The superspeciality of GI Surgery is the latest in the ever increasing waves of assault on the once unique territory of ‘General Surgery’. The wave started in the west and now settled in the Indian soil, despite the inherent resistance put up from the surgical fraternity.

In fact, the western countries have gone to the extent of starting subspecialty of GI Surgery viz. Hepatopancreatobiliary Surgery, Transplant Surgery, Esophageal surgery, Colorectal Surgery and Minimal Access GI Surgery etc.

In India , GI Surgery involves Hepatopancreatobiliary, Esophageal, Gastric , colorectal and GI advanced Laparoscopic Surgeries ( those not normally done by a general surgeon on a routine basis)

The impetus for these off-shooting of specialities probably lies in the fact that the medical knowledge base is expanding in an astounding pace, the frontier for complexities of surgical expertise is at par with that of technological innovations.

All of these changes are happening in the backdrop of increased consumer awareness, cost containment moves and changing flagposts of outcome.

In UK, the confidential report on the perioperative morbidity and mortality in the early nineties first drew attention to clinical outcome and its monitoring.

Next followed hordes of clinincal investigations into factors influencing the outcome of various surgical procedures. It was shown that results of colorectal cancer, esophageal cancer, gastric cancer and whipples procedures etc were better in the hands of formally trained surgeons than those of occasional surgeons.

Moreover , it is common observation that surgical results are always excellent in those high volume centres , where a particular disease or procedure is concentrated. A high volume surgeon should operate 20-40 cases per year.

Recently, some have suggested that results are better in the hands of trained surgeons even if they operate in low volume centres, which is an important finding because if confirmed , these information can be utilized in a country like India where high volume centres are scarce.

The incubation period for GI surgery after the primary qualifying medical degree varies from 7yrs in the USA to 6 yrs in India.

In the USA the training is in the form of formal residential fellowship of 2 years duration either in GI and Minimal Access Surgery or ‘Core’ Liver transplant Surgery after completing the 5 years MD course.

In the UK, training are in structured residential fellow in Subspecialities of GI Surgery or MCh or PhD programs while other European countries like the Netherlands are offering PhD.

There seems to be a slight difference in the direction of specialization in that while in the USA and the UK the trend is towards GI surgery subspecialization i,e., Esophageal fellowship, HPB (Hepatopancreatobiliary) fellowship, MIS (Minimlly invasive surgery) fellowship, Upper GI fellowship and Colorectal fellowship etc.

While in countries like the rest of the Eastern and Western European countries including France, Germany and Netherlands and Asian countries like the Japan and India, the trend is towards comprehensive Digestive/Gastrointestinal Surgery also known as Surgical Gastroenterolgy/ Gastroenterologic Surgery.

In India, current recognized programs in the field of GI Surgery (Surgical Gastroenterology) are PhD, MCh (GI Surgery)/ MCh (Surgical Gastroenterology) and DNB (Surgical Gastroenterology).

The madras medical college was the first to start an MCh program in the 70’s. AIIMS started PhD program in the mid-80’s, then MCh in the 90’s. Now around half –a –dozen centres are offering these programs in India.

Young general surgeons who wish to persue a career in Minimal Acces Surgery should go for FNB ( Fellow , National Board) in Minimal Acces Surgery which is for 2 years duration.

To make things even complicated, the recent times have seen spread of specialty hospitals where a particular hospital deals with diseases of only a particular organ i.e., Cardiac centres, Hepatology centres, Neurosciences centre to name a few.

In the field of Gastrointestinal Surgery, a separate department of Surgical Hepatology has been started in the Institute of Liver and Biliary Diaseases.

Also read - "Why I chose to stay in Manipur" by the same writer.

To be continued...