patients with Barrett’s oesophagus, severe oesophagitis, narrowing or new alarm symptoms.
Gastro-oesophageal Reflux Disease →It can, but these complaints have many other causes. Having only a cough or hoarseness does not establish a diagnosis of reflux.
An assessment by an ear, nose and throat specialist, a chest physician or an allergy specialist may be needed. If reflux is suspected, it may be appropriate to carry out an objective test before deciding on long-term medication or surgery.
Gastro-oesophageal Reflux Disease →After keyhole surgery, a return to desk work is usually possible within 1–2 weeks. For heavy physical work and repairs of large hiatus hernias, a longer time may be needed.
Gastro-oesophageal Reflux Disease →In the following situations, you should go to a healthcare facility without delay:
- Severe or new chest pain
- Chest pain together with shortness of breath, sweating or a feeling of faintness
- Vomiting blood
- Black, tar-like stools
- Food or liquids getting completely stuck
- Persistent vomiting
- Severe abdominal pain
The great majority of patients lose a marked amount of weight after the operation; however, the amount of weight lost varies from person to person.
The result is influenced by the type of operation, starting weight, eating behaviour, physical activity, hormonal and metabolic characteristics and attendance at check-ups. No method can guarantee a definite amount of weight loss.
Obesity and Its Surgical Treatment →Yes. Weight loss is usually faster in the first one to two years after the operation. In later years, regaining a small part of the weight lost may be seen.
In the case of marked weight regain,
- Eating habits
- Uncontrolled snacking
- Sugary and high-calorie drinks
- Reduced physical activity
- Psychological factors
- Changes in the anatomy of the stomach or intestines
are assessed.
Treatment may include renewed dietary adjustment, behavioural support, obesity medicines and, in selected patients, corrective surgery. Weight regain does not mean that the patient has failed; it is a medical condition that needs to be reassessed.
Obesity and Its Surgical Treatment →There is no single right answer for every patient. Current obesity medicines can lead to substantial weight loss; surgery, however, generally produces stronger and longer-lasting results in severe obesity.
The choice is made by considering together BMI, diabetes and other conditions, previous treatments, the side effects of medicines, cost, the patient’s preferences and surgical risks.
In some patients, medicines and surgery are not alternatives to each other but treatments used together at different times.
Obesity and Its Surgical Treatment →Metabolic and bariatric surgery can bring significant improvement in type 2 diabetes. In some patients blood sugar returns to normal and the need for medicines decreases or may disappear temporarily.
However, this improvement, known as “remission”, does not occur in everyone, and diabetes may return years later. The duration of diabetes, the pancreas’s capacity to produce insulin and the medicines used affect the result. Blood sugar checks should be continued.
Obesity and Its Surgical Treatment →There is no single method that is best for every patient.
A sleeve gastrectomy involves a simpler arrangement of the intestines; however, in some patients it can worsen reflux. A gastric bypass may offer an advantage in some patients with regard to reflux and type 2 diabetes; on the other hand, vitamin and mineral deficiencies and intestine-related problems may be more pronounced.
The choice of method should be based not only on the patient’s wishes or weight, but on a detailed medical assessment.
Obesity and Its Surgical Treatment →After a sleeve gastrectomy, new reflux may start or existing reflux may worsen in some patients. For this reason, complaints such as heartburn, a bitter fluid coming up into the mouth or difficulty swallowing must be mentioned before the operation.
In patients with significant reflux or damage to the oesophagus, a different method such as a gastric bypass may be more suitable [1,6].
Obesity and Its Surgical Treatment →Pregnancy is not recommended during the period when weight loss is fastest and the risk of nutritional deficiency is highest. In general, it is recommended to wait 12–18 months after the operation and to plan a pregnancy once weight loss has stabilised.
Before pregnancy, iron, vitamin B12, folate, vitamin D and other nutritional values should be checked. The pregnancy should be monitored jointly by an obstetrician-gynaecologist, the bariatric surgery team and a dietitian.
Because fertility may increase with weight loss, contraception after the operation should be planned in advance.
Obesity and Its Surgical Treatment →Most patients need to take a multivitamin and additional vitamin and mineral supplements suited to the type of operation for life.
The product and dose needed are not the same for everyone. Depending on blood test results, iron, vitamin B12, folate, calcium or vitamin D supplements may be changed [5].
Even if you feel well, you may have a vitamin deficiency. For this reason, supplements and annual blood tests should not be neglected.
Obesity and Its Surgical Treatment →After the operation, alcohol may be absorbed more quickly and have a stronger effect than expected. It is also high in calories and can harm liver health and weight control.
Care should be taken, as the risk of alcohol use disorder may increase in some people. Alcohol should be avoided, particularly during the early recovery period, and long-term use should be discussed with a doctor.
Obesity and Its Surgical Treatment →After marked weight loss, excess skin may form on the abdomen, arms, legs, chest and neck. How much depends on age, starting weight, genetic characteristics, smoking and skin type.
If the excess skin causes skin-fold rashes, fungal infections or difficulty moving, a plastic surgery assessment may be carried out. Body contouring operations are usually planned after weight loss is complete and weight has remained stable for a while.
Obesity and Its Surgical Treatment →Most people with desk jobs can return to work within about 2–3 weeks. For jobs that involve heavy lifting or strenuous physical effort, it may be necessary to wait 4–6 weeks.
The exact time is determined by the type of operation, the work done and the individual pace of recovery.
Obesity and Its Surgical Treatment →If any of the following symptoms develop after the operation, the healthcare team should be contacted immediately:
- Increasing abdominal or chest pain
- A markedly faster pulse
- Shortness of breath
- Fever
- Persistent vomiting or being unable to drink fluids
- Black stools or significant bleeding
- Increasing swelling of the abdomen
- Pain and swelling in one leg
- A marked decrease in the amount of urine
- Rapid deterioration in general condition
No. The opening in the abdominal wall does not close with medicines, exercise or a support garment.
