• MP 0623857
  • PR No 1141554
  • Life Suikerbosrand Hospital, Suite Cnr. HF Verwoerd, Begeman & Maré Streets, Heidelberg, 1441 PO Box 1141, Heidelberg, Gauteng, 1438
  • Sunshine Hospital, 1522 Soma St, Actonville, Benoni, 1501
  • info@etkayombo.co.za
  • 073 377 0135
  • MP 0623857
  • PR No 1141554

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Procedures

View all procedures below

Appendectomy

What is appendicitis?
  • The appendix is a small organ attached to your large intestine in the lower right side of your tummy.
  • This organ may be blocked, and start swelling, and become infected; if nothing is done, it can burst and make you sick. It is an emergency.
  • You should seek help from your doctor if you experience loss of appetite, pain around your umbilicus then moved to the lower right side of your belly, vomiting.
Why is the operation necessary?
  • If left it can burst and you may become very sick.
  • The standard treatment for appendicitis is to remove your appendix (appendectomy).
  • Your appendix isn’t an essential organ, and you won’t miss it.
      What happens before the operation?
  • You should not eat for at least six hours before your operation.
  • Let Dr Kayombo know if you take regular medications, especially blood thinning agents such as Warfarin or disprin, xeralta, and any allergies to drugs, dressings, or food also should be reported.
  • Dr kayombo would have explained the operation, and you will be asked to sign your consent form.
  • The anaesthetist who will be giving your anaesthetic will interview and examine you.
  How is the operation performed? After a discussion with Dr Kayombo, you will have either an open appendectomy or a laparoscopic appendectomy.
  • Open surgery: Dr Kayombo will make a small incision on the lower right side of your belly and get the appendix out. But if the appendix bursts already, you will have a larger incision.
  • Laparoscopic (keyhole surgery): Dr Kayombo will remove the appendix via three small incisions made across the abdomen.

What happens after the operation?

 

·       Once the operation is completed, you will be transferred back to the ward or ICU, depending on the severity of the infection.

·       Depending on the severity of the infection, one may have a tube coming out the nose that drains the tummy and a urinary catheter emptying the bladder,

·       Pain will be controlled to a level of mild discomfort with the painkillers that are prescribed. 

·       Food, you should be able to resume eating 6 to 8 hours after the operation, but depending on the severity of the infection, your bowels may be lazy for a day or two. Afterwards, you will be allowed small amounts of water, tea, or juice.

·       Hospital stays usual last one day, but in case of severe infection, it may be longer, up to five days.

 

What to expect after hospital discharge?

 

·       Continue to take painkillers, 

·       You may also need to take antibiotics for a few days, depending on the severity of the infection.

·       You will be given instructions for the wound care. 

·       You will also get an appointment for your follow-up with Dr Kayombo. 

· Return to daily routine, you can perform routine activities as soon as you get home. 

· Exercise, mild exercise like walking or climbing stairs, would be possible within 1 to 2 weeks and full exercise after four weeks.

· Driving may resume as soon as you are comfortable (within five to seven days).

· Work may be resumed usually between one and two weeks.

What are the risks associated with this operation?

 

·       Appendectomy is a relatively safe operation.

·       However, the risk may occur depending on the degree of infection and may be also related to your general condition.

·       General risks involved, which may occur with any surgical procedure, include the risk of infection, bleeding, pain, wound breakdown, blood clotting, or complications affecting the heart, lungs, or kidneys.

·       Specific risks involved, the main surgical complication is a wound infection and can occur in up to 15 % of patients. The risk is greatest if the appendix has burst. This may settle with anti-biotics, but if not, the wound will need to be re-opened, other risks include bowel injury, bleeding, delayed return of your bowels working or making a poo,

·       Late complications may occur such as a suture granuloma or a hernia at the site of the wound.

Gallbladder and Gallstone Surgery

 The gallbladder.

  • The gallbladder is a pear-shaped organ situated under the liver.
  • The gallbladder’s primary function is to collect the bile from the live and concentrate it, then release it to the intestine via narrowed channels (bile ducts) after eating, helping digestion.
  • Removal of the gallbladder is not associated with any impairment of digestion in most people. However, occasionally, some patients may have mild trouble with digestion.

Picture11

 

Most common causes of gallbladder diseases.

·       Gallstones are small hard
masses consisting primarily of cholesterol and bile salts that form in the
gallbladder or the bile duct. It is uncertain why some people develop
gallstones.

·        Stones may block the flow of bile out of the
gallbladder, causing it to swell and resulting in sharp abdominal pain,
vomiting, and indigestion.

·       Cholecystitis, because by
the blockage of the bile by the stone, the gallbladder may swell and become
infected, and the infection may spread and make you very sick.

·       Obstructive jaundice:
Jaundice (yellowing of the skin and eyes) can occur if the gallstone blocks the
common bile duct.

 

Why is the operation necessary?

·       The gold standard of
treatment is the removal of the gallbladder (cholecystectomy). Otherwise, the
infection may progress and lead to a burst of the gallbladder, with the spread
of the infection in your tummy and the blood. You will become very sick.

·       The operation will also
take away the pain from the gallstone.

 

What is expected before the laparoscopic cholecystectomy?

·       Preoperative preparation includes blood work, medical evaluation, chest x-ray and an ECG, depending on your age and medical condition.

·       You will need to provide written consent for surgery. You should shower the night before or the morning of the operation.

·       You should not eat or drink anything 8 hours before the operation but continue to take medications as discussed with Dr Kayombo, with a sip of water or clear fluids as instructed by your surgeon.

·       Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and vitamin E must be stopped temporarily for several days to a week before surgery.

 

How is the operation performed?

·       The gallbladder is removed via keyhole surgery (laparoscopic cholecystectomy).

