Specializing in trauma surgery, acute surgical emergencies and hernia surgery.
About Dr Aikman
Our Procedures
Why would it be needed?
How is an appendectomy done?
An appendectomy is a common procedure done to remove the appendix when infected. This surgery can be done using minimally invasive laparoscopic techniques; however, if the appendix has burst, open surgery may be needed.
Surgery may be done in the following way:
Laparoscopic appendectomy
Under general anaesthesia, Dr Aikman will make a small puncture-like incision into the abdomen. Through this small hole, a laparoscope, which is a narrow tube with a camera, will be inserted giving him the full view of the internal organs while he performs surgery. Other thin tools are then inserted into the abdomen to delicately remove the inflamed appendix and close the base of the appendix.
Open appendectomy
For open surgery, under general anaesthesia, Dr Aikman will make a larger incision on the lower right side of the abdomen so that he may access the appendix. If the appendix has burst, he will clean out the abdominal cavity to prevent further infection. From there he will remove the infected appendix and close the close of the appendix with dissolvable sutures. He will then close the incision with absorbable sutures.
What will recovery entail?
How long your recovery will be after surgery will depend on whether the appendectomy was done laparoscopically or through open surgery. If done laparoscopically, the incisions should be much smaller and thus the pain and recovery time is much less. After an appendectomy the following symptoms are common and should not be concerning:
- Pain in the region of the wounds.
- Pain when coughing, sneezing or laughing. .
- Red skin around your incisions.
- Constipation develops as a complication of analgesia and due to stasis of the inflamed bowel (ileus).
Symptoms to look out for include an unusually high fever, chills, vomiting, swelling and bleeding around the incisions, cramping and excessive pain as these are not normal may require additional intervention.
You should be able to return to your normal lifestyle in a few days, but you should take caution when doing physical activities and avoid heavy lifting or vigorous exercise for at least 2 weeks after surgery. After 2 weeks, Dr Aikman will check your post-surgery incisions and give you instructions for care in the following few weeks.
Why would a cholecystectomy be needed?
How is a cholecystectomy done?
A cholecystectomy is done to remove the gallbladder. Living without a gallbladder will mean that your liver will still produce bile to digest food, but now the bile will just drip straight into the small intestine and bypass the gallbladder. This surgery can be done using minimally invasive laparoscopic techniques, however, in some cases, this isn’t possible due to repeated episodes of gallbladder infection and scarring from previous surgeries. Open surgery may be better suited in these situations.
Surgery may be done in the following way:
Laparoscopic cholecystectomy
Under general anaesthesia, Dr Aikman will make a small puncture-like incision into the centre of the abdomen. Through this small hole, a laparoscope, which is a narrow tube with a camera, will be inserted giving him full view of the internal organs while he performs surgery. Other thin tools are then inserted into the abdomen to remove the gallbladder and cut off the blood supply to it. The gallbladder is then dissected of the liver and removed via one of the incisions made. The gallbladder bed is then inspected to ensure no blood or bile is present. All ports are then removed under vision. Finally, the small incisions are closed with absorbable sutures.
Open Cholecystectomy
This procedure is rarely done in the modern era but might be necessary to do if clear visualization of all the anatomical structures is not possible during the laparoscopic procedure. For open surgery, under general anaesthesia, Dr Aikman will make a larger incision on the upper right side of the rib cage so that he may access the gallbladder. From there he will cut off the blood supply to the gallbladder and remove it under direct vision. He will then close the incision in layers and close the skin with absorbable sutures. This procedure is associated with more pain and longer hospital stay.
What will recovery entail?
How long your recovery will be after surgery will depend on whether the cholecystectomy was done laparoscopically or through open surgery. If done laparoscopically, the incisions should be much smaller and thus the pain and recovery time is much less. After a cholecystectomy the following symptoms are common and should not be concerning:
- Minimal pain in the upper abdomen.
- Transient pain in the right shoulder.
- Nausea and vomiting for the first 24 hrs.
- Constipation.
- Pain when coughing, sneezing or laughing.
- Red skin around your incisions.
