General Surgery


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General Surgery

 

Definition

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, eyes, and feet, to name only a few, are areas that require specialized surgical repair.
New methods and techniques are less invasive than previous 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.

Precautions

Patients who are obese, smoke, have bleeding tendencies, or are over 60, need to follow special precautions, as do patients who have recently experienced an illness such as pneumonia or a heart attack. Patients on medications such as heart and blood pressure medicine, blood thinners, muscle relaxants, tranquilizers, insulin, or sedatives, may require special lab tests prior to surgery and special monitoring during surgery. Special precautions may be necessary for patients 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.

Description

In earlier times, surgery was a dangerous and dirty practice. Until the middle of the 19th century, as many patients died of surgery as were cured. With the discovery and development of general anesthesia in the mid-1800s, surgery became more humane. And as knowledge about infections grew, surgery became more successful as sterile practices were introduced into the operating room. The last 50 years of the 20th century have seen continued advancements.

Types of general surgery

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 pencilthin instrument, capable of 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 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, and abdominal procedures are called laparoscopies.
Endoscopyisusedinbothtreatment 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 stay. This non-invasive technique is being used for appendectomies, gallbladder surgery, hysterectomies and the repair of shoulder and knee ligaments. However, endoscopy does not come without limitations such as complications and high operating expense. Also, endoscopy doesn't offer advantages over conventional surgery in all procedures. Some literature states that as general surgeons become more experienced in their prospective fields, additional non-invasive surgery will be a more common option to patients.
ONE-DAY SURGERY. One-day surgery is also termed same-day, or outpatient surgery. Surgical procedures usually take 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.

Preparation

The preparation of patients has advanced significantly with improved diagnostic techniques and procedures. Before surgery the patient may be asked to undergo a series of tests including blood and urine studies, x rays and specific heart studies if the patient's past medical history and/or physical exam warrants this testing. Before any general surgery 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 utilized. The expected length of recovery and limitations imposed during the recovery period are also explained in detail before any general 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 patient remains awake with this form of medication. Injecting anesthetic agents into a primary nerve located near the surgical site produces block anesthesia (also known as regional anesthesia), which is a more extensive local anesthesia. The patient remains conscious, but is usually sedated. General anesthesia involves injecting anesthetic agents into the blood stream and/or inhaling medicines through a mask placed over the patient's face. During general anesthesia, the patient is asleep and an airway tube is usually placed into the windpipe to help keep the airway open.
As part of the preoperative preparation, the patient will receive printed educational material and may be asked to review audio or videotapes. The patient 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 the patient to ingest nothing by mouth for a determined period of time prior to the surgical procedure.

Aftercare

After surgery, blood studies and a laboratory examination of removed fluid or tissue are often performed especially in the case of cancer surgery. After the operation, the patient is brought to a recovery room and vital signs, fluid status, dressings and surgical drains are monitored. Pain medications are offered and used as necessary. Breathing exercises are encouraged to maximize respiratory function and leg exercises are encouraged to promote adequate circulation and prevent pooling of blood in the lower extremities. Patients must have a responsible adult accompany them home if leaving the same day as the surgery was performed.

Risks

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.

Normal results

Advances in diagnostic and surgical techniques have increased the success rate of general surgery by many times compared to the past. Today's less invasive surgical procedures have reduced the length of hospital stays, shortened recovery time, decreased postoperative pain and decreased the size of surgical incision. On the average, a conventional abdominal surgery requires a three to six-day hospital stay and three to six-week recovery time.

Abnormal results

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.

Resources

Organizations

American Medical Association. 515 N. State St., Chicago, IL 60612. (312) 464-5000. http://www.ama-assn.org.

Key terms

Appendectomy — Removal of the appendix.
Endoscope — Instrument for examining visually 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 fiberoptical 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.
References in periodicals archive ?
(5) Senior Resident, Department of General Surgery, Karpagam Faculty of Medical Sciences and Research, Coimbatore.
The objectives of this study were to (1) understand how much exposure general surgery residents currently have to robotic-assisted operations, (2) whether they have received any formal or informal training to robotic surgery, and (3) the effect of this platform on general surgical training.
Literature has established that patients of general surgery frequently pass through many psychological problems especially affecting their cognitive abilities1.
These specializations are part of the third floor expansions related to general surgery.
He has trained 45 FCPS Trainees so for, in General Surgery.
The operations have only been highlighted in the context of emergency general surgery - which is for the most acutely ill and highest risk patients.
Objective: To determine whether the number of women accepted to the University of Puerto Rico (UPR) general surgery residency program has increased in recent years.
Of these physicians, 27 (46%) completed a urology residency, with the remainder having completed a residency in general surgery (n=32, 54%; Table 4).
In 31 chapters, surgeons from the UK and US outline essential aspects of general surgery. They first address general principles, including surgical biology and pathology, surgical approaches and technologies, risk assessment and prognostic indices, perioperative care, patient-reported outcomes, intensive and high-dependency care, anemia, hypovalemia, edema, cardiovascular pathophysiology, pulmonary and renal insufficiency, surgical infections and infestations, nutrition, interventional radiology in general surgery, trauma, and head injuries, then general surgery for disorders of specific organs.
A recent study of academic and community practice leadership found that 97% of Department Chairs and 90% of Program Directors (PDs) in general surgery are men.

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