However, in some male patients who have no complaints or only very mild complaints, surgery can be postponed and monitoring carried out after the emergency symptoms have been explained. This approach does not treat the hernia; it only postpones the timing of surgery.
Groin Hernia →Not every hernia grows at the same rate. Some hernias change little for years, while others may get bigger over time, cause pain or extend towards the scrotum.
If the swelling gets bigger, the pain increases or it becomes harder to push the hernia back in, a new surgical assessment is needed.
Groin Hernia →A hernia support garment or truss does not close the opening and does not treat the hernia. It may provide temporary relief in some patients, but if used incorrectly it can lead to skin damage, pain or trapping of the hernia.
It may be used on the doctor’s advice in selected patients who cannot have surgery or who have to postpone surgery for a certain time.
Groin Hernia →Heavy lifting on its own does not cause a hernia in every healthy person. However, in people who have a structural weakness or a small hernia in the groin area, it can cause the swelling to appear and the complaints to increase.
Using the correct lifting technique and increasing the load gradually may be helpful.
Groin Hernia →The trapping of the bowel inside the hernia with impairment of its blood supply is called strangulation.
If there is severe pain, a hard swelling that does not go back in, nausea, vomiting and bloating of the abdomen, you should go to the emergency department. In this situation, the hernia should not be forced back in.
Groin Hernia →The risk is not the same in every patient. The type and size of the hernia, whether it goes back in, the patient’s sex and the complaints affect the risk.
In men without symptoms or with mild symptoms, the risk of emergency trapping is low, so monitoring may be considered. In femoral hernias and in women, on the other hand, the risk of trapping is higher, so timely repair is preferred.
Groin Hernia →There is no single best method for every patient.
The keyhole method may be advantageous for hernias on both sides, for hernias that recur after open surgery, in women and in suitable patients who want to return to activity early.
The open method may be preferred for some hernias on one side only, when local anaesthesia is needed, for large hernias extending into the scrotum or in patients not suitable for the keyhole method.
One of the most important factors determining the outcome is the surgeon’s experience with the chosen method.
Groin Hernia →Both methods are keyhole operations, and the mesh is placed behind the groin area.
In the TEP method, the abdominal cavity is not entered. In the TAPP method, on the other hand, after the abdominal cavity is entered, the peritoneum is opened, the repair is performed and the peritoneum is then closed.
When performed by experienced surgeons, the results of both methods are similar. The choice is made according to the patient’s characteristics and the surgeon’s experience.
Groin Hernia →Yes. The synthetic mesh used generally stays in the body permanently and becomes integrated with the surrounding tissues over time.
Most patients do not feel the mesh. In rare cases, infection, chronic pain or a foreign-body sensation may develop.
Groin Hernia →There is no reliable scientific evidence showing that synthetic meshes suitable for medical use in groin hernia repair cause cancer.
The possible benefits and risks of using mesh should be explained to the patient before the operation.
Groin Hernia →In suitable patients and by surgeons experienced in this area, non-mesh methods such as the Shouldice repair can be used. However, a non-mesh repair is not suitable for every hernia.
The type and size of the hernia, the structure of the tissues and the risk of recurrence should be assessed together.
Groin Hernia →With no method is the risk of recurrence zero. With modern mesh repairs and in experienced hands, the risk is generally low.
The risk of recurrence can be affected by:
- Surgical technique and experience
- A large or recurrent hernia
- Smoking
- Chronic cough
- Wound infection
- Connective tissue characteristics
After an uncomplicated operation, sexual activity can be resumed as far as pain allows. There is no mandatory waiting period that applies to everyone.
If there is pain or marked strain in the groin, it may be advisable to wait a few more days.
Groin Hernia →Infertility after uncomplicated groin hernia surgery on one side is extremely rare.
Damage to the sperm duct or the blood vessels of the testicle is a theoretical risk, particularly with operations on both sides and repeat operations. It is advisable for patients who have previously had groin surgery or who have particular concerns about having children to discuss this with their doctor before the operation.
Groin Hernia →You can start driving when you:
- Are not taking strong painkillers
- Can sit comfortably
- Can brake suddenly without pain
- Have no condition affecting your attention or movements
In most patients, this time may vary from a few days to a week.
Groin Hernia →Yes. Successful and lasting treatment with surgery may be possible, especially in colon cancers detected at an early stage.
The success of treatment depends on many factors, such as the stage of the disease, the biological characteristics of the tumour and the person’s general health.
Colon (Large Bowel) Cancer →No.
Not all colon polyps turn into cancer. However, some types of polyp carry a risk of cancer developing over time.
For this reason, it is important that polyps detected during a colonoscopy are removed appropriately and examined by pathology.
Colon (Large Bowel) Cancer →As a colonoscopy is usually carried out under sedation, most patients do not feel significant discomfort during the procedure.
For the procedure to be safe and successful, it is important that the bowel preparation before the colonoscopy is carried out correctly.
Colon (Large Bowel) Cancer →No.
A permanent stoma is not needed in most colon cancer operations. The need for a stoma varies according to the location of the tumour, the type of operation and the patient’s clinical condition.
Colon (Large Bowel) Cancer →This depends on how closely related your relative diagnosed with cancer is and the age at which they were diagnosed.
In particular, people who have first-degree relatives with colon or rectal cancer may need to be assessed earlier than the standard screening programme.
For this reason, it is important that the family history is assessed in detail and that an individual screening programme is drawn up.
