General surgery is the treatment of injury, deformity, and disease using operative procedures.
Description
In earlier times, surgery was a dangerous and dirty practice. Until the middle of the 19th century, as many patients died of surgery as were cured. With the discovery and development of general anesthesia in the mid-1800s, surgery became more humane. And as knowledge about infections grew, surgery became more successful as sterile practices were introduced into the operating room. The last 50 years of the 20th century have seen continued advancements.
Types of General Surgery
General surgery experienced major advances with the introduction of the endoscope. This is an instrument for visualizing the interior of a body canal or a hollow organ. Endoscopic surgery relies on this pencil-thin instrument, capable of its own lighting system and small video camera. The endoscope is inserted through tiny incisions called portals. While viewing the procedure on a video screen, the surgeon then operates with various other small, precise instruments inserted through one or more of the portals. The specific area of the body treated determines the type of endoscopic surgery performed. For example, colonoscopy uses an endoscope, which can be equipped with a device for obtaining tissue samples for visual examination of the colon. Gastroscopy uses an endoscope inserted through the mouth to examine the interior of the stomach. Arthroscopy refers to joint surgery, and abdominal procedures are called laparoscopies.
Endoscopy is used in both treatment and diagnosis especially involving the digestive and female reproductive systems. Endoscopy has advantages over many other surgical procedures, resulting in a quicker recovery and shorter hospital stay. This non-invasive technique is being used for appendectomies, gallbladder surgery, hysterectomies and the repair of shoulder and knee ligaments. However, endoscopy does not come without limitations such as complications and high operating expense. Also, endoscopy doesn't offer advantages over conventional surgery in all procedures. Some literature states that as general surgeons become more experienced in their prospective fields, additional non-invasive surgery will be a more common option to patients.
ONE-DAY SURGERY. One-day surgery is also termed same-day, or outpatient surgery. Surgical procedures usually take two hours or less and involve minimal blood loss and a short recovery time. In the majority of surgical cases, oral medications control postoperative pain. Cataract removal, laparoscopy, tonsillectomy, repair of broken bones, hernia repair, and a wide range of cosmetic procedures are common same-day surgical procedures. Many individuals prefer the convenience and atmosphere of one-day surgery centers, as there is less competition for attention with more serious surgical cases. These centers are accredited by the Joint Commission on Accreditation of Healthcare Organizations or the Accreditation Association for Ambulatory Health Care.
Who Performs the Procedure and Where Is It Performed?
General surgery is performed by a physician with specialized training in surgery. It is most commonly performed in an outpatient facility adjacent to a hospital or in an operating room of a hospital. Very minor procedures such as abscess incision and drainage or the removal of a small or superficial foreign body may be performed in a professional office.
Questions to Ask the Doctor
What tests will be performed prior to surgery?
Which body parts will be affected?
How will the procedure affect daily activities after recovery?
Where will the surgery be performed?
What form of anesthesia will be used?
What will the area look like after surgery?
Is the surgeon board certified?
How many similar procedures has the surgeon performed?
What is the surgeon's complication rate?
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, as vasectomy, or for more complicated operations requiring a medical team in a hospital setting, such as laparoscopiccholecystectomy (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. The brain, heart, lungs, eyes, feet, kidneys, bladder, and reproductive organs, to name only a few, are areas that require specialized surgical repair.
New methods and techniques are less invasive than older practices, permitting procedures that were considered impossible in the past. For example, microsurgery has been used in reattaching severed body parts by successfully reconnecting small blood vessels and nerves. Laparoscopic techniques are more efficient, promote more rapid healing, leave smaller scars, and have lower postoperative infection rates.
Demographics
All surgeons receive similar training in the first two years of their residency (post-medical school) training. General surgeons are the surgical equivalent of family practitioners. General surgeons typically differ from other surgical specialties in the operations that they perform. This difference is most easily understood by exclusion. For example, procedures involving nerves or the brain are usually performed by neurosurgeons. Surgeons having specialized training during the final three years of their residency period similarly focus on other regions of the body. General surgeons may perform such procedures in the absence of other surgeons with specialized training. Such procedures are the exception, however, rather than the rule.
In the United States, there are approximately 700,000 physicians licensed to practice medicine and surgery. Experts estimate that fewer than 5% of these physicians (approximately 35,000) restrict their practices to general surgery.
Description
In earlier times, surgery was a dangerous and dirty practice. Through the middle of the nineteenth century, the number of people who died from surgery approximately equaled the number of those who were cured. With the discovery and development of general anesthesia in the mid-nineteenth century, surgery became more humane. As knowledge about infections grew and sterile practices were introduced into the operating room, surgery became more successful. The last 50 years have brought continued advancements.
