I am a General & colorectal consultant surgeon. I work in East Kent NHS trust. My main sessions are at the QEQM Hospital, Margate, Kent. In addition I do regular outpatients clinics at the Kent & Canterbury Hospital, Canterbury. I used to do few endoanal ultrasound sessions at the Royal Victoria Hospital, Folkestone (I hope I will resume this soon). I am also the current lead colorectal surgeon for the East Kent NHS trust

I have been lucky enough to have quite wide ranging training and experience in surgery, both in Egypt & in the UK. This is still reflected in my practice which still encompass several fields in addition to my main interest in colorectal surgery.

Colorectal Cancer Surgery:

A large proportion of my practice center around radical colorectal cancer resections. This includes standard cancer resections as well as more extensive resections when indicated. The latter includes salvage resections for recurrent & persistent anal cancer (following failure of radiochemotherapy), extended en-bloc multivisceral resections for primary & recurrent colorectal cancer - see under research). I do pelvic exenterations in fit suitable patients. I am experienced in really all sphincter saving resections and have done may hand sewn coloanal anastomoses when oncologically safe

Since mid 2004, I have been offering in addition totally laparoscopic and laparoscopic assisted resections for both NHS & private patients.

I have done resections (anatomical & non anatomical) for liver secondaries in the past, but with super specialization, I now refer all such patients to Kings college, London.

The cancer patients are treated and cared for by a multidisciplinary team of dedicated specialists. In addition to myself, these patients are seen, treated or looked after by Professor Roger James, who is the head of the Kent cancer center (& my oncologist), Colette Leach, Sue Mccaferty & Jill Kanakri (Macmillan clinical nurse specialists), Trisha Ryder & Merille (Stoma Nurses), Mary Knott (colorectal cancer coordinator), Alex Hallier (my secretary, patient advocate & guardian angel) as well as palliative care team (Dr. Andrew Thorn, pauline & Elizabeth). We have very important input into our decision making by Pathologists (Dr Wendy Thurrell, Dr George Vittay) and Radiologists (Dr Adrian). We also work closely with the PET center at St Thomas Hospital, London (& more recently the center in Maidstone) to provide our patients with CT-PET when needed.

Needless to say there is also close cooperation with my other 2 colorectal consultant colleagues George Tsavellas & Harrison Benziger. Lastly I co-operate closely with Mr. Andy Nordin, consultant gynae-oncologist, whenever there is bowel involvement in radical cancer resections for gynae cancer.

Incontinence, Prolapse & Obstructed Defaecation Surgery:

I also have a particular interest in functional coloproctology & pelvic floor disorders (faecal incontinence, surgery for slow transit constipation & obstructed defaecation and rectal prolapse surgery).

Multidisciplinary pelvic floor team:

I co-operate closely with Mr John Shervington, consultant gynaecologist in all pelvic floor matters. We regularly discuss patients and refer patients to each other. We will start a joint monthly clinic in the very near future

The community support is provided by Caroline Greenhough (community continence advice nurse), who is both very good and very keen. She attends my clinics once a month (when we see patients jointly)

The anorectal physiological testing: Is done by Professor Norman Williams excellent physiology unit at the Royal London Hospital (Dr Mark Scott)

Surgery for faecal incontinence: This include anal sphincter repairs & levatorplasty. I am a proponent of the gluteus maximus neosphincter (I have performed many of these), however the indications for this operation in the UK is very little (with the availability of sacral nerve stimulation, electrostimulated graciloplasty & the artificial bowel sphincter in specialist centers).

Surgery for obstructed defaecation: This is a very complex area which needs a lot of expertise. Surgery is only part of the whole process of care of these patients, This typically involve the need for sophisticated anorectal physiology testing (done at the Royal London Hospital), initial conservative management (usually involving strong input from our community continence advice nurse). Surgery may be needed in some patients and the type will depend on clinical & physiological findings.

