General surgery

General Surgery in Iran

What is General Surgery?

General surgery is a medical discipline that involves performing various types of surgical procedures to treat a broad range of health problems and diseases. In fact, General Surgery is a discipline of surgery having a central core of knowledge embracing anatomy, physiology, metabolism, immunology, nutrition, pathology, wound healing, shock and resuscitation, intensive care, and neoplasia, which are common to all surgical specialties.

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About Iranian Surgery

Iranian surgery is an online medical tourism platform where you can find the best general Surgeons in Iran. The price of a general surgery in Iran can vary according to each individual’s case and will be determined based on photos and an in-person assessment with the doctor. So if you are looking for the cost of general surgery in Iran, you can contact us and get free consultation from Iranian surgery.

What do general surgeons do?

In general surgery, the surgeon is expected to perform both pre- and post-operative care and management rather than the surgery itself. General surgeons can diagnose several types of diseases, especially those that are related to the abdomen and the organs connected to it. These include bile ducts, liver, pancreas, spleen, appendix, small and large intestine, rectum, and the stomach. The surgeon may also operate the thoracic region, glands in the thyroids, and hernias. To a certain extent, general surgeons are also responsible for procedures performed on the skin and the breast.

General surgeons are also expected to treat burn patients. Hence, aside from hospitals, they can also be found in trauma centers and emergency departments.

With so many sub-specialties under surgery, people do often get confused with general surgery and cranial, cardiovascular, etc. The main difference is the kind of knowledge that general surgeons gain during training. While general surgeons learn to treat several types of diseases, they receive core knowledge. Anything that requires a more comprehensive or specific knowledge should be passed on to a specific surgeon or specialist. For example, a general surgeon can operate the vascular regions except for the heart, which should be managed by a cardiovascular surgeon.

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General surgeons go through rigorous training and education before they are allowed to practice. They spend at least two years to complete prerequisite courses before they proceed to medical school, which usually take four years. Then, they complete a five-year residency program in any accredited hospital to specialize in surgery. Depending on the program, the general surgeon should be able to perform at least a thousand surgeries. After that, they can qualify for a board certification. They also need to obtain a medical license from the state where they wish to practice. In addition, they are required to go through several continuing education programs. If the surgeons wish to specialize in a surgical field, they may spend at least three years for further training.

During the course of training, general surgeons are expected to learn:

.Technical proficiency

. Clinical knowledge

. Knowledge in various surgical procedures including minimally invasive surgeries

. Clinical evaluation

. Fluid management

. Stabilization of patients, especially those who are under critical care

. Knowledge in pediatric and geriatric care

. Referrals

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Common general surgery procedures

General surgery encompasses a broad range of surgery which includes:

. Surgical conditions of the gastrointestinal tract from the oesophagus to the anus

. Kidney, pancreas and liver transplantation

. Abdomen and its contents

. Breast, soft tissue and certain skin conditions

. Initial assessment of patients with peripheral vascular disease

. General surgery of childhood

. Alimentary tract

. Head and neck, including trauma, vascular, endocrine, congenital and oncologic disorders - particularly tumors of the skin, salivary glands, thyroid, parathyroid, and the oral cavity.

. Vascular system, excluding the intracranial vessels and heart

. Endocrine system, including thyroid, parathyroid, adrenal, and endocrine pancreas.

. Surgical oncology, including coordinated multimodality management of the cancer patient by screening, surveillance, surgical adjunctive therapy, rehabilitation, and follow-up.

. Comprehensive management of trauma, including musculoskeletal, hand, and head injuries. The responsibility for all phases of care of the injured patient is an essential component of general surgery.

. Complete care of critically ill patients with underlying surgical conditions, in the emergency room, intensive care unit, and trauma/burn units.

. Elective surgery is also an important part of the work

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Scope

General surgeons may sub-specialize into one or more of the following disciplines:

Trauma surgery/ Surgical Critical Care

In most parts of the world the overall responsibility for trauma care falls under the auspices of general surgery. Some general surgeons obtain advanced training in this field (most commonly surgical critical care) and specialty certification surgical critical care. General surgeons must be able to deal initially with almost any surgical emergency. Often, they are the first port of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilize such patients, such as thoracostomy, cricothyroidotomy, compartment fasciotomies and emergency laparotomy or thoracotomy to stanch bleeding. They are also called upon to staff surgical intensive care units or trauma intensive care units.

