Our mission statement

Treating and supporting our patients and their families in the best way possible.

Message from the Clinical Chairperson

The Department of Surgery helps a large numbers of patients every year. Many of these require planned (elective) or emergency surgery.

Patients are attended to in the wards, outpatients, day care unit, pre-operative clinic, operating theatres and endoscopy. An increasing amount of surgeries are performed as day cases.

The Department strives for excellence in standards of care with a humane and caring approach keeping our patients at the center of care.

We provide teaching for medical students and trainee surgeons with strong links and collaborations with foreign institutions. We aim to be at the forefront of the profession, developing new techniques and utilising latest technologies and innovation with continuous audit and research.

We value patients’ views and encourage feedback to further improve our services.

Clifford Caruana
Consultant General Surgeon with special interest in Upper GI surgery
Chair of the department of General and Vascular Surgery

The Hospital

The Mater Dei hospital is the major teaching hospital on the island of Malta. It opened it’s doors in 2007 to replace the older, St Lukes hospital. It covers the majority of the medical specialities and is the acute emergency hospital. Next door to the Mater Dei stands an oncology hospital and this caters for oncology and haematology patients. A smaller institution in Floriana called the Sir Paul Boffa hospital caters for dermatology. There are also a number of facilities for rehabilitation and medicine for the elderly. There is also a smaller general hospital on the island of Gozo.

The Department

The department of General and Vascular surgery is one of the largest departments at the Mater Dei hospital. The department includes a number of disciplines including, Breast Surgery, Emergency Surgery, Endocrine Surgery, Lower GI surgery, Upper GI surgery and Vascular surgery.

One must note that there are other surgical specialities which are independent from this department, these include cardiac surgery, gynaecology, orthopaedic surgery, otolaryngology, ophthalmic surgery, paediatric surgery, plastic surgery and Urology.

The department of General and Vascular Surgery offers a number of services in different parts of the hospital. After a patient is referred from a family doctor or other specialists, patients are seen in the outpatient department which can be found in the outpatients block. More urgent cases are seen at the accident and emergency department. Patients are cared for on the wards of Mater Dei and very often begin their stay at the Surgical Admissions Unit in the orange block.

The theatres at Mater Dei offer emergency surgery as well as planned operations. A number of these cases happen as day cases. General surgeons also carry out procedures in the endoscopy department. These may be as diagnostic or else as therapeutic procedures.

It must be said that modern medicine encourages healthcare staff to communicate and work as a team. The department of surgery holds multidisciplinary meetings with the other medical specialities where complex cases are discussed and treatment is planned. The surgeons also work hand in hand with the department of anaesthesia which offers the anaesthetic support to surgical operations and also runs the ITU (Intensive Therapy Unit). The department also runs its very own HDU (High Dependency unit).

Education, Training and Research.

The department of general and vascular surgery employs a spectrum of doctors. Following graduation young doctors carry out a foundation programme where they work in a number of departments in the hospital. These young doctors have an important role in the surgical teams. Following that, doctors interested in surgery apply to work as basic specialist trainees, where they rotate within the surgical departments. Following this period these junior surgeons choose to specialise in a branch of surgery and become higher specialist trainees in a surgical speciality.

As medicine has become more complex towards the end of the specialisation period, the surgeons are encourage to further focus their skills on a subspeciality and offered fellowships in these fields in foreign institutions.

The department carries out regular training and examinations. The surgeons sit for European and British examinations and these exams are being held in Malta. The local trainers are supported by a network of overseas specialists who participate in the training and examinations.

Doctors who have completed their training also keep up to date with masterclasses, scientific meetings and conferences. The surgical department regularly review new research at the journal clubs and also holds mortality and morbidity meetings and conferences in conjunction with the Association of Surgeons of Malta.

As a major national hospital many procedures are carried out at the Mater Dei hospital in the Department of General and Vascular surgery and these vary from the most routine to more complex procedures. The following are a number of common procedures carried out by the department of surgery. It is important that patients appreciate that even though an operation may be carried out on a number of people every year, every case is different in its own way.

Hernias

A hernia occurs when one of the walls of the body gives way and allows its contents to bulge out. This can happen in any part of the body but the most common are groin hernias, known as inguinal hernias and belly button hernias known as umbilical hernias.

These operations involve general anaesthetic where a surgeon finds the hernia and releasees it from surrounding tissues. Then, a special plastic mesh is placed to reinforce the body wall and prevent it from happening again for groin hernias.

The majority of these operations take place in an open fashion with an open wound. However, some cases are amenable to key hole surgery. The number of cases being treated by keyhole surgery is increasing however one must note that not all hernias can be treated in this way.

Cholecystectomy

The gall bladder is a part of the biliary tree of the liver which collects juices that digest our food. Sometimes this reservoir is problematic and start to get inflamed. This warrants that the gall bladder is removed. Although the gall bladder has a role in the digestion of food, patients can have their gall bladder removed and have a perfectly normal life. The majority of these cases can be treated by key hole surgery.

Appendicectomy

A number of us have had our appendix removed. This organ is peculiar in its function but can cause serious problems if not dealt with when it becomes inflamed. A number of these cases are operated in a key-hole fashion but in some cases, it is necessary to use an open up with a larger incision. People who have their appendix removed can lead a normal life.

Endoscopy

Surgeons also carry out procedures using fibre optic tubes. These include colonoscopies where the large bowel in inspected and stomach endoscopies known as oesophagogastroduodenoscopy (OGD). In these cases, the patient is given some drugs to be asleep or sedated while the procedure is carried out. Usually the patient is able to come in and go home on the same day. However, some patients require preparation this may include special diets and laxatives. Also, some people on anticoagulants or patients who are diabetics might need a different preparation.