·       Under general anaesthesia, using a port (a 10mm tube-like instrument), the surgeon enters the abdomen in the belly button. A tiny telescope is inserted inside your abdomen, giving the surgeon a magnified view of the patient’s internal organs on a television screen. Other ports are inserted, allowing your surgeon to delicately separate the gallbladder from its attachments and remove it through one of the openings. The small incisions are closed with a stitch or two or with surgical clips.

·       In a small number of patients, the laparoscopic method cannot be performed safely because of factors like obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation. Dr Kayombo will decide to perform an open procedure or remove only part of your gallbladder and all the stones. This is not a complication but rather sound surgical judgment. This decision is strictly based on patient safety.
Picture13

 

What to expect after gallbladder surgery?

·       Postoperative pain will be
managed with painkillers, but usually, it is very minimal.

·       Occasionally, you may have
nausea and vomiting.

·       Food, routine diet as soon
as can be tolerated.

·       Patients will be able to
return to normal activities within a week.

·       Patients undergoing the
open procedure resume normal activities in four to six weeks.

·       Make an appointment with
Dr Kayombo within two weeks following your operation for wound inspection,
stitch removal and histology report.

 

What are the possible complications?

·       It is a relatively safe
procedure; less than 1% of patients may have complications.

·       The following
complications of laparoscopic cholecystectomy may occur: Bleeding, Bile duct
injuries lead to the leakage of bile into the abdominal cavity, Damage to other
organs like the stomach or intestine.

 

 

·       General complications like
pneumonia, blood clots, or heart problems are also possible.

 

When to contact your surgeon urgently after the operation?

Call Dr Kayombo if you develop any of the following after the operation.

·  Persistent fever over 39°C

·  Bleeding

·  Increasing abdominal swelling

·  Pain that is not relieved by your medications.

·  Persistent nausea or vomiting

·  Chills

·  Persistent cough or shortness of breath

·  Purulent drainage (pus) from any incision

·  Redness surrounding any of your incisions that are worsening or getting more significant.

·  You are unable to eat or drink liquids.

Becoming yellow

HERNIA

  • Brief description
A hernia develops when a portion of tissue breaks through a weakened region of the body, usually the abdomen.

Common signs and symptoms
  • You will have a bulge with or without vague aching in the area.
  • Most of the time, the bulge can be pushed back or reduced when lying down.
  • When the hernia is complicated, the bulge can be very tender; you will not be able to reduce it, and you may start vomiting and unable to pass stools.

What causes hernia?
    • Previous surgery
    • Aging
    • Obesity
    • Smoking
    • Injury
    • Following an infection at that site of surgery.
    • Certain activities may increase the likelihood of a hernia, including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining.

Various types of hernias
  • An epigastric hernia is a hernia that forms in the epigastric part of the abdomen, underneath the ribcage, and just above the belly button.
Picture14
  • An umbilical hernia occurs when a tissue portion breaks through the belly button or umbilicus.
  • Inguinal hernia arises when fat or a piece of the intestine ruptures through the lower region of the stomach wall.
Picture16
  • A femoral hernia develops when tissue breaks through an area in the groin or inner thigh. You will know you have this hernia when a small or medium-sized lump forms in the groin.
  • An incisional hernia arises in the abdominal wall where a previous surgical incision was made. In this area, the abdominal muscles have weakened; this results in a bulge or a tear. The inner lining of the abdomen pushes through the cut area of the abdominal wall to form a balloon-like sac. This can allow a loop of intestines or other abdominal contents into the sac.
  • Hiatal hernia is noticeable because the stomach will protrude through an area in the diaphragm. A hiatal hernia causes gastro-oesophageal reflux disease and heartburn.
What to expect before the operation?
  • Preoperative preparation includes blood tests, medical evaluation, chest x-ray and an EKG, depending on your age and medical condition.
  • Afterwards, Dr Kayombo will review you and discuss the potential risks and benefits of the operation.
  • You will need to provide written consent for surgery.
  • You will be advised to shower the night before or on the morning of the operation to reduce the risk of infection.
  • You should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery or clear fluids as instructed by your surgeon.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and vitamin E must be stopped temporarily. Quit smoking and arrange for any help you may need at home several days or weeks before surgery.
How is the operation performed?  Open surgery
  • Dr Kayombo will make an incision over the hernia.
  • Then, he will push the displaced tissue or piece of bowel into the normal position.
  • The surgical mesh will be place over the area to strengthen it.
  • Finally, he closes the site using stitches.
  • For strangulated hernia, he removes the affected portion of the intestine and re-joins the ends of the remaining bowel.
Laparoscopic hernia repair
  • Dr Kayombo creates three smaller cuts over your belly next to the hernia.
  • A small camera (laparoscope) is placed inside your belly’s incision.
Finally, other surgical equipment is placed through the incisions to fix the hernia.

 

 

 

 

 

Laparoscopic vs open surgery repair

  • Your surgeon can only determine whether a laparoscopic hernia repair is proper for you after a thorough examination.
  • The procedure may not be best for some patients who have had extensive previous abdominal surgery, hernias found in unusual or difficult-to-approach locations or underlying medical conditions.
  • Results may vary depending on the type of procedure and each patient’s overall condition. Common advantages include less post-operative pain, shortened hospital stay, faster return to regular diet and quicker return to normal activity.
What to expect after the operation?
  • Pain will be controlled with painkillers at an acceptable level.
  • Food eating may resume as soon as you can tolerate food.
  • Your doctor will discuss with you whether you may be discharged the same day or whether you will be required to stay in the hospital overnight.
  • Arrangements will be made for removal of your stitches and follow-up visits.
You must refrain from strenuous exercises for up to 12 weeks. What are the possible complications?  
  • Inguinal and primary ventral hernia Complications are uncommon, but incisional hernia complications are not unusual.
  • You must be aware of the following possible complications:
 
  1. A bleed or haematoma at the hernia repair site sometimes occurs. Depending on the extent of this bleeding, this does sometimes need a repeat operation to evacuate the haematoma.
  1. The wound does occasionally become infected. How that is managed will depend on your doctor. It may necessitate dressings or other active management.
  1. Occasionally, the nerves supplying the skin around the wound and in the upper thigh and the scrotum region are injured. This may lead to temporary or permanent numbness in the area. This is specific for groin hernias.
  1. Injuries to the testes or structures to and from the testes are possible but very rare. When this occurs, the testis may swell and later shrink. Also specific for groin hernias.
  1. Systemic complications like deep venous thrombosis and pulmonary embolism are rare but possible after any operation or anesthetic.
  1. The incidence of recurrence of a hernia after a repair varies between 1% and 10% and may be higher for incisional hernia.

