Purpose Coloniality in global health manifests as systemic, non-merit based inequalities that benefit one group at the expense of another. Global surgery seeks to insert surgery into the global health agenda; however, it inherits the biases in global health. Methodology We examined inequities in global surgery using a Delphi consensus-building process drawing on the literature and our lived experiences. Results We identified five categories of non-merit inequalities in global surgery: Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, with a lack of inter-professional and inter-specialty collaboration, incorporation of Indigenous medical systems, and sociocultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia), and profession (non-specialists, non-clinicians, patients, and communities). Benefits, such as funding, authorship, and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding, and standards creation. This naturalises inequities and masks upstream resource extraction. Conclusion Shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.