Surgical Trends and Time Frame Comparison of Surgical Types of Hysterectomy: A Nationwide, Population-based 15-year Study.

STUDY OBJECTIVE: To investigate the surgical trends among different types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) over a 15-year period in Taiwan. DESIGN: A retrospective cohort study. SETTING: A population-based National Health Insurance Research Database. PATIENTS: Women undergoing various types of hysterectomy for noncancerous lesions. INTERVENTIONS: Data for this study were extracted from the inpatient expenditures by admissions files of Taiwan's National Health Insurance Research Database from 1998 through 2012 and divided into three 5-year time frames: first (1998-2002), second (2003-2007), and third (2008-2012). The variables included types of hysterectomy, patient age, gynecologist age and sex, hospital accreditation level, and surgical volume. Chi-square and trend tests were used to examine the association between the variables. MEASUREMENTS AND MAIN RESULTS: A total of 329 438 patients who underwent various types of hysterectomy were identified; 306 257 were included in the study. During the 15-year period, 45% underwent total abdominal hysterectomy, 41% underwent laparoscopic hysterectomy (LH), 9.8% underwent vaginal hysterectomy, and 4.2% underwent subtotal abdominal hysterectomy. The frequency of LHs increased from 35.9% in the first period to 43.9% in the second period and remained at 44.2% in the third period. During the same time period, there was a decrease in the frequency of total abdominal hysterectomies. Typically, younger patients underwent LHs by gynecologists with large volume surgical practices and medical centers. CONCLUSION: This 15-year study describes an increase of LHs and subtotal abdominal hysterectomies over time and provides evidence of surgical trends and a paradigm shift of hysterectomies. Surgical skills and performance extended from high- to low-surgical volume gynecologists and from medical centers to regional and local hospitals. This shift may have a great influence on patient and health care provider choice of treatment.

Lesiones quísticas pancreáticas. Origen y evolución histórica / Cystic pancreatic lesions. Origin and historical evolution

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Adopción de la laparotomía exploradora como tratamiento del trauma abdominal penetrante durante la Primera Guerra Mundial (1914-1918) / Adoption of exploratory laparotomy as a treatment of penetrating abdominal trauma during the First War World Cup (1914-1918)

La laparotomía exploradora continúa siendo el tratamiento estándar para el trauma abdominal penetrante desde la Primera Guerra Mundial (1914-1918). La conducta conservadora de finales de siglo XIX y principios del XX evolucionó a la intervencionista. Los cirujanos de los servicios sanitarios aliados de la Gran Guerra reconocieron la importancia de la intervención precoz, ejecutaron las primeras celiotomías exploradoras del hemisferio occidental de manera estandarizada y disminuyeron la mortalidad por este tipo de heridas. La retroalimentación entre la experiencia civil y militar en la terapéutica quirúrgica ha permitido la incorporación de avances en el tratamiento de este tipo de lesiones.(AU)

The exploratory laparotomy for penetrating abdominal trauma is the main treatment since the First World War. The conservative management was changed since the end of the century XIX and initial of the century XX to intervention. The allied surgeons of Great War applied the immediate surgical explorations, made the firsts celiotomies in Western Hemisphere and descended the mortality for this kind of patology. The symbiosis between the civil and military experience contribute to contemporary advances in this kind of surgeries.(AU)

The Hidden Story of Innovation: Charity Hospital, Angola Prison, and the Challenging of Surgical Dogma.

The late 1960s was a period of significant upheaval of social, cultural, and scientific norms. The generally accepted notion of mandatory laparotomy for all penetrating abdominal injuries was among those norms being called into question across the country and many advocated expectant management of selected patients presenting with this type of injury. Leaders of the surgical community published opinions on either side of the argument. The house staff at Charity Hospital during this period was among the busiest in the nation in treating these injuries, many of them inmates of the Louisiana State Penitentiary who used self-inflicted stab wounds to the abdomen as a means of temporary respite from the inhumane conditions in the prison. Inspired, in part, by the overabundance of negative laparotomies among this group, F. Carter Nance went on to systematically challenge the standard of care. This effort constitutes one of the major forces for change of the surgical dogma of mandatory laparotomy for all abdominal stab wounds. It is the first major study to show conclusively that delayed laparotomy for perforated viscous was not significantly detrimental and posed less of a risk than unnecessary laparotomy. The circumstances surrounding this initiative constitute a powerful and heretofore unknown chapter in the history of surgical innovation.

