The terms general surgery and general surgeon refers to a conglomeration of various surgical sub-specialities that historically fell under one umbrella. In the post-war era, qualified surgeons (possession of FRCS) carried out a huge variety of different operations, on different parts of the body, for many different diseases. Over the decades, it became obvious that it was impossible to be an expert in every angle of surgery and surgical disease. Specialities such as orthopaedics, neurosurgery, cardiac surgery, ENT, plastics, urology and so on then split off from general surgery and established themselves as specialities in their own right.

Currently, general surgery is still in a period of sub-specialisation. The speciality consists now of five main sub-specialities, namely, Upper GI, Colo-rectal (lower GI),Vascular,Breast and Endocrine Surgery. In order to practice on of these sub-specialities, training in general surgery is necessary. All surgeons who currently practice in these specialities should be accredited general surgeons. In the future there may be further accreditation necessary to confirm a sub-specialty interest, but this is not the case at present. At present, surgeons trained through different pathways can in fact perform the same operations. Examples include Upper GI and Thoracic surgeons who both perform oesophageal surgery, and neurosurgeons and orthopaedic surgeons who both perform spinal surgery. This is because of the historical overlap between the specialities, but moves are currently underway to recognise specific skills in surgery irrespective of training pathway.

The concept of a general surgeon now refers to certain surgical emergencies (mainly regarding the abdomen) and specific operations that do not fall neatly into any other category such as hernias. Modern surgeons thus refer to themselves as general surgeons with a special interest in… What this tends to mean is that such surgeons will specialise their routine and complex surgery within their narrow field of expertise (eg Upper GI surgery) and not dabble with other complex or routine operations that fall into another speciality category, unless this becomes a necessity because of an emergency situation. Thus it is now increasingly uncommon to see surgeons with a special interest in Upper GI surgery performing varicose veins surgery, and similarly vascular surgeons removing gallbladders.

The greater level of specialisation allows surgeons to concentrate on constantly improving the technique of their surgery and understand more of the diseases they treat. Inevitably this leads to much more progress in the treatment of all diseases than would ever have been possible if surgeons remained generalists. It is unlikely for example that laparoscopic cholecystectomies would have been refined to the level of day-surgery, or that anyone would have attempted minimally invasive surgery.

Similarly, when new technology or treatment options become available, it is more likely that a specialist surgeon will take on training to adopt this rather than a generalist who is busy maintaining a standard level of practice across many different fields. The complication rates from routine operations are considerably less when performed by the relevant specialists, and complex operations (eg cancers) should only be performed by specific specialists.

General surgery still remains vitally important in a wide area of emergency situations and some of the less defined diseases and disorders that do not clearly fall into a labelled box.

General Surgical Operations in the 21 st century

• Emergency Abdominal Conditions*: eg appendicitis, bowel perforation, obstruction and bleeding
• Hernias, minor ano-rectal and scrotal conditions
• Non-specific abdominal complaints*
• Skin and subcutaneous lesions.

  * Keyhole surgery may also be possible in the treatment of emergency abdominal conditions