General surgery is one of the highest-paying medical specialties a doctor can choose, but as specialties go, it covers a wide range of areas. The American Board of Surgery reports that general surgeons should have knowledge of the alimentary tract, abdomen, breasts and endocrine system. Several of these and the other systems and body parts treated under general surgery can be pursued as distinct subspecialties by a general surgeon who is willing to complete additional fellowship training in an area of interest.
Parts of the Alimentary Tract
The alimentary tract is composed of the organs that foods and liquids go through while being digested. This tract starts with the mouth, where food is ingested, and ends with the anus, where waste is excreted. General surgeons need to know about how all of these organs work together and how to deal with the issues these individual organs might have.
Three general surgery procedures include appendectomies, bowel resections and gastric resection. Appendectomy is typically an emergency surgery done to remove the appendix when a patient is suffering from appendicitis. In a bowel resection, general surgeons actually remove a part of the small or large intestine. This procedure could be done for a multitude of reasons ranging from cancer to scar tissue blockage. Gastric resection is used to deal with ulcers and involves a general surgeon removing a portion of or the entire stomach.
A fellowship in surgical critical care might help prepare general surgeons for medical procedures of the alimentary tract.
Focusing on the Abdomen
Although the abdomen technically falls under the alimentary tract, this subspecialty of general surgery is focused more narrowly on the stomach and related or adjacent organs. There is some overlap between surgeries of the abdomen and surgeries performed on the alimentary tract, including appendectomies and bowel reconstructions.
If a patient needs their gallbladder removed, a general surgeon will perform a procedure called a cholecystectomy. Hemorrhoids can be addressed through anorectal surgery. A hernia would also fit into the category of abdominal surgery and would often be treated by a general surgeon.
Colorectal surgery is one possible fellowship to pursue to learn how to perform surgeries on the rectal and colon areas.
General Surgery Involving the Breast
General surgery of the breast is typically performed when a patient has breast cancer. Different types and stages of cancer, along with the patient’s other personal and genetic risk factors, may prompt different kinds of breast surgery to be performed.
A breast-conserving surgery is used to remove the cancer, and possibly enough of the nearby lymph nodes to perform a biopsy on, while preserving the breast itself. Another procedure, sentinel lymph node biopsy, involves the general surgeon injecting a radioactive substance or dye near the tumor in the breast to mark lymph nodes and then removing those lymph nodes to check for the evidence of cancer cells.
The most drastic procedure a general surgeon might use to deal with breast cancer is a modified radical mastectomy. In this procedure, the surgeon removes not only the breast itself but also the lining covering the chest muscles, the lymph nodes under the arm and sometimes even the chest wall muscles. After this surgery, patients might undergo breast reconstruction, which may be performed by either a general surgeon or a plastic surgeon.
Breast surgery is currently a subspecialty of general surgery. However, due to the growing number of new cases of breast cancer, there is talk within the medical community about making breast surgery its own specialty.
Operating on the Endocrine System
The endocrine system is made up of the parts of the body that produce hormones. It includes the hypothalamus, pituitary gland, pineal gland, thyroid gland, thymus gland, adrenal glands, pancreas, and ovaries or testis.
There are numerous disorders that might need to be treated with endocrine surgery, such as diabetes, Cushing’s syndrome, Grave’s disease, hyperthyroidism, hypothyroidism, parathyroid carcinoma, adrenal cancer, and thyroid cancer. Through endocrine surgeries, doctors remove the affected part of the endocrine system. General surgeons might have to perform an adrenalectomy on the adrenal gland, a parathyroidectomy on the parathyroid gland, a thyroidectomy on the thyroid gland or a thyroid lobectomy, which only removes one lobe of the thyroid gland. In some cases, they might need to do a total pancreatectomy, in which the entire pancreas, gallbladder, part of the stomach, part of the small intestine, and the spleen are removed.
Another system of the body for which general surgeons might provide care include the vascular system, also known as the circulatory system. This system consists of the veins, arteries and other vessels that transport blood throughout the body.