Colon (Large Bowel) Cancer →No. Today it is not enough to assess colon cancer only according to its location in the bowel and its stage. The pathological, molecular and genetic characteristics of the tumour are also becoming increasingly important in treatment planning.
One of the most important of these is the Mismatch Repair (MMR) / Microsatellite Instability (MSI) status.
The MMR system is involved in correcting certain errors that can arise in DNA during cell division. Tumours with a defect in this system may be described as dMMR, and tumours showing high microsatellite instability as MSI-H.
Knowing the MMR/MSI status can contribute to:
- Assessing inherited cancer predispositions such as Lynch syndrome,
- Better understanding the biological characteristics of the disease,
- Making the decision on chemotherapy after surgery in some patients,
- Assessing treatments such as immunotherapy in advanced disease.
It can be helpful in all of these areas.
For this reason, in the modern approach to colon cancer, not only the question “What stage is the tumour?” but also the question “What are the biological characteristics of the tumour?” has become important.
Colon (Large Bowel) Cancer →One of the main determinants of colon cancer treatment is the stage of the disease. However, the treatment decision is not made according to stage alone; pathological risk factors, the biological characteristics of the tumour, the patient’s age and general health are assessed together.
Stage I: The disease is confined to the bowel wall. Appropriate oncological surgery provides sufficient treatment in most patients, and chemotherapy after surgery is generally not needed.
Stage II: The tumour has reached a deeper level in the bowel wall, but no cancer has been found in the regional lymph nodes. Not all of these patients routinely receive chemotherapy. Certain high-risk features, such as a T4 tumour, bowel obstruction or perforation, lymphovascular/perineural invasion and an insufficient number of lymph nodes examined, can affect the treatment decision. MMR/MSI status is also particularly important at this stage.
Stage III: The cancer has spread to the regional lymph nodes. After surgery, adjuvant chemotherapy is given to a significant proportion of patients to reduce the risk of the disease recurring.
Stage IV: The cancer has spread to the liver, lungs, peritoneum or other organs. However, the presence of metastases does not always mean that surgical treatment is not possible. Especially in selected patients with limited liver or lung metastases, different combinations of surgery, local treatments and systemic treatments may be considered.
For this reason, especially in advanced colon cancer, it is important that treatment is planned individually by a multidisciplinary team.
Colon (Large Bowel) Cancer →The section of bowel and the lymph nodes removed in colon cancer surgery are examined in detail by a pathologist.
The pathology report does not only give the cancer diagnosis; it also assesses features such as:
- The depth to which the tumour has grown into the bowel wall,
- Whether there is tumour in the lymph nodes,
- The number of lymph nodes examined,
- The surgical margins,
- Lymphatic or vascular invasion,
- Perineural invasion,
- The degree of differentiation of the tumour and other histopathological features
which can affect the stage of the disease and subsequent treatment decisions.
Particularly in stage II colon cancer, some of these features are important in assessing the risk of the disease recurring and in the decision on chemotherapy after surgery.
For this reason, although surgery is an important step in colon cancer treatment, the final treatment plan is often shaped after the pathology report following surgery has been completed.
Colon (Large Bowel) Cancer →Yes. Especially in advanced colon cancer, determining the molecular characteristics of the tumour can help in assessing personalised treatment options.
In addition to MMR/MSI status, the assessment of molecular markers such as RAS and BRAF may be considered, depending on the stage and clinical features of the disease.
These results can be used to determine in which patients certain targeted therapies or immunotherapy may be beneficial.
Thanks to these developments, colon cancer treatment today is increasingly moving from a “same treatment for every patient” approach towards a “personalised treatment” approach.
Colon (Large Bowel) Cancer →In colon cancer treatment, regular follow-up is important after surgery and any oncological treatments given. In addition, increasingly strong scientific evidence is emerging on the importance of healthy lifestyle habits in the period after treatment.
The CHALLENGE phase III randomised trial, published in the New England Journal of Medicine in 2025, compared a structured exercise programme with health education in colon cancer patients who had completed surgery and adjuvant chemotherapy. This study is one of the pieces of high-level evidence showing that physical activity after colon cancer treatment may be important not only for general health and quality of life but also for oncological outcomes.
However, the exercise programme needs to be planned appropriately, taking into account the person’s age, general health, surgery and oncological treatments.
Colon (Large Bowel) Cancer →The stage shows how far the disease has progressed in the rectal wall and whether it has spread to nearby lymph nodes or other organs. Various tests are used for staging, chiefly rectal MRI and computed tomography.
According to current guidelines, the treatment decision is not made by looking only at the stage of the disease. The location of the tumour in the rectum, its relationship with the anal muscles, the risk features seen on MRI, its biological make-up and the patient’s general health are also assessed together. For this reason, the treatment plans of two patients with the same stage may differ [1,2,4].
Rectal Cancer →Yes. The likelihood of a complete cure is high, especially while the disease is confined to the bowel and the surrounding lymph nodes. In more advanced stages too, long-term disease control and, in some patients, complete recovery can be achieved by giving chemotherapy, radiotherapy and surgery in the appropriate order.
The success of treatment depends on the stage of the disease, the biological characteristics of the tumour, its response to treatment and the patient’s general health. For this reason, general statistics found on the internet do not show the outcome for an individual patient with certainty [1,4]. For this reason, the outcome for each patient should be assessed individually.
Rectal Cancer →No. Not every patient who has rectal cancer surgery needs a stoma, that is, a bag. The need for a stoma is determined by the location of the tumour, its relationship with the anal muscles, the type of operation performed and the safety of the bowel join.
Some patients do not need a stoma at all. In some patients it is created temporarily to protect the healing of the bowel join and can be closed later. A permanent stoma may be needed in the smaller number of patients whose tumour has spread to the anal muscles or in whom a safe bowel join is not possible.