General surgery experienced major advances with the introduction of the endoscope. This is an instrument for visualizing the interior of a body canal or a hollow organ. Endoscopic surgery relies on this pencil-thin instrument, equipped with its own lighting system and small video camera. The endoscope is inserted through tiny incisions called portals. While viewing the procedure on a video screen, the surgeon then operates with various other small precise instruments inserted through one or more of the portals. The specific area of the body to be treated determines the type of endoscopic surgery performed. For example, colonoscopy uses an endoscope, which can be equipped with a device for obtaining tissue samples for visual examination of the colon. Gastroscopy uses an endoscope inserted through the mouth to examine the interior of the stomach. Arthroscopy refers to joint surgery. Abdominal procedures are called laparoscopies.
Endoscopy is frequently used in both treatment and diagnosis especially involving the digestive and female reproductive systems. Endoscopy has advantages over many other surgical procedures, resulting in a quicker recovery and shorter hospital stays. This noninvasive technique is being used for appendectomies, gallbladder surgery, hysterectomies, and the repair of shoulder and knee ligaments. However, endoscopy has such limitations as complications and high operating expense. Also, endoscopy does not offer advantages over conventional surgery in all procedures. Some literature states that, as general surgeons become more experienced in their prospective fields, additional noninvasive surgical procedures will become more common options.
One-day surgery is also termed same-day or outpatient surgery. Surgical procedures in this category usually require two hours or less and involve minimal blood loss and a short recovery time. In the majority of surgical cases, oral medications control postoperative pain. Cataract removal, laparoscopy, tonsillectomy, repair of broken bones, hernia repair, and a wide range of cosmetic procedures are common same-day surgical procedures. Many individuals prefer the convenience and atmosphere of one-day surgery centers, as there is less competition for attention with more serious surgical cases. These centers are accredited by the Joint Commission on Accreditation of Healthcare Organizations or the Accreditation Association for Ambulatory Health Care.
Diagnosis/Preparation
The preparation of persons for surgery has advanced significantly with improved diagnostic techniques and procedures. Before surgery, a candidate may be asked to undergo a series of tests, including blood and urine studies, x rays, and specific heart studies if the person's past medical history or physical examination warrants this testing. Before any surgical procedure, the physician will explain the nature of the surgery needed, the reason for the procedure, and the anticipated outcome. The risks involved will be discussed, along with the types of anesthesia to be utilized. The expected length of recovery and limitations imposed during the recovery period are also explained in detail before any surgical procedure.
Surgical procedures most often require some type of anesthetic. Some procedures require only local anesthesia, produced by injecting the anesthetic agent into the skin near the site of the operation. The person remains awake with this form of medication. Injecting anesthetic agents near a primary nerve located adjacent to the surgical site produces block anesthesia (also known as regional anesthesia), which is a more extensive local anesthesia. The person remains conscious, but is usually sedated. General anesthesia involves injecting anesthetic agents into the blood stream or inhaling medicines through a mask placed over the person's face. During general anesthesia, an individual is asleep and an airway tube is usually placed into the windpipe (trachea) to help keep the airway open.
As part of the preoperative preparation, surgical patients will receive printed educational material and may be asked to review audio or videotapes. They will be instructed to shower or bathe the evening before or morning of surgery and may be asked to scrub the operative site with a special antibacterial soap. Instructions will also be given to eat or drink nothing by mouth for a determined period of time prior to the surgical procedure.
Precautions
Persons who are obese, smoke, have bleeding tendencies, or are over 60 need to follow special precautions, as do persons who have recently experienced such illnesses as pneumonia or a heart attack. People taking such medications as heart and blood pressure medicine, blood thinners, muscle relaxants, tranquilizers, anticonvulsants, insulin, or sedatives may require special laboratory tests prior to surgery and special monitoring during surgery. Special precautions may be necessary for persons using such mind-altering drugs as narcotics, psychedelics, hallucinogens, marijuana, sedatives, or cocaine since these drugs may interact with the anesthetic agents used during surgery.
Risks
One of the risks involved with general surgery is the potential for postoperative complications. These complications include but are not limited to pneumonia, internal bleeding, and wound infection as well as adverse reactions to anesthesia.
Normal Results
Advances in diagnostic and surgical techniques have greatly increased the success rate of general surgery. Contemporary procedures are less invasive than those practiced a decade or more ago. The results include reduced length of hospital stays, shortened recovery times, decreased postoperative pain, and decreases in the size and extent of surgical incisions. The length of time required for a full recovery varies with the procedure.
Morbidity and Mortality Rates
Mortality from general surgical procedures is uncommon. The most common causes of mortality are adverse reactions to anesthetic agents or drugs used to control pain, postsurgical clot formation in the veins, and postsurgical heart attacks or strokes.
Abnormal results from general surgery include persistent pain, swelling, redness, drainage, or bleeding in the surgical area and surgical wound infection, resulting in slow healing.
Alternatives
For the removal of diseased or nonvital tissue, there is no alternative to surgery. Alternatives to general surgery depend on the condition being treated. Medications, acupuncture, or hypnosis are used to relieve pain. Radiation is an occasional alternative for shrinking growths. Chemotherapy may be used to treat cancer. Some foreign bodies may remain in the body without harm.
Bland, K. I., W. G. Cioffi, and M. G. Sarr. Practice of GeneralSurgery. Philadelphia: Saunders, 2001.
