Type of Surgery
Last updated: 01/28/2009
General surgery is the treatment of injury, deformity, and disease using operative procedures.
General surgery is frequently performed to alleviate suffering when a cure is unlikely through medication alone. It can be used for such routine procedures performed in a physician's office, as vasectomy, or for more complicated operations requiring a medical team in a hospital setting, such as laparoscopic cholecystectomy (removal of the gallbladder). Areas of the body treated by general surgery include the stomach, liver, intestines, appendix, breasts, thyroid gland, salivary glands, some arteries and veins, and the skin. The brain, heart, lungs, eyes, feet, kidneys, bladder, and reproductive organs, to name only a few, are areas that require specialized surgical repair.
New methods and techniques are less invasive than older practices, permitting procedures that were considered impossible in the past. For example, microsurgery has been used in reattaching severed body parts by successfully reconnecting small blood vessels and nerves. Laparoscopic techniques are more efficient, promote more rapid healing, leave smaller scars, and have lower postoperative infection rates.
All surgeons receive similar training in the first two years of their residency (post-medical school) training. General surgeons are the surgical equivalent of family practitioners. General surgeons typically differ from other surgical specialties in the operations that they perform. This difference is most easily understood by exclusion. For example, procedures involving nerves or the brain are usually performed by neurosurgeons. Surgeons having specialized training during the final three years of their residency period similarly focus on other regions of the body. General surgeons may perform such procedures in the absence of other surgeons with specialized training. Such procedures are the exception, however, rather than the rule.
In the United States, there are approximately 700,000 physicians licensed to practice medicine and surgery. Experts estimate that fewer than 5% of these physicians (approximately 35,000) restrict their practices to general surgery.
In earlier times, surgery was a dangerous and dirty practice. Through the middle of the nineteenth century, the number of people who died from surgery approximately equaled the number of those who were cured. With the discovery and development of general anesthesia in the mid-nineteenth century, surgery became more humane. As knowledge about infections grew and sterile practices were introduced into the operating room, surgery became more successful. The last 50 years have brought continued advancements.
General surgery experienced major advances with the introduction of the endoscope. This is an instrument for visualizing the interior of a body canal or a hollow organ. Endoscopic surgery relies on this pencil-thin instrument, equipped with its own lighting system and small video camera. The endoscope is inserted through tiny incisions called portals. While viewing the procedure on a video screen, the surgeon then operates with various other small precise instruments inserted through one or more of the portals. The specific area of the body to be treated determines the type of endoscopic surgery performed. For example, colonoscopy uses an endoscope, which can be equipped with a device for obtaining tissue samples for visual examination of the colon. Gastroscopy uses an endoscope inserted through the mouth to examine the interior of the stomach. Arthroscopy refers to joint surgery. Abdominal procedures are called laparoscopies.
Endoscopy is frequently used in both treatment and diagnosis especially involving the digestive and female reproductive systems. Endoscopy has advantages over many other surgical procedures, resulting in a quicker recovery and shorter hospital stays. This noninvasive technique is being used for appendectomies, gallbladder surgery, hysterectomies, and the repair of shoulder and knee ligaments. However, endoscopy has such limitations as complications and high operating expense. Also, endoscopy does not offer advantages over conventional surgery in all procedures. Some literature states that, as general surgeons become more experienced in their prospective fields, additional noninvasive surgical procedures will become more common options.
One-day surgery is also termed same-day or outpatient surgery. Surgical procedures in this category usually require two hours or less and involve minimal blood loss and a short recovery time. In the majority of surgical cases, oral medications control postoperative pain. Cataract removal, laparoscopy, tonsillectomy, repair of broken bones, hernia repair, and a wide range of cosmetic procedures are common same-day surgical procedures. Many individuals prefer the convenience and atmosphere of one-day surgery centers, as there is less competition for attention with more serious surgical cases. These centers are accredited by the Joint Commission on Accreditation of Healthcare Organizations or the Accreditation Association for Ambulatory Health Care.
The preparation of persons for surgery has advanced significantly with improved diagnostic techniques and procedures. Before surgery, a candidate may be asked to undergo a series of tests, including blood and urine studies, x rays, and specific heart studies if the person's past medical history or physical examination warrants this testing. Before any surgical procedure, the physician will explain the nature of the surgery needed, the reason for the procedure, and the anticipated outcome. The risks involved will be discussed, along with the types of anesthesia to be utilized. The expected length of recovery and limitations imposed during the recovery period are also explained in detail before any surgical procedure.
