General Surgery | Description | Precautions | Aftercare | Purpose | Risks
General surgery is the treatment of injury, deformity, and disease using operative procedures.
Purpose
General surgery is frequently performed to alleviate suffering when a cure is unlikely through medication alone. It can be used for routine procedures performed in a physician’s office, such 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.
KEY TERMS
Appendectomy— Removal of the appendix.
Endoscope— Instrument for visual examination of the inside of a body canal or a hollow organ such as the stomach, colon, or bladder.
Hysterectomy— Surgical removal of part or all of the uterus.
Laparoscopic cholecystectomy— Removal of the gallbladder using a laparoscope, a fiber-optic instrument inserted through the abdomen.
Microsurgery— Surgery on small body structures or cells performed with the aid of a microscope and other specialized instruments.
Portal— An entrance or a means of entrance.
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.
Demographics
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; however, these situations are the exception rather than the rule.
In the United States, there are approximately 850,000 physicians licensed to practice medicine and surgery. Experts estimate that fewer than 5% of these physicians (approximately 42,000) restrict their practices to general surgery.
Description
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 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 used for appendectomies, gallbladder surgery, hysterectomies, and the repair of shoulder and knee ligaments; however, endoscopy has limitations such as complications and operating expense. 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 out-patient 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.
Diagnosis/Preparation
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.
Precautions
Persons who are obese, smoke, have bleeding tendencies, or are over 60 must follow special precautions, as do persons who have recently experienced illnesses, including pneumonia or a heart attack. People taking medications such as heart and blood pressure medicine, blood thinners,muscle relaxants, tranquilizers,
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.
anticonvulsants, insulin, or sedatives may require special laboratory tests prior to surgery and special monitoring during surgery. Extra precautions may be necessary for persons using mind-altering drugs such as narcotics, psychedelics, hallucinogens, marijuana, sedatives, or cocaine since these drugs may interact with the anesthetic agents used during surgery.
Risks
A risk associated 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.
Normal results
Advances in diagnostic and surgical techniques have greatly increased the success rate of generalsurgery. 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.
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?
Alternatives
For the removal of diseased or nonvital tissue, there is no alternative to surgery. Alternatives togeneral 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.
Resources
BOOKS
Brunicardi, F. C., D. K. Anderson, D. L. Dunn, J. G. Hunter, and R. E. Pollock. Schwartz’s Manual ofSurgery, 8th ed. New York: McGraw Hill, 2006.
Ellis, H., R. Caine, and C. Watson. General Surgery: Lecture Notes, 11th ed. New York: Wiley, 2006.
Lawrence, P. F. Essentials of General Surgery, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2005.
Townsend, C.M., R. D. Beauchamp, B. M. Evers, and K. Mattox. Sabiston Textbook of Surgery, 17th ed. Philadelphia: Saunders, 2004.
Toy, E. C., T. H. Liu, and A. R. Campbell. Case Files: Surgery. New York: McGraw Hill, 2006.
PERIODICALS
Allen, T. K., A. S. Habib, G. L. Dear, W. White, D. A. Lubarsky, and T. J. Gan. “How much are patients willing to pay to avoid postoperative muscle pain associated with succinylcholine?” Journal of Clinical Anesthesia 19, no. 8 (December 2007): 601–608.
Gurusamy, K. S., and K. Samraj. “Early versus delayed laparoscopic cholecystectomy for acute cholecystitis.” Cochran Database of Systematic Reviews 18, no. 4 (October 2006).
Halpern, L. R., and S. Feldman. “Perioperative risk assessment in the surgical care of geriatric patients.” Oral and Maxillofacial Surgery Clinics of North America 18, no. 1(February 2006): 19–34.
Vergis, A., L. Gillman, S. Minor, M. Taylor, and J. Park. “Structured assessment format for evaluating operative reports in general surgery.” American Journal of Surgery 195, no. 1 (January 2008): 24–29.
OTHER
Archives of Surgery. American Medical Association. http://archsurg.ama-assn.org/ (December 23, 2007).
General Surgery. MedScape. http://www.medscape.com/generalsurgery (December 23, 2007).
Journal of Surgery. National Medical Society. http://www.medical-library.org/j_surg.htm (December 23,2007).
Online Atlas of Surgery. Wake Forest University School of Medicine. http://www.bgsm.edu/surg-sci/atlas/atlas.html (December 23, 2007).
ORGANIZATIONS
American Board of Surgery, 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA, 19103, (215) 568-4000, (215) 563-5718, http://www.absurgery.org.
American College of Surgeons, 633 North Saint Claire Street, Chicago, IL, 60611, (312) 202-5000,http://www.facs.org/.
American Medical Association, 515 N. State Street, Chicago, IL, 60610, (800) 621-8335,http://www.ama-assn.org.
American Society for Aesthetic Plastic Surgery, 11081 Winners Circle, Los Alamitos, CA, 90720, (888) 272-7711, http://www.surgery.org/.
American Society for Dermatologic Surgery, 5550 Meadowbrook Drive, Suite 120, Rolling Meadows, IL, 60008, (847) 956-0900, http://www.asds.net.
American Society of Plastic and Reconstructive Surgeons, 444 E. Algonquin Road, Arlington Heights, IL, 60005, (847) 228-9900, http://www.plasticsurgery.org.
L. Fleming Fallon, Jr., M.D., Dr.P.H.
GERD scan seeGastroesophageal reflux scan
GERD surgery seeGastroesophageal reflux surgery
