Knowledge of ancient Hindu surgeons on Hirschsprung disease: evidence from Sushruta Samhita of circa 1200-600 BC.

BACKGROUND: Congenital megacolon is eponymously named after Harold Hirschsprung, who accurately described the clinical features in 1886. Recent research revealed that this condition is perhaps well known for centuries before him. AIM: This article is intended to examine if ancient Hindu surgeons knew about congenital megacolon. METHODS AND MATERIALS: Sushruta Samhita is an ancient tome of Ayurvedic surgery compiled by Sushruta (circa 1200-600 bc). Passages of interest were identified by browsing the authentic English translation of the compendium. Accuracy of translation was verified by comparing to the original Sanskrit verses with the help of a Sanskrit scholar. RESULTS: A condition called Baddha Gudodaram, described in the Samhita, closely resembles Hirschsprung disease. There are indications that ancient Indians even deciphered the etiology as defective vayu alias vata (nerves). Although the ailment was considered incurable, a palliative operation has been discussed. Descriptive details of the operation match with that of sigmoid colostomy. CONCLUSION: Evidence from Sushruta Samhita indicates that Hindu surgeons of prehistoric India probably had considerable knowledge about Hirschsprung disease. Further research, corroborating other sources of evidence, is required to confirm this claim.

How did the surgeons treat neonates with imperforate anus in the eighteenth century?

Anorectal malformations (ARMS) are one of those challenging topics of pediatric surgery. The developments in assessing and approaching patients with these anomalies have been made in the last decades and the methods described in older textbooks functioned as a guide in planning these attempts (Kiely and Peña in Pediatric surgery, Mosby, Missouri, pp 1425-1449, 1998; Grosfeld in Anorectal malformations in children, Springer-Verlag, Berlin, pp 3-15, 2006). The aim of this study is to present the attitude of a surgeon of eighteenth century to the treatment of anorectal malformations, and the evolution in the history of the anomaly. The part about imperforate anus in a textbook of surgery, found in a second-hand bookstore, was translated. The description and the classification of the anomaly, the methods of approaching these cases together with some case reports were presented and compared with today's practice. The historical background of the anomaly was evaluated not only with regard to the book of Heister specifically but also to the other data obtained in the literature. The anomaly was reported to be "not rarely" observed. The obstetricians were warned to examine a newborn baby completely for early diagnosis. The classification of the anomaly was made according to the properties of the membrane covering the anus but prompt treatment, initiating with its simple excision, was suggested in all types. Better results in cases whose anus was covered with a thin, delicate membrane were reported. The results show that routine neonatal examination for all babies was recommended in this Textbook of Surgery which had been published 260 years ago. The physical deterioration due to delay was well described. A broad classification of imperforate anus was made and successful outcome in low-type anomalies of today was reported with some case samples. It is clear that all the efforts starting from Soranus until today improved the understanding of the anomaly. Combining previous information with today's practice in the meetings focused totally on anorectal malformations, where the leading surgeons shared their experiences and re-evaluated the problems encountered, enlightened the future status of this interesting topic of pediatric surgery.

[Hartmann 's procedure. A 30 years one-centre clinical experience]. / Operatia Hartmann. Evaluarea unei experiente clinice de 30 de ani.

Henri Hartmann described in 1921 a resection procedure for extended neoplasma of the rectosigmoid junction, in patients who were not eligible for a primary anastomosis. Since then, the technique has been widely applied and well studied. We present a 30 years one-centre clinical experience, with a total amount of 221 patients, in 3 different series. The last series had 65 patients, operated in our clinic between 2000 and 2007. 60 of them had malign tumors of the rectum and colon, while 5 patients had benign diseases. We analysed the surgical indication, the technique details and the evolution. 49 patients had a favourable evolution, 13 of them had different complications and 3 other patients deceased. The reversal of Hartmann's procedure was possible in 24 patients. The method used by us in order to increase the safety of these re-anastomosis was the trans-anastomotic tube, which avoids a protective ileostomy or colostomy.

Ileostomy and colostomy support groups.

The first organized ostomy support group in the world was formed at The Mount Sinai Hospital, in 1950, through the efforts of a surgeon and the patients themselves. Later, similar groups were set up in other locations and some even took the name of Mount Sinai's first such society (QT). These groups had two major functions: Psychological: reassurance and understanding from other ostomates before and after the operation; advice on how to deal with oneself and others. Educational: instruction on the details of stoma management; information for surgeons on the proper location and other details of fashioning a stoma; information to the public on the existence and needs of ostomates. In order to extend services to more people and with more individual attention, a special clinic was established at The Mount Sinai Hospital devoted entirely to patients with ileostomy and colostomy. It too was the first of its kind anywhere. Years later, two surgeons arranged an all-day convention of the ostomy groups in the greater New York City, New Jersey, and Connecticut areas, at the New York Academy of Medicine. At the convention, the idea of a national society was conceived. In the following years - in Detroit, then Cleveland, and finally Los Angeles - the United Ostomy Association was developed, structured, and incorporated. The educational uses of the ostomy groups were later supplemented and partly replaced by enterostomal therapists who originally were trained and practiced in Cleveland. Now the therapists, the societies, and the ostomates themselves are available to patients with various types of stomas, whether recent or longstanding, before and after surgery.

The present role of colostomy in the management of trauma.

The role of colostomy in the treatment of abdominal trauma has changed over the past several decades. Primarily as a result of its successful use in military settings, colostomy initially was the mainstay of treatment for penetrating injury to the colon, rectal injury, and some forms of blunt trauma. Subsequent civilian experience with the techniques of primary repair of penetrating colon injury resulted in a decrease in the number of colostomies performed. Coupled with this experience, early data on adverse outcome from colostomy closure tended to support the trend of the ever-diminishing place of colostomy for trauma. Colostomy has always been used for two purposes in trauma care: prevention or arrest of fecal contamination of the peritoneal cavity and diversion of the fecal stream. Despite the decreased need for colostomy in some forms of penetrating colon injury, there are several conditions that still utilize colostomy to accomplish one or both of these purposes. Indications for colostomy can now be regarded as absolute or relative depending upon the need for diversion or the requirement to prevent contamination. There are relatively few contraindications to colostomy use. Present results of colostomy closure do not represent excessive risk to the patient and should not impact negatively on the decision to perform a colostomy for trauma.

Securing the loop--historic review of the methods used for creating a loop colostomy.

Loop transverse colostomy is a procedure that has been traditionally employed on a temporary basis for a number of indications, but, with improvement of intestinal suturing and stapling techniques, the applicability of this modality has become quite limited. This paper addresses the issue of securing the loop and traces the history of the development of this method to decompress the bowel, to divert the fecal stream, and to defunctionalize the distal colon.