General Surgery

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,breast, soft tissue, and hernias. These surgeons deal mainly in the Torso.

Scope
With the prevalent trend for increasing sub-specialization in today’s medical practice, General Surgery has lost most of its former glory and scope. Nonetheless, it continues to be a somewhat competitive, rewarding and 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. General Surgeons may sub-specialize into one or more of the following disciplines:

Trauma surgery
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 port of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilize such patients, such as intubation, burr hole, cricothyroidotomy, and emergency laparotomy or thoracotomy to stanch 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.

Laparoscopic surgery
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 that are trained today are expected to be proficient in laparscopic procedures.

Colorectal surgery
General Surgeons treat a wide variety of major and minor colon and rectal diseases ranging from inflammatory bowel diseases (such as ulcerative colitis or Crohn’s disease) to diverticulitis, colon and rectal cancer, 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 and diagnosis, 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 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.

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.