Breast cancer surgery

Overview
  • Breasts are round, sharp organs situated on the chest wall.
  • With hormonal stimulation, the breast changes the volume.
  • You should regularly check your breast for the presence of any lump, nipple discharge, or any skin change.
  • Please consult Dr Kayombo or your family Dr if you have any concerns.
  • You should also consider a screening mammogram/sonar if you are above 40 or maybe even earlier, depending on your personal or family risk.
Picture21

What to expect once you have noticed a breast mass or any other lesion?

 

  • You will be sent for a mammogram (special X-ray of your breast) and sonar of your breast and axillary.
  • After the mammogram, depending on the results, Dr Kayombo may need to do a biopsy. Your breast will be numbed, and then, with a small needle, a piece of the lump will be taken and sent to the laboratory. The laboratory will confirm or exclude the cancer.

 

What to expect after the diagnostic of breast cancer is confirmed?

 

  • The cancer will be staged to check how far it has cancer has progressed.
  • The following tests will be performed: blood and imaging tests (such as CT scans  of your chest and abdomen)
  • Based on the physical findings, results of blood and scan, the cancer will be classified from stage I to stage IV. Staging will help with appropriate treatment and the overall prognosis.
    • You may need to get chemotherapy before the operation to treat the cancer that has spread beyond the breast; also, you may be submitted to the radiation of the area of cancer (chest wall).
Operation They are usually performed under general anaesthesia. That means you will be asleep and pain-free during surgery. Dr Kayombo will cut your breast and perform one of these operations:
  • Nipple-sparing mastectomy: The surgeon removes the entire breast but leaves the nipple and areola (the coloured circle around the nipple) in place. The surgeon may do a biopsy of the lymph nodes in the underarm area to see if the cancer has spread.
  • Total or simple mastectomy: The surgeon removes the entire breast along with the nipple and areola. If you have cancer, the surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread.
  • Modified radical mastectomy: The surgeon removes the entire breast with the nipple and areolar, along with some of the lymph nodes underneath the arm.
  • Radical mastectomy: The surgeon removes the breast and the entire skin over the breast, all the lymph nodes underneath the arm, and the chest muscles. This surgery is rarely performed in cases of advanced breast cancer that did not respond to chemotherapy.
  • Skin-sparing mastectomy: The surgeon removes the breast with the nipple and areola with minimal skin removal. The surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread.
The skin is then closed with sutures (stitches), and one or two small plastic drains or tubes are often left in your chest to remove extra fluid from where the breast tissue used to be. A plastic surgeon may be able to begin reconstruction of the breast during the same operation. You may also choose to have breast reconstruction later. If you have reconstruction, a skin or nipple-sparing mastectomy may be an option. Mastectomy will take about 1 to 2 hours. Lumpectomy  Dr Kayombo will remove only the cancer and tissue around the tumour, and the rest of the breast tissue is preserved. The procedure is also called breast conserving therapy or partial mastectomy. Following the surgery, you will be sent to the oncologist for the radiation of the remaining breast tissue. What to expect after the after the Procedure?
  • Most women stay in the hospital for 24 to 72 hours after the surgery. Your length of stay will depend on the type of surgery you had.
  • Most probably, you will go home with drainage tubes still in your chest after the mastectomy, and Dr Kayombo will remove them later during an office visit.
  • A nurse will teach you how to look after the drain, or you can have a home care nurse help you.
  • You will receive pain medicines before you are released from the hospital.
What are the possible complications?  
  • Bleeding, very unusual
  • Nerve injury may lead to weakness or numbness in your upper limb, which is also unusual.
  • Fluid may collect in your mastectomy wound; it is called a seroma. It often goes away on its own, but it may need to be drained using a needle (aspiration).
  • Lymphedema, swelling of the affected upper limb.

Benign breast lump surgery

Brief description

 

Breast lumpectomy is surgery to remove a lump in the breast like a fibroadenoma or cyst.

Picture23

What to expect before the procedure?

 

  • Always tell your provider If you are pregnant, what drugs you are taking, and even drugs or herbs you bought without a prescription, and allergies you may have, including medications and latex.

 

  • If you smoke, try to stop for at least two weeks before the surgery. Your provider can help.

 

  • Follow your provider’s instructions about eating or drinking and use of your chronic medications before surgery.

Dr Kayombo will tell you when to arrive for the procedure.

How is the procedure performed?

 

  • Breast lump removal is often done as a day procedure. 
  • You will be given general anaesthesia or local anaesthesia with sedation. 
  • Dr Kayombo will make a small cut on your breast and remove the lump.
  • Dr Kayombo will close your skin with stitches or staples. These may dissolve or need to be removed later.
  • Rarely, a drain tube may be placed to remove extra fluid. 
  • The lump will be sent to the pathologist for more testing.

 

What are the possible complications?

 

 Very uncommon, but the following are possible:

  • Bleeding
  • Infection
  • Poor wound healing
  • Risks associated with general anaesthesia.

 

What to expect after the surgery?

