General Surgery

Dr Margaret Dunkley specialises in surgical treatment for:

A hernia is where abdominal tissue (fatty tissue or part of an organ) pushes through a weak spot in the muscles of your abdominal wall. Getting older, heavy lifting, chronic constipation, obesity or previous abdominal surgery will increase your likelihood of a hernia. You might notice a small bulge or swelling or it may be painful. Hernias do not go away on their own and can cause serious problems if ignored.

Dr Dunkley specialises in hernia surgery including:

• Laparoscopic hernia repair – many hernia operations (including inguinal and umbilical hernias) are performed using laparoscopic (keyhole) surgery. In most cases you will be able to go home the same day.

• Open surgery hernia repair – more complex or recurrent hernias may require open surgery or more advanced surgical repair techniques. Wound care is especially important with open hernia surgery. This usually requires a longer stay in hospital to support your recovery.

• Complex hernia and Abdominal wall reconstruction - this is surgery that is sometimes needed after a patient has had a long cut down the abdomen (laparotomy) or stoma formation that results in a large hernia defect. 

Types of hernias treated: 

• Inguinal hernias – form into the inguinal canal in the groin and are most common in men who often have a natural weakness in this area. 

• Incisional hernias – any type of abdominal surgery (including keyhole or open surgery) can cause weakness around the scar tissue where intestines may push through.

• Umbilical hernias – form near the belly button and are most common in newborns or in people who have weakened abdominal wall in this area (for example due to obesity or following multiple pregnancies).

The gallbladder is a small sac that stores bile made by the liver to help you digest food. When sediment builds up, it can form gallstones that block the duct and cause severe pain. If you have problems with gallstones, you may need an operation to remove your gallbladder.

• Laparoscopic cholecystectomy – is keyhole surgery performed under general anaesthetic.

• Dr Dunkley uses a small camera and instruments inserted through four small incisions in your abdomen to remove your gallbladder and any stones. 

• Most patients recover well from gall bladder surgery and return to normal activity within 1 week.

The appendix is a small tube attached to your colon on the lower right side of your abdomen. The appendix can become swollen and infected and burst which can be painful and life threatening. This condition is called Appendicitis and most often will result in the appendix being removed. The operation to remove the appendix is called an appendicectomy. 

• Laparoscopic appendicectomy – uses three small incisions in the abdomen to insert a camera and instruments to remove the inflamed appendix.

• Open appendicectomy – uses an open incision to access the appendix, usually only when the appendix has burst and more extensive surgery to remove debris and repair damage is required. Rarely, patients are so severely unwell that they may require a lifesaving laparotomy (large cut in the middle of abdomen to open it up)  to fix the damage that the perforated appendicitis has caused.

• Most patients feel better immediately after surgery. If your appendix has ruptured, your recovery may be longer.

You may be referred to Dr Dunkley for surgical treatment for skin conditions including surgery to remove skin cancers or skin lesions. Surgery is usually the first line of treatment for skin cancers to reduce the likelihood of cancer returning, while skin lesions can be caused by many different conditions.

• Skin cancer – skin cancer occurs when normal cells start changing and growing in uncontrolled ways, potentially spreading abnormal cells to other parts of the body.

• Skin lesions – include sebaceous cysts, lipomas and skin tags. While many skin lesions are not cancerous, surgery may be performed for other reasons, for example, if they are painful or for cosmetic reasons.

Bleeding from the anal canal is very common and the most common reason that patients come to see Dr Dunkley. Bleeding can be caused by several conditions including haemorrhoids and anal fissure. However, it could also be the only symptoms that you have of bowel cancer. It is therefore extremely important that if you have bleeding from the bottom that you see a doctor. A colonoscopy should be strongly considered, with some urgency.

Bleeding from the anal canal must never be assumed to be from haemorrhoids until a cancerous condition is excluded. Bowel cancer is not a disease of the elderly. People of all ages can get bowel cancer and early treatment results in cure. There are a number of proceduralists in Mildura who offer quality colonoscopy who can help you gain more information about the cause of any bleeding.

A pilonidal sinus is a small hole or tunnel that forms in the skin on the area between the buttocks. It can be a painful condition that requires surgery to remove infected tissues and prevent the sinus from re-forming.

• Abscess drainage - sometimes the sinus forms an abscess and the abscess will need draining.  This is to drain the infection and is usually performed separate to any other pilonidal surgery.

• Surgical excision – surgery is used to remove any infection and achieve a wound closure using a skin flap. Recovery time is usually 2-3 weeks and wound dressings need to be changed regularly to avoid reinfection.

• Endoscopic ablation – a less invasive procedure that uses an endoscope (small instrument with a camera attached) to remove infection before applying heat (ablation) to seal the sinus. Recovery time is longer (around 4 weeks) but the risk of complications is lower.