Surgical procedures most often require some type of anesthetic. Some procedures require only local anesthesia, produced by injecting the anesthetic agent into the skin near the site of the operation. The person remains awake with this form of medication. Injecting anesthetic agents near a primary nerve located adjacent to the surgical site produces block anesthesia (also known as regional anesthesia), which is a more extensive local anesthesia. The person remains conscious, but is usually sedated. General anesthesia involves injecting anesthetic agents into the blood stream or inhaling medicines through a mask placed over the person's face. During general anesthesia, an individual is asleep and an airway tube is usually placed into the windpipe (trachea) to help keep the airway open.
As part of the preoperative preparation, surgical patients will receive printed educational material and may be asked to review audio or videotapes. They will be instructed to shower or bathe the evening before or morning of surgery and may be asked to scrub the operative site with a special antibacterial soap. Instructions will also be given to eat or drink nothing by mouth for a determined period of time prior to the surgical procedure.
Persons who are obese, smoke, have bleeding tendencies, or are over 60 need to follow special precautions, as do persons who have recently experienced such illnesses as pneumonia or a heart attack. People taking such medications as heart and blood pressure medicine, blood thinners, muscle relaxants, tranquilizers, anticonvulsants, insulin, or sedatives may require special laboratory tests prior to surgery and special monitoring during surgery. Special precautions may be necessary for persons using such mind-altering drugs as narcotics, psychedelics, hallucinogens, marijuana, sedatives, or cocaine since these drugs may interact with the anesthetic agents used during surgery.
One of the risks involved with general surgery is the potential for postoperative complications. These complications include but are not limited to pneumonia, internal bleeding, and wound infection as well as adverse reactions to anesthesia.
Advances in diagnostic and surgical techniques have greatly increased the success rate of general surgery. Contemporary procedures are less invasive than those practiced a decade or more ago. The results include reduced length of hospital stays, shortened recovery times, decreased postoperative pain, and decreases in the size and extent of surgical incisions. The length of time required for a full recovery varies with the procedure.
Morbidity and mortality rates
Mortality from general surgical procedures is uncommon. The most common causes of mortality are adverse reactions to anesthetic agents or drugs used to control pain, postsurgical clot formation in the veins, and postsurgical heart attacks or strokes.
Abnormal results from general surgery include persistent pain, swelling, redness, drainage, or bleeding in the surgical area and surgical wound infection, resulting in slow healing.
For the removal of diseased or nonvital tissue, there is no alternative to surgery. Alternatives to general surgery depend on the condition being treated. Medications, acupuncture, or hypnosis are used to relieve pain. Radiation is an occasional alternative for shrinking growths. Chemotherapy may be used to treat cancer. Some foreign bodies may remain in the body without harm.
Bland, K. I., W. G. Cioffi, and M. G. Sarr. Practice of GeneralSurgery. Philadelphia: Saunders, 2001.
Grace, P. A., A. Cuschieri, D. Rowley, N. Borley, and A. Darzi. Clinical Surgery, 2nd Edition. London: Blackwell Publishers, 2003.
Schwartz, S. I., J. E. Fischer, F. C. Spencer, G. T. Shires, and J. M. Daly. Principles of Surgery, 7th Edition. New York: McGraw Hill, 1998.
Townsend, C., K. L. Mattox, R. D. Beauchamp, B. M. Evers, and D. C. Sabiston. Sabiston's Review of Surgery, 3rd Edition. Philadelphia: Saunders, 2001.
Arthur, J. D., P. R. Edwards, and L. S. Chagla. "Management of Gallstone Disease in the Elderly."Annals of the Royal College of Surgery of England 85, no. 2 (2003): 91â€“96.
Cook, R. C., K. T. Alscher, and Y. N. Hsiang. "A Debate on the Value and Necessity of Clinical Trials in Surgery."American Journal of Surgery 185, no. 4 (2003): 305â€“310.
Fraser, S. A., D. R. Klassen, L. S. Feldman, G. A. Ghitulescu, D. Stanbridge, and G. M. Fried. "Evaluating Laparoscopic Skills."Surgical Endoscopy 28 (2003): 17â€“23.
Lawrentschuk, N., M. Pritchard, P. Hewitt, and C. Campbell. "Dressing Size and Pain: A Prospective Trial."Australia New Zealand Journal of Surgery 73, no. 4 (2003): 217â€“219.
L. Fleming Fallon, Jr, MD, DrPH
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
General surgery is performed by a physician with specialized training in surgery. It is most commonly performed in an outpatient facility adjacent to a hospital or in an operating room of a hospital. Very minor procedures such as abscess incision and drainage or the removal of a small or superficial foreign body may be performed in a professional office.
QUESTIONS TO ASK THE DOCTOR
- What tests will be performed prior to surgery?
- Which body parts will be affected?
- How will the procedure affect daily activities after recovery?
- Where will the surgery be performed?
- What form of anesthesia will be used?
- What will the area look like after surgery?
- Is the surgeon board certified?
- How many similar procedures has the surgeon performed?
- What is the surgeon's complication rate?
Last Updated: 01/28/2009
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