 

  • The recovery period is very short for a simple lumpectomy. 
  • You may have slight pain, but you can take pain medicine, such as acetaminophen, if you feel pain.
  • Your skin should heal in about a month. Wear a comfortable bra that provides good support, such as a sports bra.
  • Most women can return to their usual activities in a week or so.
  • Avoid heavy lifting, jogging, or activities that cause pain in the surgical area for 1 to 2 weeks.

The appearance of your breasts may change. You may notice dimpling, a scar, or a difference in shape between your breasts.

Thyroid surgery

Brief description The thyroid gland is a butterfly-shaped gland located in the lower part of the neck. The thyroid gland is part of the endocrine system. It helps to regulate your body’s metabolism.

Trouble with the thyroid gland
  • Hyperthyroidism is when the gland secretes a lot of thyroid hormones (T3, T4), and your body works fast. As a result, your heart will be beating fast; you will lose weight sweating a lot.
  • Hypothyroidism, the gland secretes fewer thyroid hormones, and your metabolism will slow; consequently, you will gain weight and feel abnormally cold.
  • Thyroid lesions: cyst, solid benign or malignant lesions.
Principle of treatment
  • In medical treatment, you will be given medication that regulates the thyroid gland to work normally.
  • Nuclear medicine (radioactive iodine) is used for patients who are poor surgical candidates or have poor responses to medical treatment.
  • What are the Indications for surgery? Dr Kayombo may suggest thyroid removal if you have any of the following:
    • A thyroid lesion (solid or cyst) to make sure it is not a cancer.
    • Hyperthyroidism and you are not a candidate for medications.
    • Cancer of the thyroid.
    • Noncancerous (benign) tumors of the thyroid that are causing symptoms.
    • Thyroid swelling ( nontoxic goitre ) that makes it hard for you to breathe or swallow.
    • Cosmetic purpose
    • Pregnant patients are not responding to medical treatment.
    • Multinodular goitre with compressive symptoms, resistant to medical therapy or suspicious of malignancy.
    What to expect before the surgical procedure?
    • You may need to have tests that show exactly where the abnormal thyroid growth is located to help the surgeon find the growth during surgery. You may have sonar of your thyroid gland or other imaging tests.
    • Dr Kayombo may also need to find out if the growth is cancerous by taking a small piece of the gland(lesion) for laboratory studies.
    • Before surgery, your vocal cord function may be checked.
    What are the different surgical options?
    • Total thyroidectomy, which removes the entire gland.
    Subtotal or partial thyroidectomy, which removes one lobe (half of the gland).

How is the procedure performed?

Picture27

  • Dr Kayombo will make a horizontal cut in the front of your lower neck just above the collar bones.
  • All or part of the gland is removed through the cut.
  • Dr Kayombo will be careful not to damage your neck’s blood vessels and nerves.
  • A small tube (catheter) will be placed into the area to help drain blood and other fluids that build up. The drain will be removed in 1 or 2 days.
  • The cuts are closed with sutures (stitches)
Surgery to remove your whole thyroid may take up to 2,5 hours. It may take less time if only part of the thyroid is removed. What to expect after the procedure?
  • You will probably go home on day 1 or 2 after surgery. In rare cases, you may need to spend more days in the hospital.
  • Dr Kayombo will check the calcium level in your blood after surgery. It is done more often when the whole thyroid gland is removed, and you will require calcium supplement if needed; it should take about 3 to 4 weeks to recover fully.
The outcome of this surgery is usually excellent.
  • Most people need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives when the whole gland is removed.
  • You may also be on calcium supplements temporarily and occasionally for life.
What are the possible complications?
  • Injury to the nerves that supply your vocal cords and larynx may cause your voice to change, or you may experience breathing difficulty and require permanent tracheostomy.
  • Bleeding with possible airway obstruction.
  • Injury to the parathyroid glands (small glands near the thyroid) can cause a temporary low calcium level in your blood (hypocalcemia).
Too much thyroid hormone may be released spontaneously (thyroid storm). It is a life-threatening condition, and you will be treated with medicine to control it.

Soft tissue tumor

Dr Kayombo also treats cancer or benign lumps affecting the body’s soft tissue, such as:
  • Lipoma (abnormal fat tissue found anywhere in the body (back, limb, etc.) is removed via a small incision. Afterwards, dressing is placed over the area to reduce the risk of a hematoma.
  • Sebaceous cysts can be removed through a minimal/punch excision. A sebaceous cyst is a slow-developing bump that forms beneath the skin. A minimally invasive procedure involves removing the cyst through a tiny cut.

Sarcoma refers to cancer in the bone and soft tissue. Certain sarcomas, usually low-level ones, can be treated with surgery. Those sarcomas larger than 5cm can be removed and treated with radiation therapy. Sometimes, radiation therapy or chemotherapy can help shrink the tumor before surgery so that it can be removed easily. Why should you consider removing other lumps?
  • Firstly, you will be freed from the symptoms.
  • Secondly, it will no longer be there to worry you.
  • Thirdly, we can examine the tissue under a microscope to determine precisely what it is.

Other skin lesions

Picture28

  • Melanoma is a skin cancer in the skin cells responsible for melanin secretion. Melanin is a pigment that adds colour to the skin. Wide local excision is a procedure to remove melanoma and healthy surrounding tissue.
  • Dr Kayombo may need to do a sentinel lymph node biopsy in the axillary or groin, depending on the location of the lesion. A sentinel node biopsy involves the removal of the first few lymph nodes that contain cancer. A biopsy can tell whether cancer has drained into the lymph nodes.
  • However, an axillary or groin lymph node dissection involves the surgical removal of several lymph nodes in the armpit or groin to test for cancer or remove cancerous tissues.
  • Other cancers are squamous cell carcinoma or basal cell carcinoma. They also required wide local excision.

