What would you say are the most common...

[Misterioso]

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...conditions operated on by a general surgeon working (1) in a private practice and (2) in an academic medical center in a mid-to-large sized city?


Below is a list of some disorders I found related to general surgery:

Abdominal Abscess
Abdominal Hernias
Anal Fissure
Appendicitis
Gastric Tumors
Neoplasm of the Small Intestine
Bile Duct Tumors
Chyle Fistula
Cystosarcoma Phyllodes
Fistula-in-Ano
Gallbladder Mucocele
Gallbladder Tumors
Gallbladder Volvulus
Gardner Syndrome
Gastric Outlet Obstruction
Gastric Volvulus
Hemorrhoids
Hepatic Cysts
Hidradenitis Suppurativa
Inferior Vena Caval Thrombosis
Intestinal Perforation
Lipomas
Liver Abscess
Lower Gastrointestinal Bleeding
Lymphedema
Meckel Diverticulum
Mesenteric Artery Ischemia
Mesenteric Tumors
Mesenteric Venous Thrombosis
Omental Torsion
Pancreatic Pseudoaneurysm
Perianal Abscess
Perianal Cysts
Perianal Granuloma
Perilymph Fistula
Peritonitis and Abdominal Sepsis
Peritonsillar Abscess
Pilonidal Disease
Proctitis and Anusitis
Pyogenic Hepatic Abscesses
Rectal Prolapse
Rectovaginal Fistula
Salivary Gland Tumors
Short-Bowel Syndrome
Solid Omental Tumors
Splenic Abscess
Splenic Infarct
Thymoma
Upper Gastrointestinal Bleeding
Zenker Diverticulum

 

[fourthyear]

I'm sure you could search for this...but it looks like you went through a lot of effort to put a list together, so I'll answer.

A good amount of things you listed are found in the books and you have to know about them, but the're things I havent' seen in 3 years residency and doubt I'll see much in my lifetime as a surgeon. For instance, you listed 3 gallbladder problems, but not the common ones - cholelithiasis (gallstones), cholecystitis (gallbladder inflammation/infection), biliary colic (gallbaladder pain), cholangitis (more severe/extensive infection involving bile ducts too) - these are the things you actually see and operate on, not gallbladder vovluous, tumor, mucoceole - most gallbadder cancers are actually found incidentally on routine cholecystectomy done for the other conditions above.

Okay, so what else is commonly seen besides gallbladders-
hernias
appendicitis
breast masses
colon masses
anal things - hemmrhoids, fistula, etc
abscesses anywhere on the body
skin lesions or subcutanous masses that need excision

Less frequently seen, but would go to the general surgeon - gastric masses, thyroid masses(unless ENT does them), spleenectomy, perforated ulcers, reflux refractory to medical treatment (both seen less often now due to PPI's), G-tubes and trachs, port-a-caths

These are the most common/top 10 kind of thing you'll expect to be operating on most days as a general surgeon in your average place. I think my list would fit for private practice or mid-size academic place. In a larger academic place you'd probably stick more to the top of the list and some of those less frequently seen ones might go to more of a specialist. At a smaller/mid-sized hospital you might get more things like liver or pancreas cases too, wheras at the large academic place it would again go to a specialist.

 

[Winged Scapula]

Interesting list...but as fourthyear notes, many of these are never seen in either an academic or private surgical practice. In my experience, both at an academic and community practice (in 4.5 years) many, if not most of your list would be referred to a specialist. I don't know any general surgeon who would attempt to repair a recto vaginal fistula, cystosarcoma phyllodes or salivary gland tumors (to name a few). These would be generally referred to a colorectal surgeon, breast surgeon and ENT or H&N specialist - as I imagine even a busy general surgeon doesn't see enough of any of these entities to feel comfortable with them.

 

[Misterioso]

Thanks for the replies fourthyear and Kimberli Cox. I had a feeling some from the list would be done by specialists other than general surgeons.

Since general surgery overlaps with some of the operations done by fellowship trained colorectal surgeons, is there much competition for cases between the two specialties?

 

[Winged Scapula]

Thanks for the replies fourthyear and Kimberli Cox. I had a feeling some from the list would be done by specialists other than general surgeons.

Since general surgery overlaps with some of the operations done by fellowship trained colorectal surgeons, is there much competition for cases between the two specialties?

Yes and no. It depends on the surgeon, the complexity of the case and the practice environment.

For example, most general surgeons would be comfortable doing a sigmoid resection or Hartmann's for diverticulitis. However, a more complex colorectal case such as low anterior or abdomino-perineal resection would almost always be referred out to a colorectal specialist, regardless of environment - if there isn't a local CRS, then the patient gets referred to a center at a variable distance which has one.

The answer is therefore not difficult for the more complex cases - as I noted in my earlier reply most rectovaginal fistulae or complications of Crohn's disease (which many of the procedures you listed in the first post could be considered as) would be referred to a colorectal surgeon unless the general surgeon had some specific interest or training in the field.

It is the more mundane cases such as pilonidal cysts or hemorrhoids (a more complex case than often anticipated) that the "competition" becomes more prevalent. IMHO these cases are commonly done by general surgeons in the community private practice even though there are local CRS in private practice. However, at the academic institution these cases are done by the CRS and not the general surgeons.

Same goes for thryoids - they can be done by general surgeons, or ENTs. At my hospital, they are done by both - the patient gets to either type of surgeon depending on the referral. If the PCP feels a nodule on exam and refers the patient to a general surgeon, if the GS is not comfortable with doing thryoids he will likely refer to a GS who is, rather than an ENT. It may be politically motivated rather than a belief that the GS does a better job than the ENT. OTOH, if the PCP refers the patient to an ENT, then that's who does the case.

See? Its not so simple.