Rectal Cancer →In some rectal cancers, radiotherapy and chemotherapy may be given before surgery. The aim of these treatments is to shrink the tumour, increase control of the disease in the area where it is located and treat at an early stage cancer cells that cannot yet be detected with imaging methods.
Not every patient receives the same treatment. The type and sequence of treatment are determined taking into account the location and stage of the tumour, the MRI findings and the patient’s general health.
Rectal Cancer →In some selected patients in whom signs of the tumour have completely disappeared after treatment before surgery, very close follow-up may be considered instead of surgery. However, this approach is not suitable for every patient.
The decision of “complete response” is not made on the basis of the biopsy result alone. Rectal examination, endoscopy and high-quality rectal MRI are assessed together. If follow-up without surgery is chosen, check-ups must be regular, frequent and long-term. It is important that surgery can be carried out in good time if the tumour grows back.
Rectal Cancer →The length of treatment varies according to the stage of the disease and the treatments to be given.
In patients with early-stage disease who need only surgery, the operation and the initial recovery period can usually be completed within 1–3 months. If chemotherapy is needed after surgery, this period may be longer.
In locally advanced rectal cancer requiring chemotherapy and radiotherapy before surgery, treatment takes longer. When chemotherapy, radiotherapy, reassessment of the response to treatment and surgery are considered together, the whole process may take about 6–9 months in most patients.
Radiotherapy may be given for about 1 week in some patients, and for about 5–6 weeks together with chemotherapy in others. The chemotherapy part usually lasts 3–4 months, depending on the medicines used and the treatment plan. After the treatments are completed, the response of the tumour is assessed with examination, endoscopy and rectal MRI, and the timing of surgery or of a close follow-up programme is decided [1–4].
These periods are approximate. The response to treatment, side effects of the medicines, recovery after surgery and the need for additional treatment can change the total time.
Rectal Cancer →Most rectal cancers are not an inherited disease passed directly from mother or father. However, some patients may have inherited predispositions such as Lynch syndrome.
Current recommendations support the assessment of MMR or MSI tests, which give guidance on Lynch syndrome, in the tumour tissue of patients diagnosed with colorectal cancer. If a suspicious finding is detected in the test result, genetic counselling and a blood test may be recommended [2,6].
Identifying an inherited condition is important not only for the patient’s treatment but also for determining at what age and how often family members should be screened. However, having rectal cancer in the family does not mean that other family members will necessarily develop cancer.
Rectal Cancer →There is no single eating plan that applies to everyone with rectal cancer. The nutrition plan should be prepared individually according to the treatment to be given, bowel habits, whether there is a stoma, weight and any other conditions.
Current nutrition guidelines recommend that weight loss and malnutrition during cancer treatment should be recognised early. Taking in enough energy, protein and fluid can help treatment to be better tolerated and support recovery [7].
If diarrhoea, constipation, loss of appetite, nausea or unintentional weight loss develops, you should talk to your doctor and a dietitian. As every patient’s needs are different, unnecessary and very restrictive diets should be avoided. Herbal products and food supplements can interact with chemotherapy medicines, so they should not be used without consulting your doctor.
Rectal Cancer →There is no fixed period for closing a temporary stoma that applies to everyone. First of all, the bowel join must have healed safely, there must be no infection or leak, and the patient must be fit for another operation.
Ongoing treatments such as chemotherapy and the patient’s general health can also affect when the stoma is closed. Before the closure procedure, the bowel join may be checked by examination, colonoscopy or imaging methods.
Current stoma surgery guidelines also recommend that the closure decision should be made individually for each patient and that stoma care education should be part of the treatment process [8].
Rectal Cancer →The nerves around the rectum are closely linked to urinary and sexual function. Surgery, radiotherapy and other treatments can, in some patients, cause reduced sexual desire, erection or ejaculation problems in men, and vaginal dryness or pain during intercourse in women.
Whether these problems arise varies according to the patient’s age, the treatment given and their function before treatment. Some complaints may decrease over time; others may require medication, pelvic floor rehabilitation or specialist support.
Current follow-up and quality-of-life guidelines recommend that urinary and sexual function should be specifically assessed at check-ups. For this reason, it is important for patients to share these complaints with their doctors [5]. If necessary, support can be obtained from urology, gynaecology, physiotherapy or sexual health services.
Rectal Cancer →No. Bleeding from the anus also has benign causes such as haemorrhoids and an anal fissure. However, bleeding should not simply be put down to “piles”.
If the bleeding recurs, or is accompanied by a change in bowel habit, unexplained weight loss, tiredness or anaemia, you should see a doctor. The cause of the bleeding should be established by examination and, if necessary, colonoscopy.
Rectal Cancer →The time to return to daily life varies from person to person. Most patients can gradually resume light daily activities within a few weeks. However, the timing of heavy lifting, driving, exercise and return to work differs according to the operation performed and the speed of recovery.
It is important to increase activities gradually and to follow your doctor’s advice. If fever, increasing pain, marked abdominal swelling, persistent vomiting, discharge from the wound or a serious bowel problem develops, you should contact your healthcare team.
In rectal cancer, the most appropriate treatment is planned by a multidisciplinary team according not only to the stage of the disease but also to the location of the tumour in the rectum, the MRI findings, its biological characteristics and the person’s priorities.
No. TAMIS is a minimally invasive procedure performed through the back passage using a camera and special surgical instruments. No surgical incision is made in the abdomen.
TAMIS →No. Colonoscopic procedures are performed with instruments passed through a flexible endoscope. TAMIS, on the other hand, is generally a transanal operation performed with the help of a surgical working port and a camera.