 

Colectomy – Large Bowel Resection

Brief description Picture29
  • A large bowel resection is an operation to remove all or part of the large bowel because it is diseased or not working correctly.
  • Indications for surgery: cancer, volvulus (twisting), diverticular disease-related complications like bleeding or perforation, inflammatory bowel disease, strictures, and others.
Before surgery
  • It would be best if you did not eat anything solid for at least six hours before your operation but can still take clear liquids until 2 hours before.
  • You should take all your regular medication as usual on the day.
  • You may be given high-energy drinks on the days preceding your operation or even on the day of the operation.
  • In some cases, your surgeon may give you some preparation to empty your bowels. Suppose you are asked to take laxatives. In that case, you will usually experience some abdominal cramps and have your bowels open several times very urgently.
  • You may be given some white stockings to wear during and after the operation. It is also usual for you to be given a small injection in your arm or tummy once a day; both measures help prevent blood clots in your legs.
  • While a stoma or bag is not always necessary for this procedure, Dr Kayombo may do one if it’s unsafe to join the two pieces of the intestine. For this reason, you may see the colorectal nurse specialist or stoma therapist preoperatively to have a mark made on your abdomen to guide the surgeon on where to place the stoma, if needed.
How is the operation performed?
  • You will be under general anaesthesia and Dr Kayombo will make an incision on your belly.
  • Dr Kayombo will cut out part of the bowel and sew or staple the remaining ends together (anastomosis). The amount of bowel removed varies, depending on the reason for the operation.
  • Dr Kayombo may bring out the piece of your intestine (Stoma) because sometimes it can be dangerous to anastomose them in the same setting. The faecal material will be evacuated into a bag via that stoma. But after 6 to 12 weeks.
  • Dr Kayombo will take you to the theatre for another operation to join the two pieces of intestines.
Picture31
  • The colon may be removed either via open surgery or keyhole surgery (laparoscopic). Your surgeon will discuss the advantages and disadvantages of the surgical options.
What happens when I wake up? .
  • On your return to the ward/ICU, you may feel sleepy but will be aware of the present drips and drains.
  • You will have a dressing over the surgical wound on your abdomen. The nurse will replace the dressing as necessary.
  • A drip will be in your arm or neck to maintain hydration and give you energy.
  • A catheter is placed into your bladder to drain urine.
  • You may have a catheter in your back for an infusion of pain medication; it is called an epidural, and your anaesthetist will have explained this to you.
  • Your stitches or clips will be removed after about 10 to 14 days, or they may be dissolvable, in which case they will not need to be removed.
  • Elderly patients may suffer some disorientation and confusion.
  • Depending on the nature of the operation, it can take up to 3-5 days; once you start drinking normally, you will be encouraged to start eating a light diet.
  • You will stay in the hospital for 5-10 days if there are no complications.
What happens when I am discharged from the ward?
  • You will be given some medication for pain.
  • You will be given instructions on dressing and caring for the wound.
  • You will also get an appointment for your follow-up in the surgeon’s room.
  • Initially, your bowel actions are very likely to be a bit unpredictable. It can take several months for this to settle and for you to develop a predictable pattern. Your bowel function is unlikely to be the same as it was before your operation.
  • If a large portion of the colon has been removed, your stool may always be looser, as less water will be absorbed. It takes time for the remaining bowel to compensate for that which has been removed, and it may never entirely do so.
  • If diarrhoea becomes a persistent problem, discuss this with Dr Kayombo. Some medicines can thicken the stool, and some must take medication permanently.
  • You can resume sexual activity as soon as this feels comfortable.
  • Some people report that it takes them 3 to 6 months to feel completely back to their usual selves, while others recover much more quickly.
  • You are expected to feel low in the first weeks and become frustrated that you cannot do everything you want. Be patient!
  • Monitor your wound for any late inflammation or infection and report it promptly.
How long will I be off work?

Most people need about four to six weeks off work, but this will depend a little on what you do.

What are the possible complications?
  • General complications: wound Infection, bleeding, pain, wound breakdown, deep vein thrombosis, complications affecting the heart, lungs, or kidneys.
  • Specific complications, Anastomotic leak is the main complication (breakdown where the two pieces of intestines are joined); it can take up to 5-7 days to declare itself, and you will be closely monitored for this in the early days. This complication occurs in less than 10% of patients. It can be life-threatening, and you may require emergency re-look surgery to wash out the infection. It may be necessary to give you a temporary colostomy or bag. Ileus, which is a temporarily paralyzed bowel for 2 to 3 days, causing nausea, vomiting, and abdominal distention. Dr Kayombo may ask you to stop eating for one day or two, and He may insert a pipe into your stomach via the nose for drainage.
  • Late complication, Incisional hernia, especially if there was an infection on the wound.

Perianal abscess

Brief description

Picture33

  • A perianal abscess is found within 2 CMS from the anal canal. Pus builds up under the skin, causing swelling and significant pain.
  • During the procedure, the pus is let out through a cut in the skin next to the anus.
  • The surgeon will try to determine if there is a fistula or tunnel connecting the inside of the anus with the abscess cavity.
  • The wound is then washed out and is usually left open without any sutures.
  • The surgeon may leave a plug made of gauze or sponge in the wound to be removed later.
  • Sometimes, antibiotics are given to help the healing.

Why is this operation necessary?

  • An abscess near the anus can become a serious problem if the infection spreads to surrounding tissues as far as the abdomen, and this will require extensive debridement or progress to sepsis and ICU admission.
  • The abscess may become chronic in about 80% of cases if a tunnel is present connecting the inside of the anus to the abscess.

 

What should I do before the operation?

  • It would help if you did not eat or drink anything for at least six hours before your operation. However, you should take all your regular medication as usual on the day.
  • Dr Kayombo may want you to stop specific medication such as disprin, warfarin, or other blood thinning medicines before the operation.
  • Dr Kayombo will have explained the operation, and you will be asked to sign your consent. If you need clarification about any part of the operation, ask for more details from the surgeon.
  • The anaesthetist who will be giving your anaesthetic will interview and examine you, and he may put up a drip or prescribe some medication to help you relax.

