Dr. Orvar Swenson and the Pull-Through.

Dr. Orvar Swenson is best remembered for developing the Swenson pull-through, a technique he developed to treat Hirschsprung's disease. After graduating from Harvard Medical School and beginning his residency at Peter Bent Brigham Hospital, Dr. Swenson observed that patients with Hirschsprung's disease and toxic megacolon resumed normal bowel function after placement of transverse colostomies. His observation led to studying the patency of his patients' colons using barium enema contrast studies. At the collapsed portion of the colon, he performed rectal biopsies leading to the discovery that the cause of Hirschsprung's disease is that the collapsed portion of the colon lacks the Auerbach plexus. The Swenson pull-through removes this aganglionic portion of the colon and cures the patient. His career grew from there as he traveled to academic institutions teaching his technique. He is remembered fondly for his contributions to pediatric surgery through the restructuring of pediatric surgery departments, pediatric surgery research, and writing and editing multiple volumes of Pediatric Surgery, the standard textbook for pediatric surgeons. He died peacefully in 2012 at the age of 103 years.

Overview of single-port laparoscopic surgery for colorectal cancers: past, present, and the future.

Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilization of a camera without a separate external light, and instruments with different lengths has brought the favorable environment for SPLS. However, performing SPLS still creates several hardships compared to multiport laparoscopic surgery; a single-port system inevitably leads to clashing of surgical instruments due to crowding. To overcome such difficulties, investigators has developed novel concepts and maneuvers, including the concept of inverse triangulation and the maneuvers of pivoting, spreading out dissection, hanging suture, and transluminal traction. The final destination of SPLS is expected to be a completely seamless operation, maximizing the minimal invasiveness. Specimen extraction through the umbilicus can undermine cosmesis by inducing a larger incision. Therefore, hybrid laparoscopic technique, which combined laparoscopic surgical technique with natural orifice specimen extraction (NOSE)--i.e., transvaginal or transanal route-, has been developed. SPLS and NOSE seemed to be the best combination in pursuit of minimal invasiveness. In the near future, robotic SPLS with natural orifice transluminal endoscopic surgery's way of specimen extraction seems to be pursued. It is expected to provide a completely or nearly complete seamless operation regardless of location of the lesion in the abdomen.

History of hysterectomy: a significant problem for colonoscopists that is not present in patients who have had sigmoid colectomy.

PURPOSE: During colonoscopy, it is often difficult to traverse the sigmoid colon in patients who have had a hysterectomy, presumably due to postsurgical pelvic adhesions. We performed this study to document this difficulty and to determine whether sigmoid colectomy prevents it. METHODS: Data were acquired from a single endoscopist's prospective database. Colonoscopies performed in women were grouped according to history of hysterectomy and/or sigmoid colectomy. Groups were compared for colonoscopy completion rate, medication used, and time of examination. Participation of fellows and rate of complications were recorded. Patients with a history of abdominal-perineal resection of the rectum were excluded. RESULTS: From 1989 to 2006, a total of 4116 colonoscopies were performed in women: 993 had undergone hysterectomy (24.1%), of whom 108 (10.9%) had also undergone sigmoid colectomy. There were 3123 exams in woman who had their uterus (75.9%); 320 (10.2%) had undergone sigmoid colectomy. Patients who still had a sigmoid colon but had a history of hysterectomy had significantly lower colonoscopy completion rates (89.2%) and significantly longer mean examination time (28.9 +/- 12.3 minutes), and more of them required sedation with benzodiazepines (88.7%) than the other groups (P < .05). Fellow participation increased time of colonoscopy and complications were more frequent in patients with hysterectomy. CONCLUSION: Posthysterectomy adhesions to the sigmoid colon make colonoscopy more difficult and more painful. These adverse effects are not present in hysterectomized women who have undergone sigmoid resection.

[An outline of history of rectal surgery]. / Zarys rozwoju chirurgicznego leczenia raka odbytnicy.

An outline of the history of rectal surgery since the XIX century to the present day has been presented. Evolution of the opinions in rectal surgery have been recalled. Development of surgical technique has been presented. Technical achievements in surgery, which pushed possibilities of surgical treatment in rectal cancer patients, has been described.