Conditions We Treat

Bowel cancer — also called colorectal cancer — is the fourth most common cancer in the UK, with around 43,000 new cases diagnosed each year. It develops in the lining of the colon or rectum and is highly treatable when caught early. Stage I bowel cancer has a 5-year survival rate exceeding 90%.

Symptoms

• Persistent change in bowel habit — looser stools or going more frequently
• Rectal bleeding or blood mixed with stool
• Unexplained weight loss
• Abdominal pain or bloating that is new or persistent
• A feeling of incomplete emptying after opening the bowel
• Unexplained iron deficiency anaemia

Diagnosis

Colonoscopy is the gold standard investigation, allowing direct visualisation of the bowel lining and biopsy of suspicious lesions. CT colonography may be used in selected patients. If bowel cancer is confirmed, CT staging of the chest, abdomen and pelvis determines treatment planning.

Treatment

Surgery remains the cornerstone of curative treatment. Mr Papettas performs minimally invasive (laparoscopic and robotic) bowel resection in 95% of cases. His anastomotic leak rate is below 1% against a national average of 3–8%, his 2-year survival is above the national average, and his elective mortality rate is 0%.

Colonoscopy is the definitive investigation of the large bowel. A thin, flexible camera is passed through the rectum to examine the entire colon. It takes 30–45 minutes and is usually performed under sedation for comfort.

When is it needed?

• Investigation of rectal bleeding or change in bowel habit
• Positive FIT test result
• Surveillance after previous polyp removal
• Family history of bowel cancer
• Inflammatory bowel disease monitoring
• Unexplained iron deficiency anaemia

Mr Papettas' endoscopy credentials

Mr Papettas holds full JAG dual accreditation for both colonoscopy and gastroscopy — the national standard for endoscopic competence in the UK. His caecal intubation rate is 100%, ensuring the entire colon is examined in every procedure. He has performed over 4,000 endoscopic procedures.

Rectal bleeding is one of the most common reasons patients seek a colorectal opinion. While the majority of cases have a benign cause — most commonly haemorrhoids or an anal fissure — rectal bleeding should never be self-diagnosed or ignored, particularly in patients over 40 or those with a family history of bowel cancer.

Common causes

• Haemorrhoids — bright red blood, often on tissue paper
• Anal fissure — bright red blood with pain on defaecation
• Diverticular disease — often larger volume, painless
• Bowel polyps or cancer — mixed with stool, darker
• Inflammatory bowel disease — associated with mucus and urgency

Assessment

Clinical examination including proctoscopy and flexible sigmoidoscopy or colonoscopy depending on risk profile. Rapid assessment is available at Nuffield Health Warwickshire.

Diverticular disease occurs when small pouches (diverticula) form in the wall of the colon, most commonly the sigmoid colon. It affects over 50% of people over 70 in the UK. Most are asymptomatic, but a proportion develop diverticulitis or complications including bleeding, abscess, or perforation.

Symptoms

• Left-sided abdominal pain — often cramping
• Change in bowel habit
• Bloating and wind
• Rectal bleeding in diverticular haemorrhage
• Fever and tenderness in acute diverticulitis

Treatment

Uncomplicated diverticulitis is managed with antibiotics and dietary modification. Recurrent or complicated disease may require laparoscopic sigmoid colectomy. Mr Papettas' conversion rate is below 5%, with a typical hospital stay of 2–4 days for elective cases.

Haemorrhoids are swollen vascular cushions in the anal canal or around the anus. They are extremely common, affecting up to 75% of people at some point in their lives. Internal haemorrhoids arise above the dentate line; external haemorrhoids below it.

Symptoms

• Bright red rectal bleeding — typically on tissue or in the pan
• Prolapse — a lump protruding from the anus
• Discomfort, itching, or soiling
• Pain — particularly with thrombosed external haemorrhoids

Grading and treatment

Haemorrhoids are graded I–IV based on degree of prolapse. Treatment options range from dietary modification and rubber band ligation through to haemorrhoidal artery ligation (HALO) and haemorrhoidectomy. Mr Papettas offers the full range of interventions tailored to grade and symptoms.

An anal fissure is a small tear in the lining of the anal canal, most commonly at the posterior midline. It is one of the most painful anorectal conditions and causes significant disruption to daily life. Fissures may be acute (under 6 weeks) or chronic.

Symptoms

• Severe pain during and after defaecation
• Bright red bleeding on tissue paper or in the pan
• Spasm of the internal anal sphincter
• A visible tear at the anal margin

Treatment

First-line treatment includes topical GTN or diltiazem cream, stool softeners, and sitz baths. Botulinum toxin injection is effective for chronic fissures. Lateral internal sphincterotomy (LIS) is the definitive surgical treatment, with high success rates and low incontinence risk in experienced hands.

An anal fistula is an abnormal tunnel connecting the inside of the anal canal to the skin around the anus. Most develop following a perianal abscess. They rarely heal without surgical treatment and have a tendency to recur without specialist management.

