Upper gastrointestinal surgery, commonly referred to as “upper GI surgery,” is surgery on the upper parts of the gastrointestinal tract. Upper GI surgery can be open or laparoscopic.

Open surgery requires a large incision, generally enough to accommodate the surgeon’s hands. Laparoscopic, sometimes referred to as keyhole surgery, involves only small incisions in the abdomen, through which instruments can be inserted to view and treat affected areas.

What is it used for?

Upper GI surgery is used to treat a number of conditions affecting the oesophagus, stomach, duodenum area of the small intestine, diaphragm, gall bladder, liver, spleen and pancreas.

Conditions that can benefit from upper GI surgery include abdominal wall hernias, gallstones, diseases of the pancreas and liver, gastroesophageal reflux disease, dysphagia, oesophageal diseases and disorders, and post-hepatic (also called obstructive) jaundice.

Who performs it?

To perform upper GI surgery, a physician must be qualified as a surgeon with a specialisation in the upper gastrointestinal tract. Some upper gastrointestinal surgeons may specialise further, focusing specifically on oesophago-gastric or hepato-pancreatico-biliary disorders.

Oesophago-gastric disorders involve the oesophagus and stomach, and hepato-pancreatico-biliary disorders involve the liver, pancreas and billiary tract. Hepato-pancreatico-biliary specialization can be even further narrowed to allow a surgeon to specialize in liver disorders, including hepatic resection and transplantation.

How to become qualified

Training to become qualified to perform upper GI surgery is the same as training for any other surgical speciality. Physicians complete five years of general medical training then undertake a two-year foundation programme. Upon completing the foundation programme, which includes general surgical training, trainees take the MRCS (Membership of the Royal College of Surgeons) Examination.

After passing the MRCS, the trainee can apply for specialist training in upper gastrointestinal surgery.

When specialist training has been successfully completed, a surgeon may apply for a Certificate of Completion of Training, or CCT, and apply to join the General Medical Council (GMC) Specialist Register. Doctors must be registered with the GMC to practice in the U.K.

This is the field of medicine that provides treatment in the form of surgery for diseases in the organs inside the chest (thorax). This includes diseases of the coronary arteries, heart valves, and congenital heart diseases. It also involves treatments for conditions, often malignant diseases, of the lungs, the chest wall, the diaphragm, and the esophagus.

There are three main specialties in the field of cardiothoracic surgery

1. Cardiac – This focuses on cardiac surgeries and inolves conditions such as coronary heart disease. Surgeries performed may include cardiothoracic heart valve replacements and the replacement of unhealthy arteries with arteries or veins from another part of the body.

2. Thoracic – These are the surgeries involved with the lungs, chest wall, esophagus and diaphragm. Some typical surgeries are the removal of a diseased lung or a portion of the lung. Alobectomy is the removal of one lobe of the lung.

3. Congenital – This is considered to be the most difficult of the cardiothoracic surgeries and is the surgical treatment of a defect of the heart that occurs in the body while the fetus is being formed. The patients are usually children or newborns with very complex heart defects.

Education and Training

Cardiothoracic surgery is one of the most difficult and taxing specialities for any doctor deciding to pursue a surgical career. Training as a cardiothoracic surgeon is ongoing, but to become fully certified and with good consultation abilities it can take over 15 years. Before anyone can begin specialized training, of course, they must attain a medical degree that includes the basics of general medicine and surgery.

This must be followed by several years of training to gain surgical qualification. These qualifications must come from an organization such as the Membership of the Royal College of Surgeons. This can take approximately four years.

To practice as a consultant, the surgical candidate must attain a Certificate of Completion of Specialist Training, meaning they must complete study in a specialized area. This usually requires six more years. Many doctors choose orthopedics and their specialty.

Training as a Cardiac Surgeon

Training is generally considered to be ongoing, but becoming a full fledged cardiac surgeon with consulting capabilities can easily take over 15 years to accomplish.

The first step in becoming a cardiac surgeon is to train as a doctor. Before specialised training can even begin, a basic medical degree must be obtained including the principles of medicine and surgery.

Depending on the university attended, the title of the degree could be different, such as BM for Bachelor of Medicine or BS for Bachelor of Surgery, but the knowledge is basically the same. This step alone can typically take up to five years to complete.

Several years follow of further specialised training during which the aspiring surgeon must gain a specific surgical qualification. Examples include MRCS, Membership of The Royal College of Surgeons, which was previously titled FRCS, Fellowship of The Royal College of Surgeons. This process generally takes an additional four years.

Education is also required

A Certificate of Completion of Specialist Training is also required if the surgeon wishes to practise as a consultant. Some surgeons choose to specialise further in fields including ophthalmology and orthopaedics. These individuals can expect an additional six years of training to obtain their qualifications.

The letters following a surgeon’s name generally indicate the school that granted the qualification, and though some surgeons may have multiple qualifications, many choose to display only their highest instead of listing all of their lesser degrees.

Register and be approved

All surgeons who were trained overseas often display different letters following their name which indicate the institutions that granted their qualifications, though before practising in the UK they must be registered with the General Medical Council, an also prove they are capable and experienced enough to handle the work.