General Surgery

Modern surgery has developed to such an extent that the body of knowledge and technical skills required have led to surgeons specialising in particular areas, usually an anatomical area of the body or occasionally in a particular technique or type of patient.

There are ten surgical specialties and this briefing covers general surgery.

What do general surgeons do?

As the title indicates, this is a wide-ranging area of surgery with many subspecialties. The defining feature of general surgeons is that they have a wide range of knowledge and skills to deal with all kinds of surgical emergencies, with an emphasis on acute abdominal problems. They also carry out a large number of elective operations.

General surgeons are essential to support the A&E department and are particularly needed in remote or rural settings due to their broad range of competence. In trauma services they deal with injuries to the abdomen and chest.

In the UK, the large majority of elective procedures carried out by general surgeons, about 80 per cent, fall outside subspecialty areas. For example, most general surgeons deal with the common conditions of the gall bladder and carry out hernia repairs. However, nearly all general surgeons have a special interest, such as intestinal surgery (upper or lower) or breast surgery. A few have become highly specialised and restrict their activities to a small number of complex, relatively unusual operations.

Some areas of general surgery have grown in extent as surgery develops, and most operating on arteries or carrying out transplants have specialised exclusively in these areas. However they retain their general surgical skills and base.

There were 1,910 consultant general surgeons working in the NHS in England in 2011, making them one of the two most common types of consultant surgeon in the UK, 25 per cent of the total. The other large surgical specialty is trauma and orthopaedics.

Subspecialties

Given the wide range of work undertaken by general surgeons, one of distinguishing features of general surgery is the range of sub-specialties that lie within it. These include:

• Breast – assessment of the large number of patient with breast symptoms, and surgery on breast cancers, often including reconstructive procedures that do not require plastic surgeons.
• Colorectal – surgery for diseases of the colon, rectum and anal canal, particularly cancer of the rectum.
• Endocrine – surgery for disease of the thyroid and other endocrine glands.
• Upper Gastrointestinal – surgery for diseases affecting the liver, oesophagus and stomach. This also covers obesity surgery. Major operations for cancer are usually done in regional specialist units.
• Transplant – kidney and liver transplantation are the routine procedures, but many other organs may be transplanted.

The specialty includes military surgeons, who will be trained with a particular focus on trauma and emergency surgery. The majority of simple operations on children are also carried out by general surgeons.

Developments

General surgery is in the vanguard for the introduction of minimally invasive procedures:

Laparoscopic (or “keyhole”) surgery is recognised as an integral and crucial skill that is developing across the entirety of general surgical practice and its subspecialties. Operations are being carried out increasingly by minimally invasive techniques that offer patients less pain, better outcomes and shorter postoperative recovery. Virtually every abdominal operation can and has been done by this route.

Examples of this are operations for morbid obesity, hernia repair and removal of malignant tumours of the bowel.

Further Information:

The Association of Surgeons of Great Britain and Ireland

Association of Breast Surgery at BASO

Association of Coloproctology of Great Britain and Ireland

Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland

British Association of Endocrine Surgeons

British Transplantation Society