Surgery, fame, and misfortune: the life of Bronislaw Kader.

Bronislaw Kader (1863-1937) introduced one of the traditional methods of gastrostomy. He was a Polish doctor who had been trained by such eminent surgeons as Ernst von Bergmann, Otto E. Küstner, Jan Mikulicz, and Eduard von Wahl. The Kader method implies blunt division of the left rectus muscle and opening of the stomach by a very small incision. A drainage tube is then inserted and fastened to the stomach wall by a stitch. Next, the stomach wall is sutured to the abdominal wall in a manner that places the tube in a tunnel surrounded by serosa. In comparison to others, Kader's method of gastrostomy was considered simpler, cheaper (fewer stitches), speedy, and safe. Although recommendations to perform gastric fistula were limited at the time, the value of gastrostomy remains undisputable. This is a method of choice for securing alimentation in cases of intractable stenosis of the pharynx or esophagus, which are usually due to cancer, chemical burns, trauma, or congenital defects. Nowadays, it is performed endoscopically or laparoscopically. This article presents the life history of Bronislaw Kader, the eponymous of this method and a gifted surgeon who lost his eyesight at the height of his fame.

The history of surgically placed feeding tubes.

Although supplemental enteral nutrition may have first been delivered by enema, the modern era of surgically placed feeding tubes began in the mid to late 1800s. Early procedures were generally disastrous, however, techniques rapidly improved. The basic techniques of surgical enteral access have not changed significantly in the last century, although endoscopic, radiologic and laparoscopic modifications have been described and adopted in the last 25 years. This article reviews some of the landmark surgical highlights in the United States and European literature regarding surgical enteral access.

The permanent gastrostomy. Use of the gastrointestinal anastomotic stapler.

A permanent feeding gastrostomy was quickly and simply constructed in 29 patients with low operative risk using the gastrointestinal anastomotic stapler. The technique consisted of a simple application of this stapler on a carefully selected section of the stomach to form a Janeway type of gastrostomy. Activation of the device placed two double rows of staples and cut between them. This left the mucosa in approximation both in the tube and in the body of the stomach. A few additional Lembert sutures was all that was necessary. There were no suture line leaks nor other complications peculiar to the method.

Surgery for carcinoma of the thoracic esophagus: Adams and Phemister in perspective.

Although carcinoma of the thoracic esophagus was well known by the early nineteenth century, surgical removal of these tumors was stifled for several reasons. The pioneer work of Drs. Adams and Phemister was a major step in the development of an esophagogastrectomy that is still performed.

El arte de la cirugía pancreática. Pasado, presente y future / The art of pancreatic surgery. Past, present and future. The history of pancreatic surgery

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[The history of the treatment of chronic duodenal ulcer]. / Historia del tratamiento de la úlcera duodenal crónica.

The author reviews the treatment of duodenal ulcer from its beginnings with gastroenterostomy one hundred years ago. He points out that treatment has changed as it was better understood that hypersecretion of acid was an important ulcerogenic factor. The Sippy regime, with diet and alkali to neutralize acid, and the resection and vagotomy were introduced. He discusses some aspects of the history of these therapies in Panama and points out the importance of the introduction of H2 receptors blocker and other drugs still under investigation.

Trinta anos de gastrostomia endoscópica percutânea: uma revisão da literatura / Thirty years of percutaneous endoscopic gastrostomy: A review of literature

Há trinta anos, Gauderer, cirurgião-pediatra, e Ponsky, endoscopista-pediatra, desenvolveram a gastrostomia endoscópica percutânea (GEP). A GEP apresenta como princípio a aproximação do estômago à parede abdominal, sem necessidade de sutura ou laparotomia, com a criação de uma abertura artificial no estômago. Ela tem se demonstrado método simples, seguro e efetivo de nutrição enteral por acesso gástrico e apresenta vantagens como baixo custo, menos tempo de hospitalização e menos morbidade quando comparada à gastrostomia tradicional. Tem sido amplamente utilizada na infância, principalmente em crianças com comprometimento neurológico e com impedimento à alimentação por via oral e como via de suplementação alimentarem doenças crônicas e debilitantes. As principais contraindicações incluem hipo albuminemia e distúrbios de coagulação. A antibiótico profilaxia com cefazolina uma hora antes do procedimento é obrigatória. A mais utilizada é a técnica pull (Gauderer e Ponsky) devido à sua simplicidade e segurança. As complicações da GEP são divididas em maiores e menores, sendo as últimas as mais comuns. É essencial que pacientes e familiares sejam bem-orientados sobre o procedimento...

Thirty years ago, Gauderer, a pediatric surgeon, and Ponsky, a pediatric endoscopist, developed percutaneous endoscopic gastrostomy (PEG). PEG is based on approximationof the stomach to the abdominal wall without the need of suture or laparotomy, creatingan artificial opening in the stomach. PEG has proven to be a simple, safe and effective enteral nutrition method by gastric access, providing advantages such as low cost, withshorter hospitalization and morbidity when compared to traditional gastrostomy. PEGhas been widely used in childhood, especially in children with neurological impairment that are unable to be orally fed and as form of supplementation in chronic and debilitating diseases. Major contraindications include hypoa lbuminemia and coagulation disorders. Antibiotic propylaxis with cefazolin an hour before the procedure is mandatory. Themost used technique is pull technique (Ponsky and Gauderer) due to its simplicity andsafety. Complications of PEG are divided into major and minor, the latter being the most common. It is essential that patients and families are well informed about the procedure...