Symptoms to look out for include an unusually high fever, chills, vomiting, swelling and bleeding around the incisions, cramping, jaundice and excessive pain as these are not normal and may require additional intervention. In the ward Dr Aikman will ask you daily if your pain is getting better, worse or staying the same. A sudden increase of pain associated with already mentioned symptoms is worrisome and will require additional evaluation.
While you should be able to return to your normal lifestyle in a few days, you should be careful when doing physical activities. Avoid heavy lifting or vigorous exercise until you have been given the go-ahead form Dr Aikman. After 2 weeks, your general surgeon will check your incisions and give you instructions for care in the following few weeks.
Why would thyroid surgery be needed?
How is a thyroid surgery done?
Thyroid surgery may be done by removing the entire thyroid (thyroidectomy) or by removing one of the two lobes of the thyroid (known as a lobectomy). This surgery is usually done using open or minimally invasive laparoscopic techniques.
Surgery may be done in the following way:
Laparoscopic techniques:
Lobectomy
Under general anaesthesia, Dr Aikman will make an incision of +/- 3cm above the collar bone in the midline of the neck. He will then dissect down to the thyroid gland. Dissection will be continued to mobilize the involved lobe from the surrounding structures. The lobe will then be removed. After ensuring there is no more bleeding the wound will be closed in different layers. A small drain may be left in the wound depending on the extent of dissection.
Total Thyroidectomy
Under general anaesthesia, Dr Aikman will again make a midline incision in the neck and remove the entire thyroid. The same procedure is followed as for a lobectomy, only this time this is done on both sides.
In both cases, if cancer is suspected the lymph nodes may also be removed during this surgery to prevent spreading of cancer to the rest of the body. The removed thyroid tissue will then be tested after surgery for cancer cells.
What will recovery entail?
If you are feeling well the day after the operation, the drain will be removed if one was placed and you will be discharged. After thyroid surgery the following symptoms are common and should not be concerning:
- Pain unresponsive to analgesia in the neck and throat.
- Hoarse voice.
- Red skin around your incision.
If Dr Aikman is not happy with your recovery on day one, you may need to stay in the hospital for a day or two after surgery to ensure your incision is healing as it should before you go home.
Symptoms to look out for include swelling and bleeding around the incision, “pins and needles” of fingers, numbness of skin around your mouth and excessive pain as these are not normal and may require additional intervention.
You should be able to return to your normal lifestyle in a few days, but you should take caution when doing physical activities. After 2 weeks, Dr Aikman will check your post-surgery incision and give you instructions for care in the following few weeks.
- Minimal pain in the upper abdomen.
- Transient pain in the right shoulder.
- Nausea and vomiting for the first 24 hrs.
- Constipation.
- Pain when coughing, sneezing or laughing.
- Red skin around your incisions.
Symptoms to look out for include an unusually high fever, chills, vomiting, swelling and bleeding around the incisions, cramping, jaundice and excessive pain as these are not normal and may require additional intervention. In the ward Dr Aikman will ask you daily if your pain is getting better, worse or staying the same. A sudden increase of pain associated with already mentioned symptoms is worrisome and will require additional evaluation.
While you should be able to return to your normal lifestyle in a few days, you should be careful when doing physical activities. Avoid heavy lifting or vigorous exercise until you have been given the go-ahead form Dr Aikman. After 2 weeks, your general surgeon will check your incisions and give you instructions for care in the following few weeks.
Why would a hernia repair be needed?
A hernia is when part of an organ protrudes through the wall of the abdominal cavity. The most common hernia is an inguinal hernia which occurs in the groin region when a part of the intestine pushes thru a weak place in the abdominal muscles. A ventral hernia develops in the midline and is commonly a congenital defect where the abdominal cavity failed to fuse during embryological development. An incisional hernia occurs at the site where surgery was performed. Failure of the muscle layer to heal completely allows a part of the bowel to push through the abdominal muscles.
Hernias are divided into uncomplicated and complicated hernias. Uncomplicated hernias are easily reducible and does not cause severe pain. Complicated hernias are painful and may be associated with decreased blood flow to the content of the hernia, which might be a piece of bowel. A warm red skin in the area of the hernia, associated with nausea and vomiting is an ominous sign and emergency surgery may be needed.
How is a hernia repair done?