Key-hole and robotic surgery

Local surgeons keep up to date with advances in surgery and medicine. They do so by attending courses, scientific meetings, bringing trainers from overseas or at times spending time at other institutions overseas.

Key hole surgery, known as laparoscopic surgery is a technique where a number of small holes are made and the surgeon operates with a fibre optic camera. At the Mater Dei many operations take place in this way and this equipment is updated regularly. The main advantage is the lack of a large surgical scar and hence a faster recovery. However, it must be said that not all surgeries can be done using this technique and open surgery may be more appropriate.

Robotic surgery is another technique where the surgeon controls a robot rather than directly operating on the patient. Robotic surgery allows for more complex surgery to be done as key hole surgery. Currently robotic surgery has been introduced for upper GI and lower GI cancer surgery and the service is expected to expand over the coming years as more surgeons get the necessary training.

Other procedures.

Advances in imaging techniques allow some procedures to take place with support from ultrasound and X-rays. Surgeons at times liaise with the x-ray and ultrasound specialists called the radiologists to carry out these interventions.

Some surgeons as well as gastroenterologists also carry out some procedures relating the liver and and digestive system. For example, they may clear the tubes of the liver and gall bladder from stones using a technique called ‘ERCP’.

Career in Surgery

Surgery is an extremely enjoyable, intellectually demanding and satisfying career. Many surgeons say that they enjoy the intellectual challenges of their job combined with its positive and active approach to treating disease and using their hands. Performing an operation and seeing a patient’s life improve almost immediately is very satisfying.

Those who apply for a career in surgery have to be ready to learn a lot and also have the right personality for the job. To be successful in surgery you need to have these skills and qualities:

  • Specialist knowledge to enable you to make an accurate diagnosis
  • Good communication skills to communicate with patients and their relatives, other members of the firm and other healthcare professionals
  • A bright, eager mind, passionate and enthusiastic about your work
  • Manual dexterity and physical skills
  • Ability to adapt to changing environment and learning new skills and techniques
  • Leadership skills
  • Maturity and empathy to make the right decision for the individual patient
  • The ability to inspire confidence in others
  • Emotional resilience and the ability to support your team in difficult circumstances and a willingness to work hard

Surgery in Malta today, and the future

Maltese surgery has an illustrious history leading back to Michel’Angiolo Grima in the times of the Knights of St John.

The present is an exciting time. We have established handover meetings, weekly journal clubs, monthly protected time teaching sessions, mortality and morbidity meetings and several multidisciplinary team meetings which all improve levels of patient care and teaching for trainees.

Audit and research are increasing with several presentations and publications and many trainees are studying for Masters or PhD.

We are experiencing a dramatic rise in laparoscopic procedures and we have invested heavily in equipment and simulators.

We have five postgraduate training coordinators who are organising teaching activities, trainee assessments and other educational activities.

The department of general and vascular surgery encourages training abroad in centres of excellence and we have links and memorandums of understanding (MOU) with various centres in the UK and other countries, in co-operation with the Postgraduate Training Centre and the Association of Surgeons of Malta. This is important so that senior trainees will gain experience in their field in large volume centres.

We are working on digitising our medical records to allow for clarity of documentation, easy access to medical notes and improvement in delivering care to our patients.

Career prospects

There are openings for trainees to progress in their career as there are still vacancies at trainee and RS level and several consultants will retire over the next few years. Also BST training can lead you on to a career in branches of general surgery e.g. Breast, Upper and Lower Gastrointestinal, Pancreatic, Bariatric, Endocrine, Emergency and other surgical specialties; Orthopaedics, Urology, Vascular, Plastics, Otolaryngology, Neurosurgery, Cardiothoracic surgery, Paediatric surgery etc.

What to do if you are interested in a career in surgery

If you are interested in joining our dynamic team please come and talk to one of the training co-ordinators. If you have the qualities to become a surgeon and you are interested I would like to encourage you to apply for the BST posts that are published yearly.

The department of surgery encourages its team members to participate in research and development. This covers a spectrum of work. Research projects are coordinated by the lead in Surgical research. Research projects are done either as an institution or in collaboration with other institutions. The results of research projects are presented in local as well as international conferences. Many of our trainees study for Masters and /or PhD and contribute actively to the department’s research portfolio. The department also collaborates with the University of Malta as well as other international universities.

One way of ensuring good quality care to or patients is to audit our work. Audit projects are carried out regularly by our trainees under the supervision of specialists within the department. The audits are coordinated by the lead in audit, guidelines and standards in surgery. Audit results are presented in our audit meeting.

Over fifty-eight thousand operations were carried out at Mater Dei in in 2023 and this represents a steady increase since the hospital opened in 2007. In 2023, just over twenty-five thousand of these were carried out by the department of surgery which includes general surgery, ear nose and throat surgery, paediatric surgery, urology, plastic and burns surgery, maxillofacial and vascular surgery. The rest of the hospital’s operations are carried out by other departments such as orthopaedics surgery, gynaecology and obstetrics gastroenterology, and ophthalmology.

These procedures include diagnostic operations such as colonoscopies. Just under five thousand of these were performed in 2023. Over a thousand hernias are operated every year with more than one thousand three hundred of hernia procedures being carried out in 2023. On the other hand complex operations such as kidney transplants occur in much smaller numbers.