[History of trauma care]. / Istoria îngrijirii pacientului traumatizat.

BACKGROUND: Since its inception, the man suffered injuries through falls, fire, drowning and interpersonal conflict. While the mechanism and frequency of different specific injuries has changed passing of millennia, trauma remains an important cause of mortality and morbidity in modern society. Although the war is presented as one of the four knights of the Apocalypse, we must emphasize the important developments of surgical experience during war. The purpose of this study is to highlight the lessons learned during the history and how they changed the modern trauma care. METHOD: Systematic review of English language literature using computer searching of Library of Medicine and the National Institutes of Health International MEDLINE database using PubMed Entre interface. RESULTS: The first historical record of a trauma medical care is 3605 years ago. Over the past decades, one of the most important changes in trauma patient care is the selective nonoperative management (SNOM) of significant abdominal visceral injuries. SNOM was first described in 1968, for splenic trauma, by Upadhyay and Simpson. It was accepted much later for liver injuries. Beginning from 1960 - 1970, SNOM was introduced for abdominal stab wounds. Exploratory laparotomy remains the standard approach for abdominal gunshot wounds until 1990, when centers from United States and South Africa first reported cases successfully managed nonoperatively. CONCLUSIONS: The trauma surgery has evolved continuously over the centuries, according to more and more severe modem injuries.

[Inguinal hernia repair: an experimental study on mesh migration with the tension-free suturless technique. 10 year follow-up]. / Ernioplastica inguinale: studio sperimentale sulla mobilità protesica con tecnica tension-free suturless. Follow-up a dieci anni.

AIM: Can the tension-free suturless technique, used in the surgical treatment of inguinal hernia, to be the gold standard for treatment of inguinal hernia? METHODS: The tension-free suturless technique is often criticized as a fundamental principle: do not have suture. The criticism stems from concern that the mesh can migrate and cause damage to important anatomical structures. We conducted a study on the mobility of prosthesis on 33 patients, by using titanium clips that we have fixed on the meshes corner, X-rays over time, done at last, a follow-up of ten years. RESULTS: The study shows that the prosthesis moves together with the anatomical space in which there is the forces present in the inguinal canal: gravity, intra-abdominal pressure, reactive force ascending gait. Across thirty-three patients have relapsed in the first six months and two recurrences in ten years, in the reconstitution of the neo-orifice, through which passes the cord. In the remaining patients the mesh were relocated upward and medially (as identified by the clips of the increase of 10-15%). CONCLUSION: Our study shows that the mesh migrates upwards and medially. Migration is more or less, depending on the patient's age and quality of its tissue. Fix the prosthesis is good practice to secure at the flag on the inguinal ligament leads to two advantages: not to frustrate the principle tension-free, since the fixed prosthesis on one side does not create moments of tension, and prevent the prosthesis returns to the opening road to relapse.

[Influence of anesthesia and antisepsis on the earliest gynecologic laparotomies: historical notes on the bicentennial of the introduction of ovariectomy]. / Influencias de la anestesia y antisepsia sobre las primeras laparotomías ginecológicas. Notas históricas a propósito del 2do centenario de la introducción de la ovariectomía.

On the occasion of the bicentennial of the first ovariectomy, we reviewed the beginnings of abdominal gynecologic surgery in Spain in order to shed light on aspects that are still unclear in medical historiography and that are often wrongly presented. We consulted a large number of sources that allowed us to follow events in the last quarter of the nineteenth century, discovering information we consider definitive and that confirmed our initial hypotheses. The work of Dr Federico Rubio, the first to perform an ovariectomy in Spain, is highlighted among the early experiences of our Spanish surgeons. Emphasis is placed on the high mortality rate associated with this operation at the beginning. We also analyze the problems of anesthesia and antisepsis and the influence of each on the surgical procedure. The events uncovered were the work of a group of forward-thinking surgeons who made considerable progress against opposing groups with more conservative views and whose contributions to Spanish surgery were far less brilliant.