A hernia is repaired surgically to remove the protruding tissue and place it back in its original position to reduce discomfort and relieve pain. This surgery can be done using minimally invasive laparoscopic techniques; however, in emergency cases, open surgery may be better suited to restore the blood flow to the protruding organ.
Surgery may be done in the following way:
Laparoscopic hernia repair
Under general anaesthesia, Dr Aikman will make a small puncture-like incision into the middle of the abdomen. Through this small hole, a laparoscope, which is a narrow tube with a camera, will be inserted giving him full view of the internal organs while he performs surgery. Other thin tools are then inserted into the abdomen to reduce the content back into place and repair the weak area of the abdomen cavity with a synthetic mesh to prevent the hernia from re-occurring.
Open hernia repair
For open surgery, under general anaesthesia, Dr Aikman will make a larger incision over the hernia site. The contents of the hernia will be evaluated to ensure it is still viable. In severe cases a piece of bowel might need to be resected. The hernia itself will then be repaired and mesh will be used to strengthen the repair and minimize the chance of recurrence. If any tissue necrosis is present, the use of prosthetic mesh to strengthen the repair is not advised. This can be placed at a later stage.
What will recovery entail?
How long your recovery will be after surgery will depend on whether the hernia repair was done laparoscopically or through open surgery. If done laparoscopically, the incisions should be much smaller and thus the pain and recovery time is much less. The following symptoms are common after a hernia repair and should not be concerning:
- Pain responsive to analgesia.
- Constipation.
- Pain when coughing, sneezing or laughing.
- Red skin around your incisions.
An unusually high fever, chills, vomiting, swelling and bleeding around the incisions, cramping of the stomach and excessive pain; however, should be reasons for concern and may require emergency care.
While you should be able to return to your normal lifestyle in a few days, you should be careful when doing physical activities. You will need to avoid heavy lifting or vigorous physical activity for at least 3 months after surgery. This is the time it takes for the prosthetic material to become incorporated into your tissue. After 2 weeks, your general surgeon will check your incisions and give you instructions for care in the following few weeks.
Why would an endoscopy be needed?
A hernia is when part of an organ protrudes through the wall of the abdominal cavity. The most common hernia is an inguinal hernia which occurs in the groin region when a part of the intestine pushes thru a weak place in the abdominal muscles. A ventral hernia develops in the midline and is commonly a congenital defect where the abdominal cavity failed to fuse during embryological development. An incisional hernia occurs at the site where surgery was performed. Failure of the muscle layer to heal completely allows a part of the bowel to push through the abdominal muscles.
Hernias are divided into uncomplicated and complicated hernias. Uncomplicated hernias are easily reducible and does not cause severe pain. Complicated hernias are painful and may be associated with decreased blood flow to the content of the hernia, which might be a piece of bowel. A warm red skin in the area of the hernia, associated with nausea and vomiting is an ominous sign and emergency surgery may be needed.
How is an endoscopy done?
Depending on your symptoms, Dr Aikman may suggest either a gastroscopy or a colonoscopy to get a better view of the internal state of the gastrointestinal tract. Both of these procedures can be done for diagnostic reasons or as a treatment for the condition that is found. The symptoms of gastro-intestinal tract pathology can be subtle, and the following symptoms can indicate an underlying problem:
- Vomiting blood or passing blood per rectum
- Difficulty swallowing
- Change of bowel habits, including sudden onset of constipation or diarrhoea
- Unplanned weight loss
- Palpable abdominal masses, which might be painful but may also be asymptomatic.
Surgery may be done in the following way:
A gastroscopy is done to investigate the upper gastro-intestinal tract from the mouth to the first part of the small bowel. The most commonly diagnosed condition during a gastroscopy is known as peptic ulcer disease. Other pathology which could be found include oesophageal strictures (benign or cancerous), gastro-oesophageal reflux, ulceration of the oesophagus, stomach or small bowel and masses. Biopsies can be taken, or the lesions can be completely removed by endoscopy.
A colonoscopy is done to investigate pathology affecting the large intestine. Most common pathology include colonic diverticula (abnormal outpouching of part of the wall of the colon), polyps and other masses. The extent of inflammation of the colon in inflammatory conditions can also be done. Biopsies can be taken, or the lesion can be completely removed.
