General surgery

This page is about the surgical specialty. For the goregrind band, see General Surgery (band)

^{A surgeon operating}

General surgery, despite its name, is a surgical specialty that focuses on abdominal organs, e.g. intestines including esophagus, stomach, colon, liver, gallbladder and bile ducts, and often the thyroid gland (depending on the availability of head and neck surgery specialists) and hernias.

Scope

With the prevalent trend for increasing sub-specialisation in today's medical practice, General Surgery has somewhat lost some of its former glory and scope. Nonetheless, it continues to be a competitive, rewarding and highly demanding specialty in its own right. Until recently, all surgeons had to have gained fellowship in the College of General Surgeons (or such equivalent) in order to progress into further sub-specialty training. However, recently, the College of Surgeons has been divided into separate sub-branches, whereby Fellowship in General Surgery is not necessarily required, but may well be desired - depending on the country and centre of practice, as well as the individual sub-specialty.

Certain sub-specialties are still part of the General Surgical training program. That is, General Surgeons may subspecialise into one or more of the following disciplines:

Breast surgery

In Australia, Canada, the United States, and the United Kingdom, general surgeons are responsible for breast care, including the surgical treatment of breast cancer. In some other countries, breast care falls under Obstetrics and gynecology.

Trauma surgery

In the United States, the overall responsibility for trauma care falls under the auspices of general surgery, some general surgeons obtaining advanced training and specialty certification in this field alone. A General Surgeon must be able to deal with any surgical emergency. Often they are the first port of call to a critically ill patient, and must perform a variety of procedure to stabilise a patient, such as craniotomy, cricothyrotomy and chest draining procedures.

Colorectal surgery

Involves evaluation and treatment of complaints from the lower intestinal tract - the large bowel, rectum and anus. A large part of this care involves management of Colorectal cancer, as well as more trivial ailments such as Hemorrhoids.

Surgical management of conditions involving the esophagus, stomach, liver, spleen, gall bladder. Cholecystectomy, the surgical removal of the gall bladder, is one of the most common surgical procedures done world-wide.Upper gastro intestinal surgery may be done as emergencies like perforated duodenal ulcers, or acutely inflammed gall baldders or as elective operations such as cancer of stomach.

Though this type of surgery was popular by open surgery, nowadays it is replaced mostly by key hole or laparoscopic surgery . Using the key hole approach, the incisions are much smaller( 1 cm or less in the place of 15 cm long incisions), the scars are less painful , there is less stay in the hospital with early return to normal activity. Key hole surgery especially in the upper gastro intestinal tract causes a lower instance of chest complications as patients breathe better after surgery with minimal pain.

Endocrine surgery

Specialising in surgical removal of endocrine glands - most commonly the thyroid, the parathyroid glands and adrenal glands.

Transplant surgery

A transplant surgeon must be ready at any time, when called to harvest organs from a suitable donor. Transplantation of organs must be done as quickly and as meticulously as possible to optimise the chances of a successful transplant.

Vascular surgery

Historically, Vascular surgery was part of the General Surgical program, although recently it has formed its own college. Nonetheless, vascular trainees must complete a certain number of General Surgical terms.

In addition to the above, a General Surgeon may deal with a plethora of less emergent procedures- depending on the training of the Surgeon. Procedures such as treatment of varicose veins, circumcision, vasectomies and skin cancer removal are often done by General Surgeons. This is especially the case in rural areas, where sub-specialist level care is not always available.

Trends

In the last few years minimally invasive surgery has become more prevalent. Considerable enthusiasm has built around robotic surgery (also known as robotic-assisted surgery), despite a lack of data suggesting it has significant benefits that justify its cost.^[1]

Training

In Canada, Australia, New Zealand, and the United States general surgery is a five-year residency and follows completion of medical school, either MD, MBBS, MBChB, or DO degrees. In Australia and New Zealand, a residency leads to eligibility for Fellowship of the Royal Australasian College of Surgeons. In Canada, residency leads to eligibility for Certification by and Fellowship of the Royal College of Physicians and Surgeons of Canada, while in the United States, completion of a residency in general surgery leads to eligiblity for board certification by the American Board of Surgery which is also required upon completion of training for a general surgeon to have operating privileges at most hospitals in the United States.

In the United Kingdom, surgical trainees enter training after five years of medical school and two-years of the Foundation Programme. During the two to three year core training programme, doctors will sit the Membership of the Royal College of Surgeons (MRCS) examination. On award of the MRCS examination, surgeons may hold the title 'Mister' rather than doctor. This a tradition dating back hundreds of years in the United Kingdom that is still in use today. Trainees will then go onto Higher Surgical Training (HST), lasting a further 4 to 5 years. During this time they may choose to subspecialise. Before the end of HST, the examination of Fellow of the Royal College of Surgeons (FRCA) must be taken in General Surgery plus the subspeciality. Upon completion of training the surgeon will become a Consultant Surgeon and will be eligible for entry on the GMC Specialist Register and may work both in the NHS and independent sector as a Consultant General Surgeon.

Subspecialization

In many countries general surgery is a prerequisite for subspecialization in:

• vascular surgery
• thoracic surgery
• cardiac surgery
• plastic surgery
• Surgical Critical Care

References

1. ↑ Lunca S, Bouras G, Stanescu AC (2005). "Gastrointestinal robot-assisted surgery. A current perspective". Romanian journal of gastroenterology 14 (4): 385–91. PMID 16400356. 

See also

• Surgery
• Abdominal surgery
• Surgeon
• Physician
• Traumatology

External links

• Association of Surgeons of Great Britain and Ireland
• American College of Surgeons
• Careers in Surgery - Association of American Medical Colleges.
• General Surgeons Australia

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