GENERAL SURGERY

Definition

General surgery is the treatment of injury, deformity, and disease using operative procedures.

Purpose

General surgery is frequently performed to alleviate suffering when a cure is unlikely through medication alone. It can be used for such routine procedures performed in a physician's office or for more complicated operations requiring a medical team in a hospital setting, such as laparoscopic cholecystectomy (removal of the gallbladder). Areas of the body treated by general surgery include the stomach, liver, intestines, appendix, breasts, thyroid gland, salivary glands, some arteries and veins, and the skin. 

Modern surgery has developed to such an extent that the body of knowledge and technical skills required have led to surgeons specialising in particular areas, usually an anatomical area of the body or occasionally in a particular technique or type of patient.

What do general surgeons do?

As the title indicates, this is a wide-ranging area of surgery with many sub-specialties. The defining feature of a general surgeons is that they have a wide range of knowledge and skills to deal with all kinds of surgical emergencies, with emphasis on acute abdominal problems. They also carry out a large number of elective operations.

Most general surgeons deal with the common conditions of the gall bladder and carry out hernia repairs. However, nearly all general surgeons have a special interest, such as intestinal surgery (upper or lower), breast surgery or vascular surgery. A few have become highly specialised and restrict their activities to a small number of complex, relatively unusual operations.

Some areas of general surgery have grown in extent as surgery develops, and most operating on arteries or carrying out transplants have specialised exclusively in these areas. However they retain their general surgical skills and base.

Sub-specialties:

Given the wide range of work undertaken by general surgeons, one of distinguishing features of general surgery is the range of sub-specialties that lie within it. These include:

• Breast – assessment of the large number of patient with breast symptoms, and surgery on breast cancers, often including reconstructive procedures  that do not require plastic surgeons. 
• Colorectal – surgery for diseases of the colon, rectum and anal canal, particularly cancer of the rectum. 
• Endocrine – surgery for disease of the thyroid and other endocrine glands. 
• Upper Gastrointestinal – surgery for diseases affecting the liver, oesophagus and stomach. This also covers obesity surgery. Major operations for cancer are usually done in regional specialist units. 
• Transplant – kidney and liver transplantation are the routine procedures, but many other organs may be transplanted. 
• Vascular – surgery on the main blood vessels of the neck, trunk and limbs. This area is becoming increasingly distinct as minimally invasive techniques develop, with an overlap into radiology, and in future the treatment of vascular disease may become a specialty in its own right.

The majority of simple operations on children are also carried out by general surgeons.

Developments:

General surgery is in the vanguard for the introduction of minimally invasive procedures:

Laparoscopic (or “keyhole”) surgery is recognised as an integral and crucial skill that is developing across the entirety of general surgical practice and its subspecialties. Operations are being carried out increasingly by minimally invasive techniques that offer patients less pain, better outcomes and shorter post-operative recovery. Virtually every abdominal operation can and has been done by this route.