Symptoms

• Persistent discharge of pus or blood-stained fluid near the anus
• Recurrent perianal abscesses
• Pain, swelling, and skin irritation
• Occasionally fever

Treatment

Treatment must balance fistula eradication with sphincter preservation to avoid incontinence. Options include fistulotomy, seton placement, the LIFT procedure, and fibrin glue or plug. Complex fistulas — including Crohn's-related — require specialist assessment and a staged surgical approach.

Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract from mouth to anus, most commonly the terminal ileum and colon. It is characterised by transmural inflammation, skip lesions, and a tendency to cause strictures, fistulas, and abscesses.

Symptoms

• Abdominal pain — often right-sided or periumbilical
• Diarrhoea, sometimes with blood or mucus
• Weight loss and fatigue
• Perianal disease — fissures, fistulas, skin tags
• Extra-intestinal manifestations — joints, skin, eyes

Surgical management

Surgery is reserved for medically refractory disease, stricturing, or penetrating complications. Bowel conservation is the guiding principle. Mr Papettas is experienced in laparoscopic ileocaecal resection, strictureplasty, and complex fistulating disease. He is one of a small number of regional surgeons with experience of ileoanal pouch surgery.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the mucosal lining of the colon and rectum. Unlike Crohn's disease, inflammation is continuous and confined to the large bowel. It affects approximately 1 in 420 people in the UK.

Symptoms

• Bloody diarrhoea — often the cardinal symptom
• Urgency and frequency of defaecation
• Abdominal cramping
• Fatigue and anaemia in moderate-to-severe disease
• Weight loss in severe or extensive disease

Surgical treatment

Surgery for UC is potentially curative. Total proctocolectomy with ileal pouch-anal anastomosis (the J-pouch) removes all affected bowel and avoids a permanent stoma in the majority of patients. Mr Papettas is one of the few surgeons in the region with regular experience of pouch surgery.

IBS is a functional bowel disorder characterised by chronic abdominal pain associated with altered bowel habit, in the absence of identifiable structural abnormality. It affects approximately 10–15% of the UK population and is more common in women.

Symptoms

• Abdominal pain or cramping — typically relieved by defaecation
• Bloating and distension
• Diarrhoea, constipation, or alternating pattern
• Mucus in the stool
• Urgency

Flexible sigmoidoscopy examines the rectum and sigmoid colon using a short flexible camera. It takes approximately 15 minutes, does not require full bowel preparation, and is usually performed without sedation.

When is it used?

• Assessment of rectal bleeding in lower-risk patients
• Investigation of left-sided abdominal symptoms
• Follow-up of known left-sided colonic pathology
• Bowel cancer screening in certain clinical contexts

Flexible sigmoidoscopy only examines the lower third of the colon. Where higher risk exists, or if pathology is identified, a full colonoscopy will be recommended. Mr Papettas will advise on the most appropriate investigation at your consultation.

Gastroscopy — also called an OGD (oesophago-gastro-duodenoscopy) — examines the oesophagus, stomach, and duodenum using a thin flexible camera passed through the mouth. It takes 5–15 minutes and can be performed under sedation or throat spray.

Indications

• Persistent heartburn or reflux not responding to treatment
• Difficulty swallowing (dysphagia)
• Upper abdominal pain or persistent nausea
• Unexplained anaemia or weight loss
• Investigation for H. pylori infection
• Surveillance for Barrett's oesophagus

Mr Papettas holds full JAG accreditation for diagnostic gastroscopy. Both gastroscopy and colonoscopy can be arranged on the same list where clinically indicated — minimising time off work and number of hospital visits.

Gallstones are present in approximately 10–15% of UK adults. Most are asymptomatic, but symptomatic gallstone disease — biliary colic, acute cholecystitis, and pancreatitis — is a common reason for surgical referral. Laparoscopic cholecystectomy (keyhole removal of the gallbladder) is the definitive treatment.

Symptoms of symptomatic gallstones

• Right upper quadrant pain — often after fatty meals
• Pain radiating to the right shoulder tip
• Nausea and vomiting
• Jaundice if a stone passes into the bile duct
• Fever and rigors in cholecystitis or cholangitis

Surgery

Mr Papettas performs laparoscopic cholecystectomy with a 0% bile duct injury rate — a key safety metric. Most patients are discharged the same day or next morning and return to normal activity within 1–2 weeks.

A pilonidal sinus is a small hole or tunnel in the skin at the top of the cleft of the buttocks. It most commonly affects young men and can become infected, forming a painful abscess. Without treatment, pilonidal disease tends to recur.

Symptoms

• Pain and swelling at the top of the natal cleft
• Discharge of pus or blood-stained fluid
• Recurrent abscess formation
• Hair protruding from the sinus opening

Treatment

Acute abscesses require incision and drainage. Definitive treatment of the sinus tract is then planned electively. Options include excision and primary closure, healing by secondary intention, or flap reconstruction (Karydakis or Bascom procedure) for complex or recurrent disease.

Rectal prolapse occurs when the rectum protrudes through the anus. It can be partial (mucosal prolapse) or full thickness (complete prolapse). It is more common in older women but can occur at any age. Pelvic floor weakness and chronic straining are contributing factors.