TAMIS can be used for some large, deep or difficult-to-reach rectal lesions that cannot be removed safely or completely by colonoscopy. Which method is suitable may be determined through a joint assessment by the gastroenterology and surgical teams.
TAMIS →No. In TAMIS only the diseased area and the necessary safe margin around it are removed. The rest of the rectum is preserved.
TAMIS →The great majority of patients who undergo TAMIS do not need a stoma, that is, a bag. However, in rare situations such as a large opening into the abdominal cavity, a serious complication or the need for further radical surgery, a temporary or permanent stoma may be considered.
TAMIS →In suitably selected, low-risk early-stage rectal cancers, TAMIS can be the definitive treatment. However, if the depth of the tumour or the risk of spread to the lymph nodes is high, local excision alone may not be sufficient.
The final decision is made by assessing MRI, endorectal ultrasound, examination and the pathology findings obtained after TAMIS together [1,5].
TAMIS →A biopsy shows only a small part of the mass. In another area of a large polyp there may be advanced cellular change or early cancer. In addition, some lesions cannot be completely removed by colonoscopy.
By allowing the lesion to be removed in one piece together with its margins, TAMIS can offer both treatment and a more reliable pathological assessment.
TAMIS →Yes. If the pathology result shows a more advanced tumour than expected, a positive surgical margin or features that increase the risk of lymph node spread, a completion rectal operation including total mesorectal excision may be recommended.
TAMIS →Most patients do not develop a permanent problem with bowel control. Because a working port is placed in the anal canal during the operation, a temporary change in wind control or a feeling of urgency may occur. In patients with a pre-existing control problem, pre-operative assessment is particularly important.
TAMIS →Because no incision is made in the abdomen, pain is usually limited. In the first days there may be tenderness or a feeling of fullness in the anal area, or pain when opening the bowels. The severity of the pain varies according to the size and depth of the removed tissue.
TAMIS →Yes. In centres with suitable equipment and experience, robotic TAMIS can be performed. Robotic systems can provide freedom of movement in a narrow space and surgical ergonomics. However, the use of a robot is not necessary for every patient and does not on its own guarantee a better result. The key factors determining success are correct patient selection, surgical experience and a procedure that follows oncological principles [3].
TAMIS →For all rectal lesions, benign or malignant, the likelihood of recurrence is not entirely zero. The risk varies according to the type and size of the lesion, the excision margins and its pathological features. Regular check-ups allow a possible recurrence to be detected early.
TAMIS →No. Some polyps can be removed more easily and safely with colonoscopic methods. For very extensive, deep or high-risk lesions in terms of cancer, radical rectal surgery may be needed. The most suitable method is determined by assessing all the features of the lesion.
TAMIS →No. A diverticulum is not a structure that turns into cancer. However, diverticulitis and cancer of the large bowel can sometimes produce similar symptoms and imaging findings. For this reason, a colonoscopy may be needed after recovery, especially if there was a complicated attack, weight loss, anaemia, blood in the stool or a persistent change in bowel habit.
Diverticular Disease and Diverticulitis →No. A diverticulum is a small sac in the bowel wall. Diverticulosis is the presence of these sacs, and diverticulitis is their inflammation. Most people who have diverticula do not develop diverticulitis.
Diverticular Disease and Diverticulitis →No. Diverticula that cause no symptoms are not on their own a reason for surgery. Surgery is considered in selected situations such as a fistula, narrowing, obstruction, uncontrollable infection or recurrent disease that markedly affects quality of life.
Diverticular Disease and Diverticulitis →Selected patients with a normal immune system, good general condition and mild uncomplicated diverticulitis can recover without antibiotics under close follow-up. However, this decision should be made by a doctor after examination and, if necessary, imaging. A “wait and see” approach on your own at home may not be safe.
Diverticular Disease and Diverticulitis →Yes, it can recur; but it does not recur in every patient. The belief that a recurrence after a first uncomplicated attack will necessarily be more severe is not correct. The decision on surgery is made not only according to the number of attacks, but according to the severity of the disease and quality of life.
Diverticular Disease and Diverticulitis →No. In the current approach, a specific number of attacks is not on its own considered sufficient for a decision on surgery. The severity of the attacks, complications such as an abscess or fistula, the need for hospital admission, ongoing complaints and the patient’s preferences are assessed together [1–4].
Diverticular Disease and Diverticulitis →If a colonoscopy is needed, it is performed after the acute inflammation has completely resolved, usually about 6–8 weeks later. In some patients who have had a recent good-quality colonoscopy and an uncomplicated attack, a repeat colonoscopy may not be needed. The decision should be made individually.
Diverticular Disease and Diverticulitis →In an uncomplicated attack, the pain starts to ease within a few days in most patients. If the symptoms do not improve within 2–3 days, are getting worse or are joined by fever and vomiting, reassessment is needed. In some people, tenderness and irregular bowel habits may last longer after the acute inflammation has passed.
Diverticular Disease and Diverticulitis →The choice of painkiller depends on the patient’s kidney, stomach and cardiovascular conditions and the medicines they take. Because frequent use of non-steroidal painkillers is associated with diverticular complications, they should not be used without consulting a doctor. Your doctor should decide on the appropriate pain treatment.
Diverticular Disease and Diverticulitis →The great majority of patients do not need a stoma. However, in emergency situations such as perforation of the bowel, widespread infection inside the abdomen or when a safe bowel join is not possible, a temporary or, less commonly, permanent stoma may be needed.
Diverticular Disease and Diverticulitis →Assessment without delay is needed in the following situations:
- Increasing or severe abdominal pain
- Rigidity or marked swelling of the abdomen
- High fever and chills
- Persistent vomiting or inability to take fluids
- Being unable to pass wind or stool
- Heavy bleeding from the anus
- Dizziness, a feeling of faintness or palpitations
- Rapid deterioration in general condition
Mild complaints can improve by softening the stool, eating a fibre-rich diet and reducing straining. However, the haemorrhoid tissue may not disappear completely, and symptoms may come back from time to time.
