The surgeon of today is witness to unprecedented change in the delivery of healthcare. Our populations are ageing and the available options for treatment are expanding. Surgeons are becoming increasingly specialist and patients in hospital are sicker than ever before. Pressures on trainees include a shorter working week and there is an emphasis on operating theatre efficiency, which reduces opportunity for supervised trainee operating. Add to this the increasing scrutiny of an individual surgeon's outcomes that can act to limit a trainee's exposure to operative experience. Traditional team structures of surgical firms and the apprentice-style training have been consigned to history.

Over recent years, the examination process in surgery has also changed and the Intercollegiate Surgical Curriculum Project now emphasizes the different domains of surgical practice, based on the Can-MEDS framework and underpinned by the principles of Good Medical Practice. As well as becoming a surgical expert, with the appropriate knowledge, clinical skills, technical skills and professional attitudes, a surgeon must develop skills as a Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional. These are admirable goals and the examination system is indeed evolving to assess the full range of these qualities.

This new edition of Fundamentals of Surgical Practice is aimed at the surgeon in training preparing for the Intercollegiate MRCS Examination. The book follows the syllabus for the examination, which has been agreed by, and is common to, the Surgical Royal Colleges of Great Britain and Ireland.

Landmarks in the history of surgical management

An appreciation of the history of hernia surgery may prevent us repeating the mistakes of the past and put in perspective the knowledge that has been accumulated in order to allow development of the successful techniques used today. The high prevalence of hernia, for which the lifetime risk is 27% for men and 3% for women, has resulted in this condition inheriting one of the longest traditions of surgical management.

• Hernia surgery has a 3500-year history (Figure 26.1)

• Castration was an essential part of the earliest operations for hernia, which carried with it an obvious stigma

• The Dark Ages until the sixteenth century halted further progress in effective treatment

• Femoral hernia was distinguished from inguinal hernia in the fourteenth century.

The great contribution of the surgical anatomists was between the years 1750 and 1865 and was called the age of dissection. The main contributors were Antonio Scarpa and Sir Astley Cooper and few major advances in our knowledge of the anatomy of the groin have been made since this time. The names of these great anatomists are Pieter, Camper, Antonio Scarpa, Percival Pott, Sir Astley Cooper, John Hunter, Thomas Morton, Germaine Cloquet, Franz Hesselbach, Friedrich Henle and Don Antonio Gimbernat.

One of the first challenges for aspiring surgeons to negotiate is the intercollegiate MRCS examination, which has replaced similar examinations previously run by the four Royal Surgical Colleges. The first edition of Fundamentals of Surgical Practice has become a recommended and standard text for the MRCS examination largely due to the reputation of its contributors. As editors of the second edition we are delighted that the majority of our authors have signed up to a revision and update of their chapters. There are some new contributors and some of our senior authors have revised their chapters with junior colleagues attuned to modern surgical thinking.

Technological aspects of surgery have undergone rapid change in the last two decades. A parallel change has taken place in the educational concepts underpinning transfer of basic knowledge into surgical practice. The knowledge base itself may not have changed a great deal but its method of presentation has. Therefore, we have selected authors with a gift for imparting the enthusiasm of their specialist interest in a straightforward and easily understood way but without missing out on the detail. In this edition the alimentary system has been expanded into two chapters on Upper gastrointestinal and Lower gastrointestinal surgery and a separate chapter on Hernia management has been added to emphasise the importance of surgery of the abdominal wall as an expanding area of specialist interest.