 

What happens after the operation?

  • A gauze dressing will be on the wound, which should be changed by the next day.
  • You will go to the toilet as usual after the operation.
  • The pain will be controlled to mild discomfort with the painkillers.
  • Eating can resume as usual as soon as you wake up.
  • You can go home on the same day. Some patients prefer to stay overnight, especially if the operation is scheduled in the afternoon or if the abscess is huge.

What happens when I am discharged from the ward?

  • You will be discharged on pain medication; sometimes, antibiotics will be prescribed.
  • You will be given instructions on sitz bath, dressings, and wound care.
  • The ooze of a small amount of bloodstained fluid will continue.
  • The final healing can take up to two weeks.

How long will I be off work?

  • Usually, two weeks

 

What are the possible complications?

  • The general risk may occur with any surgical procedure. These complications include the risk of infection, bleeding, pain, wound breakdown, deep vein thrombosis, or complications affecting the heart, lungs, or kidneys.
  • Specific risks include a chance of damage to the sphincter (circular anal muscle) and may lead to an incontinence.
  • Late complications may occur, such as an anal stricture or narrowing of the anus and recurrence of another abscess forming.

Peri-anal Fistula Repair

What is perianal fistula? Picture34
  • The tunnel is connecting the inside of the anus and the skin.
  • The tunnel opens around the anus. Stool continues to travel through the tract, preventing healing, with repetitive abscesses, intermittent pain, and bleeding.
  • It often occurs after a perianal abscess.
Why is the operation necessary?
  • Antibiotics and a simple incision may temporarily relieve symptoms and abscess, but it is likely to return.
  • The operation remains the definitive treatment.
What are the different surgical options? Picture36
  • Fistulectomy, for simple and superficial fistula: Cutting open the roof of the tract, curettage out and laying it open to heal by secondary intention.
  • Fistulotomy, for deep and complex fistula: excise the whole tunnel intact.
  • Seton catheter insertion, also for deep fistula. Insertion of a special plastic tube in the tunnel, allowing it to drain and avoid the formation of abscess, and promote healing over time. Seton remains in place for 6 to 12 weeks; either remover falls off themselves.
  • The closing of the inside opening of the tunnel: by suturing a flap of healthy mucosa over it.
  • Treatment is also being studied where a tissue plugs, or glue is inserted in the tunnel to seal it off.
What to expect after the operation?
  • There will be a gauze dressing over the wound, but this can be removed as soon as you go to the toilet for the first time.
  • The pain should be controlled to a level of mild discomfort with the painkillers that are prescribed.
  • You can eat normally as soon as you wake up.
  • You should be able to walk without discomfort as soon as you wake up and will be encouraged to mobilize as much as possible.
What happens when I am discharged from the ward?
  • You will be given instructions on dressing and caring for the wound.
  • You will also get an appointment for your follow-up in the surgeon’s room.
  • It may be a bit painful the first time you open your bowels, but this rapidly improves.
  • If you have not passed any stools after two days and feel uncomfortable, contact the doctor.
  • Sitz baths help clean the area twice or thrice a day, but you could bathe or shower normally. Two tablespoons of salt in a shallow bath helps to aid the healing.
  • The final healing can take up to two months.
How long will I be off work?

About two weeks

What are the possible complications? The general risk may occur with any surgical procedure, infection, bleeding, pain, wound breakdown, deep vein thrombosis, or complications affecting the heart, lungs, or kidneys. The Specific risks include damage to the external anal sphincter (circular anal muscle), leading to the incontinence. Late complications may occur, such as an anal stricture or narrowing of the anus opening. The possibility of recurrent fistula forming later is about 10%.

Haemorrhoid Surgery

Brief description
  • Haemorrhoids (piles) are abnormal swollen veins that develop in the anal canal.
  • Mostly, they are small and have no symptoms, but they can become painful and inflamed. Also, they may bleed when passing stool or a foreign body sensation.
  • During a haemorrhoid operation, the swollen veins are cut away, and the resulting wound is either left open or absorbable sutures are used to close the raw area.
When are the haemorrhoids should be operated on?
  • When medical treatment has failed.
  • When haemorrhoids are complicated by bleeding, thrombosing, and prolapse.
What are the different surgical options? Picture38
  • Excision using a staple device.
  • Ultrasound-guided sutures to interrupt the blood supply.
  • Surgical excision and suturing.
What to expect before surgery?
  • The surgeon will have explained the operation, and you will be asked to sign your consent. If you need clarification about any part of the operation, ask for more details from the surgeon.
  • The anaesthetist who will be giving your anaesthetic will interview and examine you, and he may put up a drip or prescribe some medication to help you relax.
What should you expect after surgery?
  • Haemorrhoid operation is painful, but this should be controlled to a level of mild discomfort with the painkillers.
  • You can eat normally as soon as you wake up.
  • You should be able to walk without discomfort as soon as you wake up and will be encouraged to mobilize as much as possible.
What should you expect on discharge from the ward?
  • You will be given instructions on dressing and caring for the wound.
  • You will also need to make an appointment for your follow-up in the surgeon’s room.
  • Have a normal diet.
  • It may be painful the first time after passing stool, but this rapidly improves.
  • If you have not passed any stools after two days and feel uncomfortable, contact Dr Kayombo. It is important to avoid becoming constipated.
  • There will be an ooze of a small amount of bloodstained fluid, so wear a pad to prevent staining your clothes.
  • Keep the wound clean and dry as possible.
  • Sitz baths help clean the area twice or thrice a day, but you could bathe or shower normally. Two tablespoons of salt in a shallow bath helps to aid the healing.
  • Work can be resumed within two to three weeks.
What are the possible complications?
  • General risks: These are risks that may occur with any surgical procedure, including the risk of infection, bleeding, pain, wound breakdown, deep vein thrombosis, or complications affecting the heart, lungs, or kidneys.
  • Specific risks include a slight possibility of damaging the external anal sphincter muscle, causing wind, mucous or stool incontinence, and delayed wound healing.
  • Late complications include chronic anal tear, which is very painful, anal stricture or narrowing of the anus opening, and haemorrhoids recurrence.
Are there alternative treatments available?
  • Following a healthy diet and preventing constipation may prevent piles.
  • Once the haemorrhoids are present, it is often necessary to treat this with ointment when it flares up.
  • Small haemorrhoids can be injected with a solution that makes them shrink, or small rubber bands can pinch them off.


