General surgery

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^{A surgeon operating}

General surgery, despite its name, is a surgical specialty that focuses on surgical treatment of 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.

1 Scope
2 Trends
3 Training
- 3.1 Subspecialization
4 References
5 See also
6 External links

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:

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.

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, cricothyroidectomy and chest draining procedures.

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.

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

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.

Historically, Vascular Surgery was part of the General Surgical program, although recently it has formed its own college. Nonetheless, vascular trainees must complete are 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.

Thus it can be seen why a General Surgeon is often called a "Master of all Trades".

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]

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, etc) or (DO) degree. Following high school, it takes approximately thirteen years to make a fully licensed general surgeon (four years undergraduate training, four years medical school and five years residency).

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

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

v • d • e Health science - Surgery - General surgery
neck	Resection (Thyroid cancer, Lymphoma)
esophagus - stomach	Resection (Esophageal cancer, Stomach cancer), Bariatric surgery (Morbid obesity), Repair (Trauma)
abdomen (non-GI)	Kidney transplant (Chronic renal failure), Resection (Kidney cancer, Metastatic disease), Debulking surgery (Ovarian cancer), Hernia repair
liver - pancreas gallbladder - biliary tree	Liver transplant (Hepatitis, Cirrhosis, PBC, PSC), Resection (HCC, Metastatic disease of the liver), Resection (Whipple procedure (Pancreatic cancer)), Cholecystectomy (Cholecystitis)
small intestine	Resection (due to bowel infarction and/or small bowel obstruction - Intussusception, Volvulus, Crohn's disease, Meckel's diverticulum, Meconium ileus (due to Cystic fibrosis), Cancer of the small bowel)
colon	Appendectomy (Appendicitis), Resection due to obstruction and/or perforation (Toxic megacolon (due to IBD), Colorectal cancer, Hirschsprung's disease, Trauma, Intussusception, Volvulus, Inguinal hernia, Adhesions (due to previous surgery))