General Surgery

General surgery is a surgical speciality mainly dealing with the diagnosis, treatment, and prevention of a wide range of surgical conditions affecting various parts of the body, like the digestive system, lungs, kidneys, heart , brain, and many more. It is a discipline of surgery that has a central core of knowledge in anatomy, physiology, metabolism, immunology, pathology, intensive care, shock and resuscitation, neoplasia, and wound healing. 

Being on the cutting-edge of medical innovation, general surgery constantly innovates for the benefit of the patient. Modern high-tech equipment and sophisticated technologies have made operations like major abdominal surgeries easy and less invasive. Minimally invasive laparoscopic techniques are used, which results in less pain and faster recovery at lower costs. 

Research in general surgery on immune systems and genetics has resulted in personalised treatment plans for patients, providing new insights into the causes of diseases and how they advance. General surgeons are well experienced in the diagnosis and preoperative, perioperative, and postoperative management, along with all the associated complications. 

What is general surgery?

General surgery encompasses a broad spectrum of operative procedures related to diagnosing and treating conditions in any part of your body. It deals with treating a wide range of diseases affecting the skin, abdomen, chest, head, neck, and other parts of the body. General surgeons are specialists trained to perform both elective and emergency surgeries, such as abdominal, breast, endocrine, soft tissue, vascular, and trauma surgeries. General surgeons care for the whole patient in all the ways necessary before, during, and after the surgery. 

Surgical methods

• Endoscopy: An endoscopy is done to examine the internal organs and structures inside the body. In this procedure, surgeons insert a long, thin tube called an endoscope inside the body until it reaches the required site. At the end of the endoscope, a camera is fixed to get the internal view. It allows the surgeon to perform procedures without making any incisions. The endoscope is inserted into the body through the throat, which is called upper endoscopy, or through the anus, which is called colonoscopy. It is performed for various treatments, like sealing wounds, stopping internal bleeding, placing stents, removing damaged tissue, injecting medicine, draining fluid, fixing blockages, and many more. 
• Laparoscopic surgery: It is a minimally invasive procedure used to diagnose and treat diseases in the abdomen region. A thin, telescopic rod with a video camera at the end is inserted in the abdomen region through a small incision, no more than half an inch long. The rod is called a laparoscope. The images are projected on the monitor. This is used for procedures like appendectomy, cholecystectomy, fundoplication and gastric bypass surgery and many more. 
• Robotic surgery: It is a surgical technique where a robot assists surgeons in treating specific conditions without performing an open surgery, which requires large incisions. A minimally invasive surgery requires small incisions, which lead to less damage to the healthy tissues. In robotic surgery, surgeons mainly use mechanical arms controlled by a surgical console. The arms comprise small surgical instruments at the tip. They also contain cameras to create 3D images that enable the surgeon to view the affected areas more clearly. Robotic surgery makes use of miniaturised surgical instruments assisted by advanced robots. It mainly aims at smaller and more precise incisions, which result in faster recovery with less pain. It is performed with the help of a specialised robot. The surgical equipment is fixed to the arms of the robot and is controlled remotely by surgeons. Robots recreate the movements of the surgeons and prevent the shakiness associated with human hands. Surgeons are able to visualise the procedures on a computer/monitor with a stereoscopic visual system. 

The robotic system mainly contains four components:

• Robotic arms: The tiny hand-shaped arms hold the surgical equipment. They are equipped with small tools and flexible wrists. It provides the surgeons with seven degrees of freedom of movement. This flexibility results in more precise and smooth movement during the surgery. The arms are often referred to as surgical arms.
• A high-definition camera: It is a camera that enables surgeons to view the surgical area with 3D vision.
• Surgical console: It is where the surgeons control the robot remotely. It acts as a dashboard for the surgeons. It helps move the camera to the site they want. 
• Specialised Lens: The surgical system contains a lens that is responsible for creating magnified 3D images of the surgical site. It results in more visibility and accuracy.

