General surgery is a surgical specialty that focuses on abdominal contents including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts. They also deal with diseases involving the skin, breast, soft tissue, trauma, peripheral vascular surgery and hernias.
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.
This is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 0.3 to 1 cm incisions. Gallbladders, appendices, and colons can all be removed with this technique. Hernias are now repaired mostly laparoscopically. General surgeons that are trained today are expected to be proficient in laparoscopic procedures.
General surgeons treat a wide variety of major and minor colon and rectal diseases including inflammatory bowel diseases (such as ulcerative colitis or Crohn’s disease), diverticulitis, colon and rectal cancer, gastrointestinal bleeding and hemorrhoids.
Surgical oncologist refers to a general surgical oncologist (a sub-specialty of general surgery). The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume—i.e., the more cancer cases a surgeon treats, the more proficient he or she becomes, and his or her patients experience improved survival rates as a result. This is another controversial point, but it is generally accepted—even as common sense—that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure.
In Canada, Australia, New Zealand, and the United States general surgery is a five to seven 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 or the American Osteopathic 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 is a tradition dating back hundreds of years in the United Kingdom. Trainees will then go onto Higher Surgical Training (HST), lasting a further five to six years. During this time they may choose to sub-specialise. Before the end of HST, the examination of Fellow of the Royal College of Surgeons (FRCS) must be taken in general surgery plus the sub-speciality. 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. The implementation of the European Working Time Directive limited UK surgical residents to a 48-hour working week. The introduction of a sub-consultant grade to enable those who have recently received a UK Certificate of Completion of Training may be necessary.