The general surgeon takes care of a wide range of conditions which can be as complex as major cancer surgery, to common ailments such as hernias, gall stones and appendicitis. The clinical discipline of general surgery at AKUH is highly demanding due to the high proportion of surgical emergencies it caters to. The General Surgery programme has 10 full-time and three non full-time faculty members and is the largest section within the Department of Surgery. Among the clinical departments, it has one of the busiest patient care and teaching programmes.

Since its inception in 1985, General Surgery at AKUH has subscribed to quality patient care and education. The last decade has seen a greater emphasis on the development of expertise in gastro-intestinal, hepatobiliary, pancreatic, colorectal, breast and endocrine, and trauma and vascular surgery.

"With strong support from oncology, pathology and radiology as well as nursing services, the section of General Surgery has been able to develop a multi-speciality approach to managing complex clinical states, such as the comprehensive management of breast cancer, including breast reconstruction and prosthesis," says Dr. Shaista M. Khan, Professor and Head of the Section.

Minimally Invasive Surgery, based on the philosophy of minimal interference with the body's natural structures, results in reduced hospital stay and rapid return to work. It began in 1992 and is now well established. Following vast experience in laparoscopic-assisted procedures in General Surgery, the general surgeons have helped establish these procedures in the sections of urology and gynaecology. The Section owes much of its progress to its surgeons who have remained relentless in their quest for continuing professional development.

Dr. Turab Pishori, Assistant Professor, completed a fellowship in colorectal surgery at the Cleveland Clinic in Florida in 2001. A service for functional colorectal disorders is in the process of being established under the leadership of Dr. Khalid Hameed, Associate Professor. Dr. Hasnain Zafar, Assistant Professor, is spearheading organised trauma management at AKUH following his fellowship in Trauma and Critical Care at Liverpool Hospital in Sydney, Australia.

The need for an alternative services model as envisaged by the University, has led to the development of a strong ambulatory surgery service. The proportion of Day Care Surgery procedures, in which patients do not have to stay in the Hospital overnight, has increased by 12 per cent since 2001. These procedures constitute 40 per cent of total surgical procedures, resulting in reducing costs for patients and increasing access.

Competitive price packages are offered for inguinal hernia repair, laparoscopic cholecystectomy and mastectomy. Dr. Inam Pal, Assistant Professor, has been innovative in enhancing cost effectiveness of inguinal hernia surgery and laparoscopic cholecystectomy.

The Section of General Surgery pioneered the programme of extending services to underprivileged communities under the auspices of Aga Khan Health Service, Pakistan (AKHS,P) in urban and rural areas of the country. Dr. Tabish Chawla, Assistant Professor, established surgery clinics in AKHS,P diagnostic centres in Karachi. For four years now, Dr. Rehman Alvi, Assistant Professor, has been deputed at a first-level referral centre in Singal, in the Ghizar district of the Northern Areas of Pakistan, where emergency obstetrical and trauma care are offered in addition to general surgery.

General Surgery carries one of the heaviest undergraduate teaching workloads in the clinical departments and is responsible for teaching medical students in their third and fifth years. In the field of postgraduate training, General Surgery was one of the first specialties to introduce structured residency training programmes in Pakistan. Dr. Asad Jamil Raja, Associate Professor, has played an important role in enhancing the programme by holding skills workshops, developing the core curriculum and clearly defining the objectives of training at each level of residency.

To date, 28 residents have completed their training and received their certification since the programme commenced in 1986. Graduates have gone on to pass their Fellowship examinations of College of Physicians and Surgeons Pakistan and UK Royal Colleges. The Royal College of Surgeons of Edinburgh has recognised AKU General Surgery residency programme towards fulfilling requirements for higher surgical training and the Intercollegiate Examination of UK. Fellowship positions in General Surgery with emphasis on trauma, breast and GI oncology are designed with the goal of producing academic surgeons. Dr. Hasnain Zafar and Dr. Rakhshanda Layeeque are the first graduates of the fellowship programme. The commitment to continuous medical education in the Section is spearheaded by Dr. Rizwan Azami, Associate Professor, who imparts training in laproscopic surgery to surgeons from other institutions in Pakistan.

"The deep involvement of faculty in scholarly activities, education and clinical services has resulted in a strong section of General Surgery," said Dr. Mushtaq Ahmed, the Quaid-e-Azam Professor and Chairman of the Department of Surgery, a general surgeon with an interest in hepatobiliary diseases. A research culture is also taking root in the General Surgery section, as in other sections of the Department, with an increasing number of clinical studies being undertaken.