Background: Surgeons undertake diverse roles in clinical practice, administration, education, research and innovation. These responsibilities can give rise to conflicts of interest when personal, financial or professional interests intersect with the fundamental obligations to patient care, research integrity and ethical conduct. While conflicts of interest are inherent in modern surgical practice, inadequate recognition and management risk undermining ethical decision-making and public confidence in the profession. Current frameworks provide general principles but lack practical guidance to support the identification, disclosure, and management of these conflicts of interest. Objective: To review existing literature and policies addressing conflicts of interest in surgery and provide a structured framework to support surgeons and institutions in identifying and managing conflicts of interest. Methods: A comprehensive literature search was conducted using PubMed, Embase and Scopus databases to identify publications addressing conflicts of interest in surgical practice, including clinical practice, research, innovation and industry collaboration. Policies from surgical specialty colleges in Australia, Canada, Ireland, the United Kingdom, and the United States of America were also reviewed to assess definitions, disclosure procedures, and management strategies. Conclusions: Conflicts of interest are an inherent aspect of modern surgical practice. However, existing policies often lack practical, context-specific guidance to address these conflicts. A structured process involving identification, disclosure, evaluation and risk assessment, management, monitoring and ongoing transparency and accountability should be adopted to uphold professional integrity, support ethical decision-making, and maintain public trust within surgical practice.