Grace, P. A., A. Cuschieri, D. Rowley, N. Borley, and A. Darzi. Clinical Surgery, 2nd Edition. London: Blackwell Publishers, 2003.
Schwartz, S. I., J. E. Fischer, F. C. Spencer, G. T. Shires, and J. M. Daly. Principles of Surgery, 7th Edition. New York: McGraw Hill, 1998.
Townsend, C., K. L. Mattox, R. D. Beauchamp, B. M. Evers, and D. C. Sabiston. Sabiston's Review of Surgery, 3rd Edition. Philadelphia: Saunders, 2001.
Periodicals
Arthur, J. D., P. R. Edwards, and L. S. Chagla. "Management of Gallstone Disease in the Elderly." Annals of the Royal College of Surgery of England 85, no. 2 (2003): 91–96.
Cook, R. C., K. T. Alscher, and Y. N. Hsiang. "A Debate on the Value and Necessity of Clinical Trials in Surgery." American Journal of Surgery 185, no. 4 (2003): 305–310.
Fraser, S. A., D. R. Klassen, L. S. Feldman, G. A. Ghitulescu, D. Stanbridge, and G. M. Fried. "Evaluating Laparoscopic Skills." Surgical Endoscopy 28 (2003): 17–23.
Lawrentschuk, N., M. Pritchard, P. Hewitt, and C. Campbell. "Dressing Size and Pain: A Prospective Trial." Australia New Zealand Journal of Surgery 73, no. 4 (2003): 217–219.
Organizations
American Board of Surgery. 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA 19103. (215) 568-4000; Fax: (215) 563-5718. http://www.absurgery.org.
American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-32311. (312) 202-5000; Fax: (312) 202-5001. Web site: http://www.facs.org. E-mail: postmaster@facs.org.
American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.ama-assn.org.
American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, CA 90720. (800) 364-2147 or (562) 799-2356. http://www.surgery.org.
American Society for Dermatologic Surgery. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. http://www.asds-net.org.
American Society of Plastic and Reconstructive Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org.
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, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland (depending on the availability of head and neck surgery specialists). They also deal with diseases involving the skin and hernias. These surgeons deal mainly in the Torso.
With the prevalent trend for increasing sub-specialization in today's medical practice, General Surgery has 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 in the United States were required to be board certified by the American Board of Surgery in order to progress into further sub-specialty training. However, recently, board certification has been delegated into separate sub-branches, whereby successful completion of a Residency in General Surgery is not necessarily required, but may well be desired - depending on the country and area of practice, as well as the individual sub-specialty.
Many sub-specialties are still part of the General Surgical training program. That is, General Surgeons may sub-specialize into one or more of the following disciplines:
In the United States and Canada, the overall responsibility for trauma care falls under the auspices of general surgery. Some general surgeons obtain advanced training and specialty certification in this field alone. General surgeons must be able to deal initially with almost any surgical emergency. Often they are the first part of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilise such patients, such as intubation, burr hole, cricothyroidotomy, and emergency laparotomy or thoracotomy to staunch bleeding.
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. Ruptures of the appendix and small bowel obstructions are other common emergencies.
Is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 0.5 to 1 cm incisions. Robotic surgery is now evolving from this concept (see below). Gallbladders, appendices, and colons can all be removed with this technique. Hernias are now repaired mostly laparoscopically. Most bariatric surgery is performed laparoscopically.
General Surgeons treat a wide variety of colon and rectal diseases ranging from colorectal cancer, inflammatory bowel diseases (such as ulcerative colitis or Crohn's disease), diverticulitis, gastrointestinal bleeding, hemorrhoids, etc.
Breast surgery
General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy to mastectomy, especially pertaining to the evaluation, diagnosis, and surgical treatment of breast cancer.
General Surgeons can perform vascular surgery if they receive special training and get certified in vascular surgery. Otherwise, these procedures are performed by vascular surgery specialists. However, general surgeons are capable of treating minor disorders.
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.
Dermatological Surgery
General Surgeons perform a wide variety of skin-related surgeries ranging from removing suspicious moles to treating major burns. General Surgeons also remove tumors that often grow just below the skin such as fatty tumors or tumors that arise in muscles or other soft tissues. General Surgeons also treat more complex skin or subcutaneous infections including necrotizing fasciitis and will often employ skin grafts to cover defects in the skin resulting from burns, trauma, or infections.
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 or six-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 eligibility 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' or 'Miss/Ms' 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 (FRCS) 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. However, with the implementation of the European Working Time Directive limiting UK surgical residents to a 48-hour working week there are concerns that upon completion of training UK surgeons will not be confident enough to work independently. The introduction of a sub-consultant grade to enable those who have recently received a UK Certificate of Completion of Training may be neccessary.
Subspecialization
In many countries general surgery is a prerequisite for subspecialization in:
^Lunca S, Bouras G, Stanescu AC (2005). "Gastrointestinal robot-assisted surgery. A current perspective". Romanian journal of gastroenterology14 (4): 385–91. PMID16400356.