These treatments only work for small (grade 1-2) haemorrhoids and need multiple sessions, up to five times a week apart.

Upper endoscopy/Gastroscopy

Picture39 What can be expected during the upper endoscopy?  
  • You may have your throat sprayed with a local anaesthetic before the test begins and given medication through a vein to help you relax during the examination.
  • You will be laid on your side or back in a comfortable position as the endoscope is gently passed through your mouth and into your oesophagus, stomach, and duodenum.
  • Air is introduced into your stomach during the procedure to allow a better view of the stomach lining.
  • The procedure usually lasts 5-20 minutes. The endoscope does not interfere with your breathing.
Most patients fall asleep during the procedure; a few find it only slightly uncomfortable. What happens after upper endoscopy?
  • You will be monitored for 1-2 hours until the effects of the sedatives have worn off.
  • Your throat may be a little sore for a day or two.
  • You may feel bloated immediately after the procedure because of the air that is introduced into your stomach during the examination.
  • You will be able to resume your diet and take your routine medication after you leave the endoscopy area, unless otherwise instructed.
  • Dr Kayombo will usually inform you of your test results on the day of the procedure, unless biopsy samples were taken. These results take several days to return.
What are the possible complications?  
  • Generally safe when performed by surgeons who has experience in these endoscopic procedures.
  • Bleeding from the site of a biopsy or polypectomy, a tear, perforation through the lining of the intestinal wall also is possible in a rare occasion.
  • A reaction to the sedative’s medications can occur.
  When should I contact Dr Kayombo urgently:
  • Worsening difficulty swallowing or throat pain,
  • Chest pains
  • Severe abdominal pain
  • Fevers or Chills
  • Rectal bleeding of more than half a cup.

Colonoscopy bowel prep

Colonoscopy bowel prep

INSTRUCTIONS FOR A MORNING COLONOSCOPY.

(PicoPrep® or Picolax bowel preparation)

Two days before the procedure: 

  1. Take Macrogol (Movicol) x 1 sachet. Mix each sachet in 125 mL water.
  2. Commence Low Fiber diet (ref diet suggestions).
  3. Continue to take your regular medications as instructed.

The day before the procedure:

NB. Do not take any further Macrogol (Movicol) after starting to drink PicoPrep

In the morning:

morning colon

Prepare the Solution by dissolving the contents of each sachet in one glass of warm water (approx.250ml). If preferred, this can be refrigerated for 1-2 hours before drinking it.

For breakfast: you may have a light breakfast (low-fiber diet).

After breakfast, refrain from eating any further solid food. Start drinking clear fluids only.

5 pm to 6 pm:

  • Drink 1st glass of the Sodium Picosulfate Powder (PicoPrep or Picolax
  • Followed by 1 glass of water.
  • And 1 litre of clear fluids.

9 pm – 10 pm:

  • Drink 2nd glass of PicoPrep solution
  • Followed by 1 glass of water.
  • 1 litre of clear fluids This extra fluid is to maintain adequate hydration.

The Day of procedure:

4 am – 5 am:

  • Drink the final prepared glass of PicoPrep solution.
  • Followed by 1 glass of water.

At 6 am:

  • Unless instructed otherwise, take your usual morning medications with a sip of water.
  • Stop drinking ALL types of fluid.
  • NO Chewing gum or lollies

NB: Example of diet

  • The day before the procedure, you may have a normal breakfast.
  • It would help if you ate a light lunch that should not contain any fruit or vegetables to avoid fiber.
  • Suggestion for lunch:

Thin soup: Eggs (fried, boiled, scrambled); white bread; chicken; Pasta, Backed potato; sweet potato.

  • After lunch, you should be on a clear fluid diet, including water, clear apple juice, grape juice, Energade/Powerade, Black tea/coffee,
  • Avoid the following: Solid foods, milk, or dairy products(yogurt, custard, ice cream) allowed.No gas cool drinks, red and purple drinks or red wine allowed

Colonoscopy lower Hastrointestinal endoscopy

What is colonoscopy?   Lower endoscopy (also known as colonoscopy) is an insertion of long small tube fitted with a camera from your anal canal (between the Bumbs) to visualize the entire large intestine right to the last part of your small intestine, that allow to examine the lining of the large intestine.

