General surgery in Tijuana

What a general surgeon does

The general surgeon is the specialist trained to diagnose and operate on disease of the abdomen, the abdominal wall, the digestive tract, soft tissue, the thyroid gland and the anal region. It is not «the one who operates on anything»: it is a specialty with its own residency, its own examination and a defined field.

Procedures fall into two broad groups. Elective ones, scheduled after investigation and preparation — hernias, gallbladder, thyroid, haemorrhoids, lipomas — and emergency ones, resolved within hours — appendicitis, acute cholecystitis, an incarcerated hernia, bowel obstruction, acute abdomen. The same specialty covers both.

The commonest procedures

In this practice the most frequent are removal of the gallbladder for stones, repair of inguinal, umbilical and abdominal wall hernias, removal of the appendix, haemorrhoid surgery, excision of lipomas and biopsy of lesions for diagnosis.

Also performed are thyroidectomy for a nodule or goitre, resection of benign and malignant soft-tissue tumours, treatment of complex wounds that will not close, and day surgery: procedures where the patient comes in and goes home the same day, without an overnight stay.

Open or laparoscopic: how the decision is made

The route of access is not a matter of fashion. It is chosen from the diagnosis, the patient's anatomy, their previous operations and what is found on entering. Laparoscopy offers less pain, fewer days in hospital and small scars, and it is today the usual route for gallbladder, appendix, hernias and reflux.

But there are situations where open surgery is the right decision: very advanced inflammation, dense adhesions from previous operations, bleeding, large tumours or an unstable patient. Converting from laparoscopic to open during the procedure is not a complication: it is a safety decision, and it is explained before the consent is signed, not afterwards.

What is assessed before scheduling

Every elective operation is preceded by an assessment: full labs, surgical risk evaluation and, depending on age and associated conditions, an ECG, a chest film or a cardiology review. The imaging depends on the condition: ultrasound for gallbladder and abdominal wall, CT for complex hernias and intra-abdominal disease, endoscopy for stomach and oesophagus.

The point that causes most trouble when it is overlooked is blood thinners. Warfarin, acenocoumarol, apixaban, rivaroxaban, clopidogrel and aspirin usually have to be stopped days in advance, and that pause is coordinated with the physician who prescribed them. Never on your own initiative.