If the bleeding continues, the swelling is getting bigger or daily life is affected, an assessment by a doctor is needed.
Haemorrhoids (Piles) →No. Haemorrhoids do not turn into cancer. However, haemorrhoids and cancers of the large bowel and rectum can sometimes cause similar bleeding from the back passage. For this reason, it should not be assumed without an examination that the bleeding is due to haemorrhoids.
Haemorrhoids (Piles) →There may be pain after haemorrhoidectomy, especially in the first days. Today, with suitable painkillers, stool-softening medicines, warm sitz baths and regular follow-up, this period can be got through more comfortably.
The severity of the pain varies according to the type of operation performed and individual characteristics. With non-surgical procedures, pain and recovery time are generally less.
Haemorrhoids (Piles) →Yes. Haemorrhoid symptoms can reappear after treatment. The chance of recurrence varies according to the method used and the person’s bowel habits.
Preventing constipation, eating enough fibre, and avoiding straining and sitting on the toilet for long periods help to reduce the risk of recurrence.
Haemorrhoids (Piles) →Haemorrhoids can be common during pregnancy. The first approach is usually a fibre-rich diet, drinking an appropriate amount of fluid, preventing constipation and avoiding standing or sitting for long periods.
For creams, suppositories, painkillers or other medicines to be used during pregnancy, you should talk to an obstetrician-gynaecologist and the relevant doctor. A large proportion of the complaints may lessen after the birth. If there is severe pain or heavy bleeding, assessment should not be delayed.
Haemorrhoids (Piles) →Foods rich in fibre, such as vegetables, fruit, pulses, oats and whole grains, can help make the stool softer. Fibre intake should be increased gradually, and if your state of health allows, you should drink enough fluid.
No single food can cure haemorrhoids completely. The aim is to have regular, easy bowel movements without straining too much.
Haemorrhoids (Piles) →After non-surgical procedures, most patients can return to their daily lives on the same day or the next day.
After surgical treatment, returning to desk work usually takes 1–2 weeks, while returning to heavy physical work may take about 2–4 weeks. The exact time varies according to the method used and the individual speed of recovery.
Haemorrhoids (Piles) →- Eat a fibre-rich diet.
- Drink an amount of water appropriate to your state of health.
- Do not put off going to the toilet.
- Do not strain too much during bowel movements.
- Do not sit on the toilet longer than necessary.
- Stay physically active on a regular basis.
- If you have constipation or frequent diarrhoea, see a doctor for treatment.
These measures can reduce the risk of haemorrhoids coming back; however, they do not guarantee that it will be eliminated completely.
Haemorrhoids (Piles) →No. With haemorrhoids, the vascular cushions in the anal canal enlarge and can slip outwards. In rectal prolapse, the wall of the rectum slips downwards and comes out through the anus. The two conditions can be confused in appearance; a definite distinction is made by examination.
Rectal Prolapse (Bowel Prolapse) →No. Rectal prolapse does not turn into cancer. However, if there is bleeding, anaemia, a change in bowel movements or weight loss, a colonoscopy may be needed to rule out other bowel diseases.
Rectal Prolapse (Bowel Prolapse) →In adults, full-thickness rectal prolapse does not correct itself. Reducing constipation and straining can ease the complaints, but the lasting treatment for a marked prolapse is usually surgery.
Rectal Prolapse (Bowel Prolapse) →Correcting the prolapse improves bowel control in many patients. However, if the damage to the anal muscles or nerves is advanced, the incontinence may not improve completely. If needed, pelvic floor treatment can also be given after the operation.
Rectal Prolapse (Bowel Prolapse) →Not always. If the constipation is due to the prolapse, there may be improvement. If there are other causes, such as uncoordinated working of the pelvic floor muscles or slow bowel movement, constipation may continue.
Rectal Prolapse (Bowel Prolapse) →No. The decision is made by assessing the type of prolapse, constipation, previous operations, accompanying pelvic floor problems and the risks specific to the use of mesh.
Rectal Prolapse (Bowel Prolapse) →In the great majority of planned rectal prolapse operations, a stoma, that is, a bag, is not needed. If a serious problem with the bowel join or a very particular surgical situation develops, a temporary stoma may rarely be needed.
Rectal Prolapse (Bowel Prolapse) →If the prolapsed tissue does not go back in, keeps swelling, turns dark purple or black, or causes severe pain or heavy bleeding, you should go to an emergency department. This may indicate that the blood supply to the tissue is impaired.
Rectal Prolapse (Bowel Prolapse) →Most patients can start light daily activities within a short time. Returning to work usually takes between 2 and 4 weeks. For heavy lifting and intensive exercise, you should wait for the period recommended by your doctor.
Rectal Prolapse (Bowel Prolapse) →The vast majority of fistulas do not turn into cancer. However, fistulas that have been present for a very long time, that change in appearance, become hard, bleed more or do not heal despite treatment should be reassessed. A biopsy may be needed, particularly in long-standing Crohn’s disease, to check for the very rare possibility of a tumour.
Perianal Fistula (Anal Fistula) →No. A cryptoglandular perianal fistula is not passed from person to person. It is generally not caused by poor personal hygiene.
Perianal Fistula (Anal Fistula) →No. A perianal fistula forms between the inside of the anal canal and the skin around the anus. A pilonidal sinus, on the other hand, usually develops in the skin and the tissue under the skin between the buttocks, over the tailbone.
A pilonidal sinus located close to the anus may rarely be confused with a fistula. The distinction is made by examination and, if necessary, MRI.