What are the indications of colonoscopy?
  • Routine screening for cancer, generally after the age of 45, or depending on the personal and familial history of colon cancer.
  • Patients with known polyps or previous polyp removal.
  • Before or after some surgeries.
  • Evaluate bowel habit change.
  • Rectal bleeding.
  • Unexplained anaemia, weight loss.
  • Primary tumor search
  • Therapeutic procedures like polypectomy, control bleeding, removal of foreign bodies, insertion of stent for malignant stricture.
Preparation is required.
  • The rectum and colon must be completely emptied of stool for the procedure to be performed.
  • Preparation consists of consumption of a special cleansing solution and clear liquids prior to the examination.
  • Follow Dr Kayombo’s instructions carefully! If you do not complete the preparation, it may be unsafe to perform the colonoscopy and the procedure may have to be rescheduled.
  • You will be sedated during the procedure and an arrangement to have someone drive you home afterward is imperative.
INSTRUCTIONS FOR AN AFTERNOON COLONOSCOPY. Two days before the procedure:
  1. Take Macrogol (Movicol) x 1 sachet. Mix each sachet in 125 mL w
  2. Commence a low fiber diet (reference diet suggestions).
  3. Continue to take your regular medications as instructed.
The day before the procedure: In the morning: morning colon Prepare the Solution (PicoPrep or Picolax) by dissolving the contents of each sachet in one glass of warm water (approx.250ml). If preferred, this can be refrigerated for 1- 2 hours before drinking it. For breakfast: You may have a light breakfast (low-fiber diet). After breakfast: Do not eat any further solid food. Start drinking clear fluids only. 5 pm to 6 pm:
  • Drink 1st glass of the Sodium Picosulfate Powder (PicoPrep or Picolax)
  • followed by 1 glass of water.
  • And 1 litre of clear fluids.
9 pm – 10 pm:
  • Drink 2nd glass of PicoPrep or Picolax) solution
  • Followed by 1 glass of water.
  • And 1 litre of clear fluids. This extra fluid is to maintain adequate hydration.
The Day of procedure: At 6 am: Take your usual morning medications with a sip of water unless instructed otherwise. 9 am – 10 am:
  • Drink the final glass of PicoPrep or Picolax) solution.
  • Followed by 1 glass of water.
At 11 am:
  • Stop drinking ALL types of fluid.
  • NO Chewing gum or lollies
NB: Example of diet
  • The day prior to the procedure, you may have a normal breakfast.
  • It would help if you ate a light lunch that should not contain any fruit or vegetables to avoid fiber.
  • Suggestion for lunch: Thin soup; Eggs (fried, boiled, scrambled); white bread; chicken; Pasta; backed potato, sweet potato.
  • After lunch, you should be on a clear fluid diet, including water, clear apple juice, grape juice, Energade/Powerade, Black tea/coffee.
Avoid the following: Solid foods, milk or dairy products (yogurt, custard, ice cream) allowed. No gas cool drinks, red and purple drinks or red wine allowed. What can be expected during a colonoscopy?
  • The procedure is usually well tolerated, but there is often a feeling of pressure, gassiness, bloating or cramping at various times during the procedure.
  • You will be lying of your side or your back while the colonoscope is advanced through the large intestine.
  • The lining of the colon is examined carefully while inserting and withdrawing the instrument.
  • The procedure usually lasts for 15 to 60 minutes. In rare instances (10% of the cases) the entire colon cannot be visualized, and your surgeon could request a CT colonography.
What if colonoscopy shows an abnormality?
  • Biopsy may be obtained and submitted to a laboratory for analysis from the area that look abnormal.
  • Polyps are generally removed, although most of them are benign (non-cancerous), they will be sent to the laboratory for assessment to exclude a cancer.
  • It may take your surgeon more than one sitting to do this if there are numerous polyps or they are very large.
  • Sites of bleeding can be identified and controlled by injecting certain medications or coagulating (burning) the bleeding vessels.
  What happens after colonoscopy?
  • Dr Kayombo will explain the results to you after the procedure or at the follow up visit.
  • You may have some mild cramping or bloating from the air that was placed into the colon during the examination. This should quickly improve with the passage of the gas.
  • You should be able to normally eat the same day and resume your normal activities after leaving the hospital.
  • If polyps were found during your procedure, you will need to have a repeat colonoscopy. Dr Kayombo will decide on the frequency of your colonoscopy exams.
What are the possible complications?
  • Colonoscopy and biopsy are safe when performed by surgeons who have had special training and are experienced in these endoscopic procedures.
  • However, the following complications are possible, perforation of the intestine, bleeding from the site of a biopsy or polypectomy.
  • Should this occur, it may be necessary for your surgeon to perform abdominal surgery to repair the intestinal tear. Blood transfusions are rarely required.
  When to contact Dr Kayombo urgently. It is important to contact your surgeon if you notice symptoms of severe abdominal pain, fevers, chills, or rectal bleeding of more than one-half cup. Bleeding can occur up to several days after a biopsy. Picture40 Picture40

Consent forms

Treatment Consent Form

Welcome to Dr. Emile Tshisola Kayomba’s Patient Forms Portal. You’re about to access the Treatment Consent Form, essential for your upcoming medical treatment. Should you require any guidance, our dedicated team is readily available. Contact us via cell at 0736968788 or email at info@etkayombo.co.za.

Accessing Your Treatment Consent Form: This document is crucial for authorizing general medical treatment.

Next Steps: Download the form, fill it out with all necessary details, and send it back securely via email to info@etkayombo.co.za. We prioritize your privacy and ensure the secure handling of your information. We appreciate your cooperation.

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Procedure Consent Form

Greetings from Dr. Emile Tshisola Kayomba’s Patient Forms Portal. You are about to fill the Procedure Consent Form, specifically designed for surgical or specialized procedures. Our team is on standby to assist you. Reach out at 0736968788 or via email at info@etkayombo.co.za for support.

Procedure Consent Form Instructions: This form is tailored for patients undergoing surgical or specialized procedures.

Proceeding Forward: Please download this form, complete it with the necessary information, and return it to us securely via email at info@etkayombo.co.za. We are committed to maintaining your privacy and handling your information with care. Thank you for your attention to this matter.

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General Consent Form

Welcome to Dr. Emile Tshisola Kayomba’s Patient Forms Portal. You’ve arrived at the General Consent Form section, suitable for a variety of contexts. For assistance, our team is available at 0736968788 or via email at info@etkayombo.co.za.

General Consent Form Overview: This form is a broad document that can be used for multiple purposes.

How to Complete: Download the form, fill in the required details, and email it back to us securely at info@etkayombo.co.za. Your privacy is of paramount importance to us, and we ensure your information is treated with the highest level of care. We appreciate your cooperation.

Download Here