Classification of Surgical Diseases
Surgical diseases can generally be divided into seven categories:
Trauma
Trauma involves damage to human tissues caused by violence or other injurious factors, such as organ rupture, fractures, or burns. These conditions often require surgical intervention or other specialized techniques to repair tissues and restore function.
Infections
Infections occur when pathogenic microorganisms invade the human body, causing damage and destruction to tissues and organs, which may lead to localized infection sites or abscesses. Surgical treatment is often necessary, such as in cases of suppurative appendicitis or liver abscess.
Tumors
Most tumors are benign and can be cured by surgical excision. For malignant tumors, surgery may achieve radical cure, extend survival time, or alleviate symptoms.
Deformities
Congenital deformities, such as cleft lip and palate, congenital heart disease, or anorectal atresia, require surgical correction. Acquired deformities, such as scar contractures following burns, also necessitate reconstructive surgeries to improve appearance and restore function.
Endocrine Dysfunction
Diseases such as hyperthyroidism and hyperparathyroidism fall under this category.
Parasitic Diseases
Examples include hepatic hydatid disease and biliary ascariasis.
Other Conditions
Other surgical conditions include obstruction of hollow organs (e.g., intestinal obstruction or ureter obstruction), circulatory disorders (e.g., varicose veins of the lower limbs or portal hypertension), stone diseases (e.g., cholelithiasis or urinary calculi), and massive hemorrhage caused by various factors. These often require surgical management.
The distinction between surgical and medical diseases is often relative. While surgery typically employs operative or manual techniques as the primary intervention, not all surgical diseases require surgery in every stage of development. For example, acute cholecystitis is usually managed with anti-infective therapy in its early stages, with cholecystectomy considered only if the inflammation cannot be controlled and shows signs of worsening. Similarly, internal medicine typically relies on pharmacological therapies, but certain medical conditions may necessitate surgery during their advanced stages. For instance, congenital Wilson's disease may require a liver transplant when progression cannot be controlled with medications.
Advancements in medical science have also shifted the approach to some conditions from surgical to non-surgical treatments. For example, over 90% of urinary stones can now be treated using extracorporeal shock wave lithotripsy (ESWL) to fragment and expel the stones. Additionally, the application of endoscopic and laparoscopic techniques in both medicine and surgery has led to a convergence between the two disciplines, making it increasingly difficult to clearly classify certain diseases as exclusively medical or surgical in nature.
Subspecialties in Surgery
With the rapid development of modern surgery in both breadth and depth, it has become increasingly difficult for any single surgeon to master all the knowledge and skills of the entire field. The specialization of surgery has thus become an inevitable trend.
Surgical disciplines can be categorized in various ways:
By Scope and Nature of Work
Surgery can be divided into experimental surgery and clinical surgery (commonly referred to as general surgery).
By Human Systems (Secondary Disciplines)
Clinical surgery can be subdivided into specialties such as orthopedics, urology, neurosurgery, vascular surgery, and others. The remaining disciplines fall under general surgery (tertiary discipline).
By Anatomical Regions
Subspecialties include head and neck surgery, thoracic and cardiac surgery, and abdominal surgery.
By Patient Age Groups
Subspecialties include pediatric surgery and geriatric surgery. It is even possible to perform surgery on fetuses, though this has not yet developed into a distinct specialty.
By Surgical Techniques
These include reconstructive surgery, microsurgery, and transplant surgery.
By Disease Nature
Subspecialties include tumor surgery, emergency surgery, and others.
By Organ Systems and Functions
Examples include endocrine surgery and related disciplines.
Certain specialties have grown and evolved to include subspecialties (quaternary disciplines). For instance, general surgery has led to the development of thyroid surgery, breast surgery, hepatobiliary surgery, and gastrointestinal surgery, among others.