Influencias de la anestesia y antisepsia sobre las primeras laparotomías ginecológicas. Notas históricas a propósito del 2º centenario de la introducción de la ovariectomía / Influence of anesthesia and antisepsis on the earliest gynecologic laparotomies: historical notes on the bicentennial of the introduction of ovariectomy

Con motivo del segundo centenario de la primeraovariectomía, hemos realizado este trabajo con el propósitode revisar los comienzos de la cirugía ginecológicaabdominal en España, a la vez que se pretende esclareceralgunos aspectos históricos que aparecen en nuestrahistoriografía médica no perfectamente claros y, muchasveces, tergiversados. Se analiza una importante bibliografíaque nos permitió hacer un seguimiento a lo largodel último cuarto del siglo XIX, proporcionándonosdatos que consideramos definitivos y que confirmaríannuestras suposiciones iniciales. Se hace hincapié en lalabor del Dr. Federico Rubio cómo iniciador en Españade la operación de la ovariectomía, así como de las experienciasprimeras de nuestros cirujanos; destacando lagran mortalidad de esta operación durante estos primerosensayos. También se analizó el problema de la anestesiay de la antisepsia, y la influencia que ambas tuvieronsobre esta cirugía, resaltando la labor de un grupode cirujanos de nueva mentalidad que con el auxilio deestos medios, lograron éxitos notables en contraposicióna otros, que anclados en el pasado, escribían una páginade mucho menos brillo en nuestra cirugía(AU)

On the occasion of the bicentennial of the firstovariectomy, we reviewed the beginnings of abdominalgynecologic surgery in Spain in order to shed light onaspects that are still unclear in medical historiographyand that are often wrongly presented. We consulted alarge number of sources that allowed us to follow eventsin the last quarter of the nineteenth century, discoveringinformation we consider definitive and that confirmedour initial hypotheses. The work of Dr Federico Rubio,the first to perform an ovariectomy in Spain, ishighlighted among the early experiences of our Spanishsurgeons. Emphasis is placed on the high mortality rateassociated with this operation at the beginning. We alsoanalyze the problems of anesthesia and antisepsis andthe influence of each on the surgical procedure. Theevents uncovered were the work of a group of forwardthinkingsurgeons who made considerable progressagainst opposing groups with more conservative viewsand whose contributions to Spanish surgery were farless brilliant(AU)

The ancient technique of "gastrorrhaphy".

OBJECTIVE: The paper describes "gastrorrhaphy," deriving from the Greek words "gastir" meaning "abdomen" and "rhaphy" meaning "suturing," which was a technique used for the treatment of abdominal wounds. METHODS: The technique is described in detail in the texts of Celsus (first century A.D.) and in those of Galen (second century A.D.). Furthermore, references were found in Oribasius' texts (fourth century A.D.) and in the writings of two veterinarian doctors of the same period. We provide our drawings in order to elucidate the different techniques of suturing. RESULTS: Celsus described one method of "gastrorrhaphy" while Galen presented two different methods for this procedure. All three methods agree on the processes required: replacement of the prolapsed viscera, cleaning of the wound, and suturing. The difference in methods is in the way of suturing the wound; Celsus suggests stitches in layers. While Galen's first method refers to stitching of the peritoneum with the abdominal wall, his second method refers to stitching of similar structures, meaning peritoneum to peritoneum and abdominal wall to abdominal wall. CONCLUSIONS: Celsus' method strongly resembles stitching in layers with cross-sutures, while both of the Galenic techniques of gastrorrhaphy are versions of the full-thickness sutures used nowadays. It should be stressed out that Galen's methods of "gastrorrhaphy" were used by Andreas Vesalius and Ambroise Paré many centuries later.