Perianal Fistula (Anal Fistula) →No. An anal fissure is a tear or sore in the anal canal. A fistula is a tunnel that develops between the anal canal and the skin. In a fissure, sharp pain, particularly when opening the bowels, is the main feature; in a fistula, recurrent swelling and discharge are more prominent.
Perianal Fistula (Anal Fistula) →Most cryptoglandular fistulas do not close permanently on their own. The external opening may close temporarily, but the tract left inside can form an abscess again.
Perianal Fistula (Anal Fistula) →Usually not. Antibiotics can help control active infection, but they often do not eliminate an established fistula tract. If there is an abscess, the main treatment is drainage; a fistula also requires an appropriate surgical plan.
Perianal Fistula (Anal Fistula) →This depends on the type of fistula and the method used. In a simple, low fistula, a very small portion of the muscle may be affected when the tract is opened. In high and complex fistulas, muscle-sparing methods such as a seton, LIFT or an advancement flap may be preferred in order to preserve bowel control.
Perianal Fistula (Anal Fistula) →There is no single best method for all patients. While a fistulotomy can achieve a high rate of healing in simple fistulas, the same procedure may be risky for bowel control in complex fistulas. The most suitable method is chosen according to the MRI and examination findings of the fistula, its relationship with the anal muscles and the patient’s characteristics.
Perianal Fistula (Anal Fistula) →No. Laser is a method that preserves the anal muscles and can reduce the size of the wound; however, it is not suitable for every fistula and recurrence can occur. The evidence on long-term results is more limited than for conventional methods [1,3].
Perianal Fistula (Anal Fistula) →No. A seton is usually used to allow the infection to drain safely and to protect the anal muscles. In complex fistulas it may be a planned part of staged treatment.
Perianal Fistula (Anal Fistula) →Most patients can walk, work and carry on with their daily lives with a seton. There may be some discharge; it may be necessary to use a thin pad. If pain or swelling increases, you should see a doctor.
Perianal Fistula (Anal Fistula) →The risk varies according to the fistula’s relationship with the anal muscles, the method used, previous operations and muscle function before the operation. Different problems can occur, ranging from difficulty holding wind to more marked faecal incontinence. Appropriate imaging, correct choice of method and muscle-sparing treatments aim to reduce this risk.
Perianal Fistula (Anal Fistula) →Recurrence may be associated with the following:
- An unrecognised side tract or abscess
- Failure to control the internal opening
- A complex or horseshoe fistula
- Crohn’s disease
- Conditions that impair wound healing
- Previous fistula operations
For a recurrent fistula, assessment with a pelvic MRI may be needed before a new procedure.
Perianal Fistula (Anal Fistula) →In almost all cryptoglandular perianal fistulas, a stoma, that is, a bag, is not needed. In special situations such as very severe Crohn’s disease that is resistant to treatment, or widespread life-threatening infection, a temporary stoma may rarely be considered.
Perianal Fistula (Anal Fistula) →You should go to a healthcare facility without waiting if you have the following symptoms:
- Rapidly increasing pain and swelling around the anus
- High fever or chills
- Spreading redness of the skin
- Severe weakness
- Inability to pass urine
- Anal pain together with uncontrolled diabetes or a suppressed immune system
- Painful swelling developing after the discharge has suddenly stopped
These symptoms may suggest a new abscess or one that needs to be drained.
Perianal Fistula (Anal Fistula) →Small sinuses that cause no complaints can stay quiet for a long time. However, a channel that has already formed under the skin is not expected to disappear completely on its own.
If there is pain, discharge or recurrent abscesses, treatment may be needed. In patients with no complaints at all, monitoring may be preferred after assessment by a doctor.
Pilonidal Sinus (Pilonidal Cyst) →No. Disease that causes no complaints can be monitored. In limited disease, hair control, phenol, removal of the small sinus openings or endoscopic methods can be used.
In extensive, complex or recurrent disease, more extensive surgery may be needed. Treatment is chosen individually according to how the disease looks.
Pilonidal Sinus (Pilonidal Cyst) →Antibiotics can reduce infection in the surrounding skin; however, on their own they do not clear the pus inside an abscess that has formed or the sinus channels.
If there is an abscess, the main treatment is usually surgical drainage of the pus. The doctor decides whether antibiotics are needed.
Pilonidal Sinus (Pilonidal Cyst) →In limited disease without an abscess, options such as phenol, cleaning of the small sinus openings or endoscopic methods can be used. However, these methods are not suitable for every patient, and in some patients the procedure may need to be repeated.
Pilonidal Sinus (Pilonidal Cyst) →Laser hair removal can support treatment by reducing the hair in the area, and in suitable patients it may lower the risk of recurrence [4].
However, it does not drain an active abscess and on its own does not get rid of extensive sinus channels. For this reason, it should be considered not as a replacement for the main treatment but as part of the treatment, depending on the state of the disease.
Pilonidal Sinus (Pilonidal Cyst) →Yes. Whichever method is used, there is a chance that the condition will recur. This chance varies according to the extent of the disease, the method used, the position of the wound, the hair type and the length of follow-up.
Off-midline closure techniques, proper care of the area, weight control and, in selected patients, laser hair removal can help to reduce the risk of recurrence [1,3,4].
Pilonidal Sinus (Pilonidal Cyst) →Most patients can sit for short periods, as far as their pain allows. However, sitting still for long periods can increase discomfort.
Restrictions on sitting vary according to the method used. Following your surgeon’s advice and standing up at regular intervals is the right approach.
Pilonidal Sinus (Pilonidal Cyst) →When you can shower depends on whether the wound is open or closed and on the dressing used. Some patients can shower from the first days, while in others the wound may need to be protected for a short time.
