General Surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid gland. They also deal with diseases involving the skin, breast, soft tissue, trauma, peripheral artery disease and hernias and perform endoscopic as such as gastroscopy, colonoscopy and laparoscopic procedures.
Scope:
General surgeons may sub-specialize into one or more of the following disciplines.
Trauma Surgery:
In many parts of the world including North America, Australia and the United Kingdom, the overall responsibility for trauma care falls under the auspices of general surgery. Some general surgeons obtain advanced training in this field (most commonly surgical critical care) and specialty certification surgical critical care. General surgeons must be able to deal initially with almost any surgical emergency. Often, they are the first port of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilize such patients, such as thoracostomy, cricothyroidotomy, compartment fasciotomies and emergency laparotomy or thoracotomy to stanch bleeding. They are also called upon to staff surgical intensive care units or trauma intensive care units.
All general surgeons are trained in emergency surgery. Bleeding, infections, bowel obstructions and organ perforations are the main problems they deal with. Cholecystectomy, the surgical removal of the gallbladder, is one of the most common surgical procedures done worldwide. This is most often done electively, but the gallbladder can become acutely inflamed and require an emergency operation. Infections and rupture of the appendix and small bowel obstructions are other common emergencies.
Laparoscopic Surgery:
This is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 3- to 15-mm incisions. Robotic surgery is now evolving from this concept (see below). Gallbladders, appendices, and colons can all be removed with this technique. Hernias are also able to be repaired laparoscopically. Bariatric surgery can be performed laparoscopically and there a benefits of doing so to reduce wound complications in obese patients. General surgeons that are trained today are expected to be proficient in laparoscopic procedures.
Colorectal Surgery:
General surgeons treat a wide variety of major and minor colon and rectal diseases including inflammatory bowel diseases (such as ulcerative colitis or Crohn's disease), diverticulitis, colon and rectal cancer, gastrointestinal bleeding and hemorrhoids.
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Breast Surgery:
General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy to mastectomy, especially pertaining to the evaluation, diagnosis and treatment of breast cancer
Vascular Surgery:
General surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are typically performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders.
Endocrine Surgery:
General surgeons are trained to remove all or part of the thyroid and parathyroid glands in the neck and the adrenal glands just above each kidney in the abdomen. In many communities, they are the only surgeon trained to do this. In communities that have a number of subspecialists, other subspecialty surgeons may assume responsibility for these procedures.
Transplant Surgery:
Responsible for all aspects of pre-operative, operative, and post-operative care of abdominal organ transplant patients. Transplanted organs include liver, kidney, pancreas, and more rarely small bowel.
Surgical Oncology:
Surgical oncologist refers to a general surgical oncologist (a specialty of a general surgeon), but thoracic surgical oncologists, gynecologist and so forth can all be considered surgeons who specialize in treating cancer patients. The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume (i.e., the more cancer cases a surgeon treats, the more proficient he or she becomes, and his or her patients experience improved survival rates as a result). This is another controversial point, but it is generally accepted, even as common sense, that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of complex cancer resections such as pancreaticoduodenectomy for pancreatic cancer, and gastrectomy with extended (D2) lymphadenectomy for gastric cancer. Surgical oncology is generally a 2-year fellowship following completion of a general surgery residency (5–7 years).
Pediatric Surgery:
Pediatric surgery is a subspecialty of general surgery. Pediatric surgeons do surgery on patients under age 18. Pediatric surgery is 5–7 years of residency and a 2-3 year fellowship.
The most common abdominal surgeries are described below.
• Appendectomy: surgical opening of the abdominal cavity and removal of the appendix. Typically performed as definitive treatment for appendicitis, although sometimes the appendix is prophylactically removed incidental to another abdominal procedure.
• Caesarean section (also known as C-section): a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus.
• Inguinal hernia surgery: the repair of an inguinal hernia.
• Exploratory laparotomy: the opening of the abdominal cavity for direct examination of its contents; for example, to locate a source of bleeding or trauma. It may or may not be followed by repair or removal of the primary problem.
• Laparoscopy: a minimally invasive approach to abdominal surgery where rigid tubes are inserted through small incisions into the abdominal cavity. The tubes allow introduction of a small camera, surgical instruments, and gases into the cavity for direct or indirect visualization and treatment of the abdomen. The abdomen is inflated with carbon dioxide gas to facilitate visualization and, often, a small video camera is used to show the procedure on a monitor in the operating room. The surgeon manipulates instruments within the abdominal cavity to perform procedures such as cholecystectomy (gallbladder removal), the most common laparoscopic procedure. The laparoscopic method speeds recovery time and reduces blood loss and infection as compared to the traditional "open" method.
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