The robotic surgery involves the following procedure :

• Initially, surgeons make one or more tiny incisions at the required surgical area after giving anaesthesia.
• Through these incisions, a thin tube-like device is inserted and connected to robotic arms. These ports act like temporary tunnels from the surgical instruments.
• One of the incisions is attached to the flexible camera called a scope to get high-definition 3D images during the procedure. 
• Then, the robotic devices are attached to the ports, and instruments are placed in them.
• Then, surgeons control the robotic arm’s movements with precision while sitting at a console a few feet away from the patient. However, one assistant surgeon remains by the side of the patients to help adjust the instruments as needed and be ready to convert the surgery to open if required. 
• After performing the surgery, the surgeons remove all surgical instruments and ports.
• Then, the incisions are closed by stitches. 

Which diseases are treated under general surgery?

Abdominal abscess

This condition is caused when infected fluid, pus, builds up and forms a pocket in the abdominal region. The pus formation leads to infection and illness. Sometimes, it can become life-threatening without proper treatment. The symptoms include lower back pain, fever due to infection, nausea, and loss of appetite. This condition is categorised into the following types: 

• Intraperitoneal abscesses: It develops in the region below the diaphragm, intestine, pelvis, and stomach. 
• Retroperitoneal abscesses: It develops in the region near the kidneys and the pancreas.
• Visceral abscess: It develops near the spleen and the liver. 

Abdominal hernias

Abdominal hernia occurs when a part of an internal organ bulges out through an opening or weak muscles. The abdominal organs push through one of the walls of the abdominal cavity, forming a bump. It is most commonly seen in the lower chest through the diaphragm, groin, and abdominal surgery incisions. It is classified into the following types:

• Inguinal hernia: It is the most common type and mainly affects men. It is caused when the bowel protrudes into the inguinal canal near the inner thigh. 
• Femoral hernia: It is a type of groin hernia that occurs in the femoral canal.
• Hiatal hernia: It is caused when the opening in the diaphragm through which the esophagus passes widens , and the upper part of the stomach pushes up through the opening into the chest.
• Congenital diaphragmatic hernia: It is a type where the diaphragm does not close during foetal development. This condition occurs at birth, leading to birth defects.
• Umbilical hernia: It is caused when a part of the intestine bulges through an opening in the abdominal wall near the belly button. 

Anal fissure 

It is characterised by a crack or a tear in the lining of the anal canal. It causes anal pain and bleeding. It leads to the formation of fissures from straining to pass hard stools. The symptoms include sharp pain while pooping, burning and itching sensation, and the appearance of blood in the faeces. 

Anal fistula

It is an abnormal condition that develops from inside the anus to the outside. It is caused in the upper part of the anus near the anus glands. These glands are infected by bacteria, causing fistula. The infection is called perianal abscess. Fistula looks like a hole in the anus. It might ooze and drain when it is disturbed. The common symptoms include anal pain, inflammation, rectal bleeding, fever, and pain during urination.

Appendicitis

It is the infection of appendix a organ extending from the large intestine. It could be due to several reasons including fecal impaction In the appendix and also due to bacterial infection. The symptoms include abdominal pain more in the right lower abdomen and may be associated with vomiting and loose stools. 

Cholecystitis

It is the infection of gall bladder. Gall bladder is a storage organ of bile which is attached to the liver and drains bile into the gastro intestinal tract whenever required. Due to any reason the bile does not get drained leading to stasis of bile inturn causes accumulation of the bile causing stones to form. These may further obstruct the flow of bile from the gall bladder and causes infection and inflammation of the gall bladder. The classic symptoms include epigastric pain radiating to bak or to the right side of abdomen, dyspepsia and vomiting. 

Symptoms that tell you that you require general surgery 

The common signs and symptoms that may indicate the need for a general surgery include:

General symptoms

• Fatigue
• Sudden weight loss
• Severe headache
• Fever
• Treatment options under general surgery

Abdominal symptoms

• Abdominal pain
• Nausea and vomiting
• Abdominal rigidity
• Abdominal swelling
• Diarrhoea
• Constipation
• Rectal bleeding
• Blood in faeces
• Bloating 
• Stomach ache

Breast symptoms

• Change in breast shape
• Nipple discharge
• Skin dimpling
• Appearance of a tumour
• Lump on the surface of breast tissue
• Chest pain