No exfoliating mitt, rough sponge or irritating product should be used on the wound. The shower and dressing advice given to you personally should be followed.
Pilonidal Sinus (Pilonidal Cyst) →After minimally invasive procedures, return to daily life is usually within a few days. After operations in which the wound is closed with stitches, returning to desk work or school can generally take 1–3 weeks.
Before returning to heavy work, cycling, intensive sport and swimming, the state of the wound should be assessed. The exact time is decided according to the method used and the individual speed of recovery.
Pilonidal Sinus (Pilonidal Cyst) →A decrease in pain does not mean that the illness has definitely gone away. When the appendix perforates, the character or location of the pain can change temporarily, and more widespread abdominal pain can then develop. Pain that increases within a few hours or settles in the lower right abdomen requires a medical assessment.
Appendicitis →There is no strong evidence that appropriate pain relief prevents appendicitis from being diagnosed; pain control in the emergency department should not be delayed. However, people should not put off being examined by taking painkillers, should not start antibiotics on their own and should not use laxatives or enemas for severe abdominal pain of unknown cause.
Appendicitis →Because surgery or sedation may be needed, you may be asked not to eat for a while when you go to a healthcare facility. If you have severe abdominal pain, it is safer to get the advice of the emergency healthcare team before eating. If you are thirsty or have diabetes or another illness, tell the healthcare staff.
Appendicitis →No. In patients with uncomplicated appendicitis whose general condition is stable, the operation can be planned within the first 24 hours. In some selected patients, antibiotic treatment can also be discussed. However, if there is perforation, widespread infection or a deterioration in general condition, emergency surgical intervention may be needed.
Appendicitis →Surgery is the definitive treatment that removes the appendicitis and largely prevents the risk of recurrence. Antibiotic treatment, on the other hand, can be an option only in suitably selected patients with uncomplicated appendicitis. If there is an appendicolith, perforation, an abscess or a suspected tumour, the choice of treatment changes. The decision should be made by considering the imaging results and personal preferences together.
Appendicitis →Antibiotic treatment has also been studied in selected uncomplicated cases in children. However, patients must be selected carefully; there must be no appendicolith, perforation or abscess. In children, laparoscopic appendicectomy is still the established and definitive treatment. The decision should be made by the paediatric surgery team.
Appendicitis →The diagnosis of appendicitis in pregnancy should not be delayed. The first imaging method is usually ultrasound, followed by MRI if the result is not sufficient. Once the diagnosis is confirmed, surgery is usually the standard treatment, and the necessary operation can be performed at any stage of pregnancy. Delaying treatment can pose a greater risk to the mother and baby.
Appendicitis →Although the appendix has some functions related to the immune system, no known significant deficiency in the digestive or immune system develops after it is removed. Patients can continue their normal lives after an appendicectomy.
Appendicitis →When the appendix has been removed completely, appendicitis is not expected to recur. Very rarely, “stump appendicitis” can develop in a part of the appendix left behind. Even if the operation was performed years ago, new severe pain in the lower right abdomen should be assessed.
Appendicitis →After uncomplicated keyhole surgery, a return to desk work may be possible within 1–2 weeks in most patients. For heavy physical work, after open surgery or with perforated appendicitis, a longer time may be needed. The exact timing is determined according to the operative findings and the individual rate of recovery.
Appendicitis →No. A rectocele is not cancer and does not turn into cancer. However, if there is a change in bowel movements, bleeding, anaemia or weight loss, other bowel diseases need to be ruled out.
Rectocele →No. In a rectocele, the front wall of the rectum forms a pouch towards the vagina. In rectal prolapse, the rectum slips downwards and sometimes comes out through the anus. The two conditions can occur together in the same patient.
Rectocele →An anatomical rectocele may not disappear completely. However, with bowel regulation and pelvic floor treatment, the complaints can be considerably reduced. A rectocele that causes no symptoms does not need to be treated.
Rectocele →No. Most patients are first given non-surgical treatments. Surgery is considered only in appropriately selected patients with marked complaints that do not respond to treatment.
Rectocele →No. A large rectocele may cause few symptoms, while a smaller rectocele may affect bowel movements. The decision is made according to the complaints, the examination and whether the rectocele empties during a bowel movement.
Rectocele →If bowel movements become easier when support is given to the back wall of the vagina or to the perineum, this may suggest a rectocele. However, internal rectal prolapse and uncoordinated working of the pelvic floor muscles can also cause the same symptom.
Rectocele →Pelvic floor physiotherapy may not make the rectocele disappear completely in anatomical terms. However, by teaching correct use of the muscles, it can reduce straining, difficulty with bowel movements and some pelvic floor complaints.
Rectocele →Some patients may experience vaginal fullness, pressure or discomfort during intercourse. After surgical treatment, temporary tenderness or, rarely, painful intercourse may also develop. These complaints should be discussed openly with the doctor when treatment is being planned.
Rectocele →In most standard vaginal rectocele repairs, the patient’s own tissues are used. Mesh may be considered only in selected situations and as part of other pelvic floor operations. If mesh is to be used, its benefits and its specific risks should be discussed in detail.
Rectocele →In the great majority of rectocele operations, a stoma, that is, a bag, is not needed. It may be needed extremely rarely if a serious bowel-related complication develops or there is a very particular surgical situation.
Rectocele →Light daily activities can be started within a short time. Returning to desk work is usually possible within 2–4 weeks. For heavy lifting, exercise and sexual intercourse, you should wait for the period set by your doctor.
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These answers are for general information; they do not replace personal medical advice. Decisions on diagnosis and treatment are made after an examination.
Is your question not on the list?
You can ask all your questions during the examination. Patients are seen every Thursday.