Prior to the procedure, your stomach and bowels will need to empty. Your general surgeon will instruct you to stop eating either 8 hours (for a gastroscopy) or 24 hours prior (for a colonoscopy) to the procedure. You may also be prescribed a laxative to flush out the colon before a colonoscopy.
Gastroscopy
A gastroscopy can be done as an outpatient procedure, which means you won’t need to go into hospital. If there are other risks present, like heart, lung or kidney disease, it may be safer to do the procedure in hospital. Dr Aikman will decide which of the two will be the safest for you.
Dr Aikman does all gastroscopies under deep sedation and an anaesthetist will be present for the sedation. An intravenous cannula will be placed prior to the procedure. Ideally you will not experience any discomfort during this procedure.
The endoscope is fitted with a camera that will give your general surgeon a view of the internal oesophagus, stomach and small intestine on a video screen. From here he can make a diagnosis. If narrowed areas are found, these may be treated by stretching up with a dilator passed down the endoscope. Bleeding ulcers can be treated, and biopsies of polyps and small cancerous tumours can be taken during this procedure.
Colonoscopy
A colonoscopy is done as an inpatient procedure in theatre. After you have been given a sedative to relax, your general surgeon will put the tube-like endoscope into your rectum. The endoscope, otherwise known as a colonoscope, is also fitted with a camera to provide a view of the internal lining of the colon and rectum. The colonoscope is also fitted with a tube that allows your general surgeon to pump in the air and inflate your colon. This helps to get a better view of the lining and make a more accurate diagnosis. In the same procedure, abnormal growths like polyps can be removed. Other abnormal-looking tissues can be sampled, and a biopsy may be done to test for cancerous cells.
What will recovery entail?
You can go home immediately after completely recovering from the sedation. You will however need someone to drive you home after the procedure. Mild stomach cramps and gas are normal after an endoscopy. If you experience any fever, chills, extreme pain in the abdomen or bleeding in the stool, be sure to contact your doctor as this may be cause for concern.
Why would colon surgery be needed?
What kind of colon surgery may be needed?
As a Specialist General Surgeon, Dr Aikman has extensive experience in various gastrointestinal surgeries. Depending on the cause or condition, different surgeries may be done, including:
Colonoscopy and biopsy
When possible, a colonoscopy (which is a non-surgical endoscopy procedure) may be sufficient to diagnose a particular condition. Using a colonoscopy, Dr Aikman may get a better view of the internal gastrointestinal tract and test any abnormalities found in the colon and rectum, by taking a biopsy of tissue.
Laparoscopic surgery
Minimally invasive surgery may be used for drainage of an abscess collection secondary to localized perforation of the colon. Thru small puncture-like incisions, using thin laparoscopic tools, the abscess may be drained and washed out to relieve pain and prevent further infection. Laparoscopic surgery for removal of the colon is also becoming more popular. This can be done for benign conditions for instance diverticular disease with recurrent episodes of diverticulitis or bleeding, or for cancer patients. The advantages of minimally invasive surgery is well documented in the literature and include less pain, earlier mobilization, earlier discharge from hospital and earlier return to work.
Laparotomy and resection of part of the colon
In cases where minimally invasive surgery isn’t possible, a laparotomy may be needed to perform a partial or complete colon resection. Access is gained via a large midline incision through which the procedure will be done.
Colostomy
In cases where a part of the colon has been operated on and requires time to heal a colostomy may be done temporarily. In more severe cases, after too much of the colon has been resected, a colostomy may be considered as a permanent treatment. During a colostomy, Dr Aikman will create a hole (stoma) in the abdominal wall and will secure the end of the colon to the skin, allowing faecal matter to pass through to a bag, which collects the waste from your body. There are two types of colostomies that can be done, an end colostomy and diverting loop colostomy.
- Vomiting blood or passing blood per rectum
- Difficulty swallowing
- Change of bowel habits, including sudden onset of constipation or diarrhoea
- Unplanned weight loss
- Palpable abdominal masses, which might be painful but may also be asymptomatic.
What will recovery entail?
How long your recovery will be after surgery will depend on which colon surgery was done and whether it was done laparoscopically or through a laparotomy. If done laparoscopically, the incisions should be much smaller and thus the pain and recovery time is much less. Mild stomach cramps and gas are normal after any colon surgery and should not be concerning.