Respiratory symptoms

• Chest pain
• Cough
• Shortness of breath
• Breathing difficulties
• Wheezing

Treatment options under Minimally invasive surgery

Appendectomy

It is a surgical procedure used to remove a damaged or infected appendix, which is a small tube-like organ that extends from the colon to the lower-right side of the stomach. The procedure is as follows:

• Surgeons, after giving anaesthesia, make three small incisions near the belly button and insert a small port into one of the incisions.
• Through the port, a small tube called a cannula is inserted.
• The cannula inflates the belly with carbon dioxide to get a clear view with a laparoscope.
• Then, the cannula is removed, and the laparoscope is inserted.
• Through the instruments, they tie off the appendix with sutures, isolate it from the colon, and remove it from the body. 
• Then, the incisions are closed with stitches. 

Cholecystectomy 

It is a surgical procedure used to remove the gall bladder in case of gall bladder stones or infection of gall bladder. Gall bladder is a storage organ of bile produced by liver and when bile stasis occurs , gall bladder stone occur or infection occurs. The procedure is as follows: 

• Surgeons, after giving anaesthesia, make three small incisions near the belly button and insert a small port into one of the incisions.
• Through the port, a small tube called a cannula is inserted.
• The cannula inflates the belly with carbon dioxide to get a clear view with a laparoscope.
• Then, the cannula is removed, and the laparoscope is inserted.
• Through the instruments, they tie off the gall bladder and its blood supply with sutures, isolate it from the liver, and remove it from the body. 
• Then, the incisions are closed with stitches. 

Hernia Repair 

It is a surgical procedure used to reduce the hernia. Hernia is protrusion of abdominal organs through a defect in the abdominal wall. The procedure is as follows: 

• Surgeons, after giving anaesthesia, make three small incisions near the belly button and insert a small port into one of the incisions.
• Through the port, a small tube called a cannula is inserted.
• The cannula inflates the belly with carbon dioxide to get a clear view with a laparoscope.
• Then, the cannula is removed, and the laparoscope is inserted.
• Through the instruments, they reduce the contents of the hernia and place a mesh to close the defect . 
• Then, the incisions are closed with stitches. 

Nissen fundoplication surgery

It is an anti-reflux surgery used to treat gastroesophageal reflux. It is a procedure that tightens the junction between the oesophagus and stomach to prevent acid reflux. The procedure is as follows: 

• Before the surgery, the surgeons perform diagnostic tests like X-rays, oesophageal manometry, and endoscopy to examine the stomach and the oesophagus. 
• Then, the surgeon makes a large incision in the abdomen and wraps the upper part of the stomach, which is called the fundus, around the lower part of the oesophagus.
• Then, the incision is closed with staples.

Bariatric surgery

It is a weight-loss surgery which is used to treat obesity. It mainly works by modifying the digestive system, like the stomach and small intestine, to regulate the number of calories you absorb and consume. It also reduces the hunger signals that travel from the digestive system to the brain. Bariatric surgery is of four types:

• Gastric sleeve
• Gastric bypass
• Biliopancreatic diversion with duodenal switch
• Stomach intestinal pylorus sparing surgery

Road to recovery after general surgery

Some of the guidelines for postoperative recovery are as follows:

• Follow the surgeon’s instructions on caring for your incision site, pain management, and medications.
• Keep your surgical site dry and clean to avoid any infections.
• Consume proper medications prescribed by doctors at the right time and the right dose to recover quickly.
• Get plenty of rest to allow your body to heal. Avoid any physical activities to reduce any complications.
• Follow a healthy diet as instructed by the doctor. Eat healthy food, like fruits, vegetables, pulses, proteins, vitamins, and whole grains, even after recovery to maintain good health.
• Always stay active. Do gentle exercises like walking to prevent rigidness and to allow proper blood circulation.
• Attend follow-up appointments to monitor your recovery phase, detect any complications or risks, and clarify any doubts regarding your health with the surgeons, who guide you at every stage until you are fully recovered.

Conclusion

To sum up, general surgery is essential as it treats a wide variety of ailments affecting soft tissues, abdominal organs, and other parts of the body. The ongoing advancement of surgical techniques, like robotic surgery and other minimally invasive procedures, has greatly enhanced the outcomes of treatment, shortened recovery periods, and minimised complications.