Clinical Practice

Biliary Surgery - Gall stone disease
Pancreatic Surgery - malignant jaundice, pancreatic cancer
Endocrine Surgery - thyroid, parathyroid and adrenal disease
Hernia Surgery - with specialist interest in sportsman's hernia

• As a biliary surgeon I am able to provide all forms of therapeutic management of gall stone disease including endoscopy, ERCP, laparoscopic cholecystectomy, small incision cholecystectomy and a 'one stop' urgent or emergency 'jaundice' service.
• I am involved in convening and teaching on training courses for laparoscopic cholecystectomy both nationally for the Royal College of Surgeons of England and internationally.
• I provide a comprehensive endoscopic biliary service for gall stone disease as well as biliary and pancreatic malignancy for both adults and children and our success rate and complication rate are some of the lowest recorded:-
  'Are complications of endoscopic sphincterotomy age related?' GUT 1997;
  41:545-548
• I am involved in research projects relating to biliary disease and have published on several different topics relating to management:-
  'Extracorporeal shock-wave lithotripsy for the management of bile duct stones ; is
  it always a safe procedure?' Gastroenterology 1991;101:1754
  'Investigation of the biliary tree and the jaundiced patient' Surgery 1997;15:182-8
  'In vitro responses of gallbladder muscle from patients with acalculus biliary
  pain' Digestion 2000;61(2):140-144
  'Extracorporeal shock wave lithotripsy for common bile duct stones' Br. J. Surg
  1997;84:29-32
• As a unit we provide a comprehensive and regional service for bile duct injuries using both advanced endoscopic and surgical techniques for correction.

Pancreatic Disease

• I am able to provide a comprehensive service for all pancreatic surgical problems and was on the British Society of Gastroenterology working party that drew up the national guidelines for:-
  'The management of patients with pancreatic, periampullary and ampullary carcinomas'
• I provide a full endoscopic (ERCP) service with stenting of malignant biliary and pancreatic strictures.
• I head up the surgical service for pancreatic surgery and over the last 10 years we have had no hospital mortality following pancreatic surgery and I am currently performing over 25 pancreatic resections a year as well as multiple other pancreatic operative procedures for chronic pancreatitis or endocrine tumours. We provide a regional pancreatic service for the whole of North Trent area and beyond. We have an International referral service for pancreatic conditions such as endocrine tumours with patients coming from as far afield as Pakistan.
• I have a particular interest in the management of pancreatic cancer and have published on this vexing condition:-
  'Surgical aspects of jaundice: surgery for malignant disease.' Hospital Update
  1992;18:201-209
  'Pancreatic Cancer - A Scourge of our Time.' Current Practice in Surgery
  1994;6:133-135
• As a unit we run a regional service with a weekly joint Multi Disciplinary Team Meeting with radiologists, pathologists and oncologists.
• I provide a comprehensive clinical service for both acute and chronic pancreatitis and once again have published on these topics:-
  'Acquired dysfibrinogenaemia masquerading as D.I.C. in acute pancreatitis.'
  J Clin Pathol 1988;41:615-618
  'Thrombophlebitis migrans in association with acute relapsing pancreatitis'
  Br J Surg 1995;82:674
• For chronic pancreatitis we provide definitive surgery as clinically indicated including pancreatic resection, pancreatico-jejunostomy, cysto-jejunostomy etc., as well as palliative procedures such as thoracoscopic splanchnicectomy for pain.

Endocrine Surgery

• I provide a full endocrine surgical service and run joint clinics with Medical Endocrinologists as well as Endocrine Oncologists
• I have a particular interest in parathyroid disease and am involved in research projects with regard to the bone changes in hyperparathyroidism:-
  'Longitudinal changes of bone density and bone turnover in post-menopausal
  women with primary hyperparathyroidism.'
  J Clin Endo Met 1996;81:3487-3491
  'Parathyroid Disease: Hyperparathyroidism and Hypercalcaemia'
  Surgery 2001;19:233-236
  'Differential effects of primary hyperparathyroidism on ultrasound properties of
  bone.' Osteoporosis Int. 2002;13:572-578
• I have long been interested in clinical protocols for management of thyroid disease and as a result of speaking at a symposium at the Royal Society of Medicine published a suggested protocol:-
  'Thyroid swellings - a protocol for management.'
  J. R. Soc. Med. 1998;91(Suppl. 33):21-27
• The technical details and outcome of thyroidectomy have long been one of my particular interests. I am involved in the British Association of Endocrine Surgeons national audit programme and have also published on the technical aspects of thyroidectomy:-
  'Thyroidectomy and its complications' Surgery 2001;19:9:223-225
• As a unit we provide a regional service for endocrine malignancies especially thyroid and pancreatic endocrine tumours including all MEN sufferers. All such cases are subjected to discussion at the regular Multi Disciplinary Team Meeting.

Hernia Surgery

• I provide a comprehensive surgical service for all hernia sufferers, including local, regional and general anaesthetic as well as the newer forms of mesh repair. Patient preference is always taken into consideration after full and informed discussion.
• I have a particular interest in Sportsman's Hernia and have serviced many of the major football and ice hockey teams. This service is provided with the full support of rheumatologists or orthopaedic physicians and a joint consultation is regularly available.
• I have a major medico-legal practice with regard to industrial hernias or those deemed to have resulted from accidents at work or through other injuries.
• I have long been an advocate of true informed consent and this is particularly relevant with regard to hernia repair:- 'Who's afraid of informed consent?' Br Med J 1993;306:298-300