Symptoms to look out for include an unusually high fever, chills, vomiting, swelling and bleeding around the incisions, cramping and excessive pain as these are not normal may require additional intervention.
After 3 weeks, Dr Aikman will check your post-surgery incisions and give you instructions for care in the following few weeks. Because the reason for colon surgery is usually due to chronic conditions, surgery may not be the only treatment. You may need to continue with medications to control conditions like diverticular disease, diverticulitis and inflammatory bowel diseases. Of course, a colostomy placement is a life-altering surgery which may require many lifestyle changes. For this Dr Aikman will require a few follow-up consultations.
Why would breast surgery be needed?
How is breast surgery done?
Because the type and stage of the breast cancer are different for each individual, each woman’s treatment strategy will be unique. Breast surgery like a lumpectomy and mastectomy may be a part of treatment. Both of these surgeries require open surgery. The size, location and type of tumour as well as lifestyle and psychological concerns will be considered by your general surgeon when deciding which surgery will be best.
Lumpectomy
A lumpectomy (otherwise known as breast conserving therapy) is the removal of a tumour and surrounding tissue from the breast. Under general anaesthesia, Dr Aikman will make a small incision between 2 and 5cm in length into the breast. For aesthetic reasons, Dr Aikman will try to make the incision in a hidden place. The lump is then removed along with surrounding tissue. The surrounding tissue is sent for testing to see if the cancer cells are present in this tissue. This is done so that your general surgeon can see if all of the cancer was removed. Removing a lump from the breast should not affect the shape and size of the breast.
Mastectomy
A mastectomy, on the other hand, is the removal of the entire breast as well as the lymph nodes. Under general anaesthesia, Dr Aikman will make a much larger incision so that he can remove the entire breast tissue. Because many women feel that their breasts are an important part of their feminine identity and sexuality, if you are to have a mastectomy, Dr Aikman may assist your plastic surgeon in reconstruction of your breasts post-mastectomy.
In both cases, the lymph nodes may also be removed during this surgery to prevent spreading of cancer to the rest of the body.
What will recovery entail?
Depending on which of the two surgeries was done, your recovery may differ. If a lumpectomy was performed, you might experience some pain in your breast and chest and red skin around your wounds after surgery. If a mastectomy was done your recovery will be very different. Due to the presence of a large potential space where the breast tissue used to be, two drains are placed during the operation to evacuate any fluid that can build up in the wound. These drains will only be removed once the daily drainage has decreased sufficiently. Physiotherapy is begun in hospital to prevent stiffness of the shoulder on the side of the operation. After breast surgery the following symptoms should not be concerning as they are normal:
- Pain in the chest and breast.
- Itching and sensitivity as nerves grow back.
- Red skin around your incisions.
You may need to stay in the hospital for a day or two after surgery to check the drainage and ensure your incisions are healing as they should be before you go home. Symptoms to look out for include an unusually high fever, chills, vomiting, swelling and bleeding around the incisions and excessive pain as these are not normal may require additional intervention.
You should be able to return to your normal lifestyle in a few days, but you should take caution when doing physical activities for the next 6 – 8 weeks. After 32 weeks, Dr Aikman will check your post-surgery incisions and give you instructions for care in the following few weeks. You may be given exercises to do by a physiotherapist to assist in recovery.
Excision of skin and soft tissue lesions
How is an excisional biopsy done?
For skin lesions and growths, the area may be numbed with a local anaesthetic. If the lesion is deeper into the soft tissue, you may be put under general anaesthetic for the surgery. Dr Aikman will then use a small scalpel to remove a section of skin or lump including the fatty layer beneath it. Your general surgeon will then close the incision with absorbable stitches trying to make the wound as unnoticeable as possible.
What would happen after an excision?
Depending on the lesion and the size of the incision you will be told how to care for the wound after surgery. After Dr Aikman has removed a lesion from the skin or soft tissue, he will send this for histological evaluation. This is done to get a final diagnosis as to the nature of the lesion. If the histological evaluation confirms the lesion to be cancerous, additional surgery might be needed to ensure complete removal of the lesion in all dimensions.