Although in recent times the concept of the “generalist” has been thought to be outdated, emergency general surgery is an area where a breadth of experience and skill is essential, and there is a current resurgence of the true General Surgeon, with the creation of the role of “Consultant Emergency Surgeon” to provide senior led, high quality, emergency care. A general surgery on call sees an almost unparalleled diversity and severity of illnesses, providing both a challenge and rich training opportunity of Core Surgical Trainees.
Electively, general surgeons will usually have one or more sub-speciality, in addition to the broad range of common operations. These can be broadly classified as:
- Breast: assessment and treatment of benign and malignant breast disease, including surgery, hormonal and chemotherapies and reconstructive procedures
- Colorectal: management of colorectal cancers, increasingly by laparoscopic approaches (3rd Commonest Cancer in the UK), benign perianal disease, surgical management of IBD, advanced endoscopic procedures including treatments
- Upper GI & HPB: a broad range from gallstone disease, benign and pre-malignant oesophageal disease, to complex upper GI, pancreatic and liver cancer resections. Recently, HPB surgeons working hand in hand with colorectal surgeons have radically changed how we perceive advanced colorectal cancer, as liver metastases can now sometimes undergo a curative resection.
- Endocrine: work with an MDT in the management of many endocrinopathies, from thyroid cancers and hyperparathyroidism, to MEN syndromes and Pheochromocytoma
- Transplant: as the leading causes of CKD (hypertension and diabetes) become more common, the need for transplant surgery rises, including dialysis access, solid organ retrieval from living and deceased donors, and implantation surgery.
- Bariatrics: Formerly known as ‘weight loss surgery’, the focus of bariatric surgery in recent years has changed to being known as ‘Metabolic surgery’. It is well known that surgery in any form helps in remission of diabetes and certainly the primary aims of bariatric surgery performed in this population group is to improve a patient’s quality of life and comorbidities associated with obesity.
General Surgical training is delivered in a large number of units of varying sizes throughout the deanery. All have a great deal to offer the trainee; even smaller district general hospitals are richly innovative (one DGH in our region claims fame for developing both Halothane, andMcEvedys’ approach to femoral hernias). In addition, there are many tertiary units in the region, allowing trainees to gain valuable experience in rarer diseases and how they are best managed.
Innovation and research is at the heart of general surgery, with innumerable local, national and international projects available within this field.