All general surgeons are trained in emergency surgery. Bleeding, infections, bowel obstructions and organ perforations are the main problems they deal with. Cholecystectomy, the surgical removal of the gallbladder, is one of the most common surgical procedures done worldwide. This is most often done electively, but the gallbladder can become acutely inflamed and require an emergency operation. Infections and rupture of the appendix and small bowel obstructions are other common emergencies.

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Laparoscopic surgery

This is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 3 to 15mm incisions. Robotic surgery is now evolving from this concept (see below). Gallbladders, appendices, and colons can all be removed with this technique. Hernias are also able to be repaired laparoscopically. Bariatric surgery can be performed laparoscopically and there a benefits of doing so to reduce wound complications in obese patients. General surgeons that are trained today are expected to be proficient in laparoscopic procedures.

Colorectal surgery

General surgeons treat a wide variety of major and minor colon and rectal diseases including inflammatory bowel diseases (such as ulcerative colitis or Crohn’s disease), diverticulitis, colon and rectal cancer, gastrointestinal bleeding and hemorrhoids.

Breast surgery

General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy to mastectomy, especially pertaining to the evaluation, diagnosis and treatment of breast cancer.

Vascular surgery

General surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders.

Endocrine surgery

General surgeons are trained to remove all or part of the thyroid and parathyroid glands in the neck and the adrenal glands just above each kidney in the abdomen. In many communities, they are the only surgeon trained to do this. In communities that have a number of subspecialists, other subspecialty surgeons may assume responsibility for these procedures.

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Transplant surgery

Responsible for all aspects of pre-operative, operative, and post-operative care of abdominal organ transplant patients. Transplanted organs include liver, kidney, pancreas, and more rarely small bowel.

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Surgical oncology

Surgical oncologist refers to a general surgical oncologist (a specialty of a general surgeon), but thoracic surgical oncologists, gynecologist and so forth can all be considered surgeons who specialize in treating cancer patients. The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume—i.e., the more cancer cases a surgeon treats, the more proficient he or she becomes, and his or her patients experience improved survival rates as a result. This is another controversial point, but it is generally accepted—even as common sense—that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of complex cancer resections such as pancreaticoduodenectomy for pancreatic cancer, and gastrectomy with extended (D2) lymphadenectomy for gastric cancer. Surgical oncology is generally a 2 year fellowship following completion of a general surgery residency (5-7 years).

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Cardiothoracic surgery

Most cardiothoracic surgeons (D.O. or M.D.) first complete a general surgery residency (typically 5–7 years), followed by a cardiothoracic surgery fellowship (typically 2–3 years).

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Pediatric surgery

Pediatric surgery is a subspecialty of general surgery. Pediatric surgeons do surgery on patients’ age lower than 18. Pediatric surgery is 5–7 years of residency and a 2-3 year fellowship.

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Where do they work?

General surgeons have an important role to play in A&E departments where emergency surgery is needed. In rural and remote areas general surgeons are in demand for their wide range of skills.

General surgeons also perform trauma surgery following accidents, although this has decreased because of improved car safety. This work requires close collaboration with other specialist colleagues and a holistic approach to treatment.

A small number of general surgeons are highly specialised and they only perform complex surgery within their own subspecialty, such as organ transplant surgery.

Within the Armed Forces military surgeons are general surgeons, where their work has an emphasis on trauma and emergency surgery.  General surgeons also carry out many simple childhood operations.

Specialist training is also provided for advanced trauma surgery (for military surgery and trauma centres) and for remote and rural surgery.

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Training as a Surgeon

Medical Students who want to be surgeons first apply to a surgical residency program. Once they graduate from medical school they are, officially, a physician, but their education is less than halfway to completion at this point. A surgical residency begins in the first year of residency, which is called the intern year, followed by at least four additional years of surgical training. This is the training all surgeons go through on the path to their final surgical career.

During their training, general surgeons are required to complete 48 months of full-time clinical activity. They may complete some training in another specialty, but no more than 12 months may be spent focused allocated to any one surgical specialty other than general surgery.

At the completion of the intern year and four subsequent years of training, the surgeon is fully trained in general surgery and can then choose their path to either practice in the specialty of general surgery or to pursue a surgical specialty and several more years of training as surgical resident or fellow.

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