General surgery is a surgical specialty that focuses on abdominal contents including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland (depending on local reference patterns). They also deal with diseases involving the skin, breast, soft tissue, and hernias.
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 port of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilize such patients, such as 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.
This is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 0.3 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 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.
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.
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.
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.
Responsible for all aspects of pre-operative, operative, and post-operative care of abdominal organ transplant patients. Transplanted organs include liver, kidney, pancreas, and more rarely small bowel.
Surgical oncologist refers to a general surgical oncologist (a subspecialty of general surgery), but thoracic surgical oncologists, gynecologic oncologists and so forth can all be considered surgeons who specialize in treating cancer patients. 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. This is particularly true of complex cancer resections such as pancreaticoduodenectomy for pancreatic cancer, and gastrectomy with extended (D2) lymphadenectomy for gastric cancer.