Symptoms

• A visible mass protruding from the anus, especially on straining
• Faecal incontinence or urgency
• Mucus or blood discharge
• Difficulty with defaecation and a sensation of incomplete emptying

Surgical treatment

Laparoscopic ventral mesh rectopexy (VMR) is the preferred approach at specialist centres, with excellent results for prolapse correction and functional outcomes. Perineal approaches (Delorme's or Altemeier's) are used in patients unfit for major abdominal surgery.

Bowel polyps are growths on the inner lining of the colon or rectum. Most are benign, but adenomatous polyps carry a risk of malignant transformation if left untreated. The majority of bowel cancers arise from adenomatous polyps over a period of years.

Types

• Adenomatous polyps (tubular, tubulovillous, villous) — pre-cancerous
• Hyperplastic polyps — generally benign
• Serrated polyps — some carry malignant potential
• Inflammatory polyps — associated with IBD

Removal and surveillance

Polyps detected at colonoscopy are removed during the same procedure where possible. Larger polyps may require endoscopic mucosal resection (EMR) or surgical resection. A surveillance colonoscopy programme is recommended based on polyp number, size, and histology. Mr Papettas' 100% caecal intubation rate ensures no polyps are missed from an incomplete examination.

Appendicitis is inflammation of the appendix and is the most common surgical emergency in the UK, with a lifetime risk of approximately 7%. Left untreated, the appendix can perforate, leading to peritonitis and serious systemic illness.

Symptoms

• Central abdominal pain migrating to the right lower quadrant
• Nausea and vomiting
• Fever and loss of appetite
• Rebound tenderness at McBurney's point

Treatment

Laparoscopic appendicectomy is the standard surgical treatment, offering faster recovery and lower wound complication rates than open surgery. Selected cases of uncomplicated appendicitis may be managed with antibiotics, though surgery remains the definitive option for most patients.

Abdominal pain is one of the most common presenting complaints in surgical and gastroenterological practice. Causes range from functional (IBS, constipation) to structural (gallstones, diverticular disease, hernia) to serious (cancer, IBD, mesenteric ischaemia). Accurate diagnosis requires careful clinical assessment and targeted investigation.

Assessment

Mr Papettas offers a comprehensive approach to the investigation of abdominal pain, including clinical examination, blood tests, imaging (ultrasound, CT), and endoscopy where indicated. The goal is an accurate diagnosis and clear management plan — avoiding prolonged, inconclusive investigation.

The Faecal Immunochemical Test (FIT) detects tiny amounts of blood in the stool invisible to the naked eye. It is the primary bowel cancer screening test in England, offered to adults aged 50–74 every two years. A positive result requires urgent specialist follow-up.

What a positive FIT test means

A positive FIT result does not mean you have bowel cancer. Most patients with a positive result do not have cancer — the blood may come from polyps, haemorrhoids, or other benign causes. However, it means the bowel needs to be examined by colonoscopy without delay.

A perianal abscess is a collection of pus in the tissues surrounding the anus or rectum, most commonly arising from infection of the anal glands. It is painful and requires prompt surgical drainage. Up to 50% of perianal abscesses will go on to develop an anal fistula.

Symptoms

• Severe throbbing pain around the anus
• Swelling, redness, and warmth at the perianal skin
• Fever and systemic upset
• Difficulty sitting or defaecating

Treatment

Surgical incision and drainage is the standard treatment, usually as a day case under general anaesthetic. Following drainage, the wound is assessed for evidence of a fistula tract. If present, staged fistula treatment is planned to protect sphincter function.

Constipation is defined as fewer than three bowel movements per week, or significant difficulty passing stool. It is one of the most common GI complaints, affecting up to 20% of the UK population. While most cases are functional, new or worsening constipation — particularly in patients over 50 — warrants investigation to exclude structural causes including cancer.

Causes

• Dietary — insufficient fibre or fluid intake
• Medications — opiates, iron supplements, calcium channel blockers
• Structural — stricture, cancer, or external compression
• Functional — slow transit constipation, pelvic floor dyssynergia
• Metabolic — hypothyroidism, hypercalcaemia

Assessment and treatment

Mr Papettas offers colonoscopy and transit studies to characterise constipation accurately. Treatment is directed at the underlying cause — from dietary measures and laxatives for functional constipation through to surgical intervention in carefully selected cases of refractory slow transit constipation.

Diarrhoea is defined as passing loose or watery stools more than three times a day. Acute diarrhoea (under 4 weeks) is usually infective and self-limiting. Chronic diarrhoea (over 4 weeks) requires investigation to exclude IBD, coeliac disease, microscopic colitis, bile acid malabsorption, or colorectal cancer.

Causes of chronic diarrhoea

• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Coeliac disease
• Microscopic colitis — particularly in older women on NSAIDs or PPIs
• Bile acid malabsorption — following ileal resection or cholecystectomy
• Colorectal cancer or villous adenoma
• Functional — IBS with predominant diarrhoea

Investigation

A systematic approach including stool cultures, faecal calprotectin, blood tests, and colonoscopy with biopsies allows accurate diagnosis in the majority of cases. Mr Papettas offers rapid-access endoscopy and will guide you through the appropriate investigation pathway at your initial consultation.