This may include Intra-anal Delorme's & resection-rectopexy for symptomatic internal rectal intussusception as well as transperineal & transanal repairs of symptomatic rectocoeles (associated with functional bowel symptoms). Professor Norman Williams offer the EXPRESS procedure instead (which depends on the use of a very expensive collagen sheets, currently unfunded in East Kent).

Surgery for Slow transit constipation: These patients are fully investigated at the Royal London Hospital and only those who failed maximum medical therapy, have proven slow transit & normal small bowel motility are candidates for subtotal colectomy & ileo-rectal anastomosis.

Surgery for rectal prolapse: I perform perineal repairs (Delorme's & Altmeire's procedures) as well as laparoscopic abdominal rectopexy (almost always with an added anterior resection). The choice is based on a variety of factors as well as a clinical test which I described (see under innovative techniques). I have 2 publications on surgery for rectal prolapse.

Surgery for inflammatory bowel disease:

Naturally another strong area of interest. This includes various resections & strictureplasty for Crohn's disease and Ileal pouch operations for ulcerative colitis (or familial polyposis). This provide patients in East Kent with a choice of treatment locally rather than referral to London

Anal & pelvic floor surgery:

I have already mentioned my interest & expertise in pelvic floor surgery (see above). Needless to say I also provide the whole spectrum of anal operations from measured sphincterotomy for fissures, through haemorrhoidectomy and including anoplasty & rectal strictureplasty for anal & rectal strictures. Stapled anopexy (Stapled haemorrhoidectomy - PPH - Longo procedure): over 100000 of these have been done in the continent, we have been slow to adopt this for various reasons, but is now available as day case in East Kent (NHS funding is not always easy!).

Anal Fistula surgery:

Another area I am interested in. I offer treatment for complex and high fistulae, with a concomitant immediate sphincter repair with excellent results. We presented our results in the Tripartite international colorectal meeting in Dublin in July 2005 (see under research). A publication about the technique is being prepared. Setons is sometimes used as appropriate.

Rectovaginal Fistula Surgery:

These are difficult problem with high recurrence rates. Its treatment needs skill on the surgeon's side and patience on the patient side. I use a variety of techniques, depending on circumstances). These include perineal proctotomy with sphincter repair or endorectal advancement flaps. Some patients also need transposed vascularized tissue (for which I normally would use the right gracilis muscle).

Pilonidal sinus surgery:

I perform my own operation with very very low recurrence rates (XRD - see under innovative techniques, submitted for publication)

Endoscopy:

I perform diagnostic and therapeutic colonoscopy and gastroscopy. I have done several thousands of these over the years.

Laparoscopic (Key-hole) operations:

I have been practicing laparoscopic surgery since 1991, with almost 2000 laparoscopic procedures under my belt. I provide laparoscopic cholecystectomy (gall bladder), adhesiolysis (division of adhesions) as well as laparoscopic or laparoscopic assisted colorectal resections. I have also done laparoscopic Toupet's & Nissen's fundoplication for gastro-oesophageal reflux, laparoscopic extraperitoneal repairs for groin hernias as well as high ligation of varicocoeles. I also did (in Egypt) many laparoscopic posterior truncal vagotomies & anterior seromyotomies for peptic ulceration (damn the PPIs!).

Thyroid & parathyroid operations:

I was trained under Professor Goode at the Royal London Hospital (1987-1990), where I became proficient in both Thyroid & parathyroid operations. I have done a huge number of these operations over the years (since 1984). I still offer thyroid surgery (total lobectomy, total thyroidectomy) to my patients as needed.

Abdominoplasty:

I do this for private patients mainly. I only offer this on the NHS as part of repair of incisional hernias or other indications, but not for cosmetic reasons.

Submandibular & parotid surgery:

I do this in a small number of patients

Hernia operations:

I treat all types of hernias, open & laparoscopic. I have also developed a new technique for repair of recurrent parastomal hernias (see under innovative techniques).

Varicose veins surgery:

I still do this in a small number of patients

Vasectomy:

I provide this service to private patients