Haemorrhoids are a normal part of the anal canal anatomy and everybody has them. However, sometimes they become dilated resulting in painful lumps in the bottom that are uncomfortable and bleed. Often Dr Dunkley can advise on non-operative treatment to help the haemorrhoids however, occasionally surgery is required. 

• Haemorrhoid banding – a common treatment for moderate sized haemorrhoids and can be performed at the same time as a colonoscopy procedure. Small rubber bands constrict blood flow to the area causing the haemorrhoid to disappear in a few days.

• Haemorrhoidectomy - Dr Dunkley treats the larger painful haemorrhoids with open haemorrhoidectomy.

Recovery from haemorrhoid surgery is focused on keeping you as comfortable as possible with pain relief, keeping your wounds clean and ensuring normal bowel movements.

An anal fissure is a small tear in the tissue that lines the anus caused by spasm of the anal muscles resulting in severe pain, and bleeding especially with bowel movements.  Please ensure that you seek a surgical opinion for management and also for a colonoscopy.  Whilst you are waiting for a surgical opinion it is important to keep your stools soft and regular (Movicol is very helpful) and avoid straining.  There are medications that your GP can prescribe whilst awaiting surgical opinion and these can be very helpful.   Surgical options include:

• Botulinum Toxin injection – applying this medication directly into the anal sphincter helps the muscles relax, reducing pain and spasms and allowing the fissure to heal.

• Lateral internal sphincterotomy – a small incision is made on inner part of the anal sphincter to reduce pressure on and restore blood flow to the anus, allowing the fissure to heal.

Both types of surgery are typically done as same-day outpatient procedures. 

Anal fistula is a condition of the perianal area that results in a connection between the inside of the bowel and the outside the bowel, usually in the buttock just near the anus. This can result in an abscess or a small lump that results in leakage of pus, blood or faecal material. This needs to be reviewed and treated by a surgeon as in itself it can be dangerous if left untreated. It may also represent a more serious diagnosis that a surgeon can diagnose. Dr Dunkley has treated many fistulas and can offer more complex fistula surgery such as anal fistula plug and LIFT (of Intersphincteric Fistula Tract) when appropriate. 

Dr Dunkley has performed two years fellowship training in advanced laparoscopic colon and rectal surgery. The colon is the large bowel that connects the small bowel to the rectum and then the anus.  The colon and rectum are the most common location of bowel cancer, otherwise known as colorectal cancer. 

Dr Dunkley has advanced specialist training in removal of the colon and rectum for cancer and will always do this laparoscopically (keyhole) where possible. Dr Dunkley has many skilled and helpful colleagues in tertiary centres who have a large team to manage more difficult cases. This may include patients with a high BMI or with bowel cancer very close to the anus and cancer that may have become involved with other structures. Dr Dunkley will not hesitate to refer to another surgeon if she thinks this is in the best interests of the patient, and if you have any concerns, she would like you to ask.

The colon can also be involved in non-cancerous (benign) conditions that Dr Dunkley is very experienced in managing. This includes inflammatory bowel disease and diverticulitis, and other injuries, infections or blockages in your bowel. These conditions are often managed during emergency surgery in the public hospital and may not be able to be managed using laparoscopic (key hole) surgery in many cases.

Endoscopy procedures are used to look at your digestive tract from the inside. They are an important tool used in preventative screening, diagnosis and treatment of digestive disorders and some cancers.

Surgery is usually the first line of treatment for breast cancer. Dr Dunkley has been trained in breast cancer surgery at large high volume tertiary and metropolitan hospitals including the Mater Misericordiae Hospital in Brisbane. She is compassionate and caring and able to perform many modern breast cancer operations including breast conserving surgery, wide local excision and mastectomy, sentinel node biopsy and axillary dissection.

Dr Dunkley works very closely with the local oncologists and the local McGrath nurse to provide expert care for patients. All cancer cases are discussed at a Cancer Multidisciplinary Meeting held every fortnight. Many patients with cancer can now have all of their treatment locally. 

Whilst Dr Dunkley does not perform reconstruction, she has a number of colleagues who can do this in the metropolitan area. In certain cases of very early breast cancer or as a preventative procedure this can sometimes be performed as mastectomy and immediate reconstruction. If you have any questions about this, Dr Dunkley will happily guide you and refer you to an appropriate specialist in the area of reconstruction.

Dr Dunkley will also review and manage benign breast disease and this can include nipple discharge, fibroadenoma and cystic breast disease. 

Dr Dunkley is a General Surgeon based in Mildura. She consults and operates from her rooms in Mildura, Her main practice rooms are located at 236 Thirteenth Street, Mildura. Dr Dunkley operates at the Calvary in Adelaide, Mildura Private Hospital and also Mildura Base Public Hospital.