Blind alleys and dead ends: researching innovation in late 20th century surgery.

This article examines the fortunes of one particular surgical innovation in the treatment of gallstones in the late 20th century; the percutaneous cholecystolithotomy (PCCL). This was an experimental procedure which was trialled and developed in the early days of minimally invasive surgery and one which fairly rapidly fell out of favour. Using diverse research methods from textual analysis to oral history to re-enactment, the authors explore the rise and fall of the PCCL demonstrating that such apparent failures are as crucial a part of innovation histories as the triumphs and have much light to shed on the development of surgery more generally.

Black bile of melancholy or gallstones of biliary colics: historical perspectives on cholelithiasis.

Barely 130 years after its first description, cholecystectomies are among the most commonly performed surgeries in the USA. The success of this operation with subsequent technical improvements, such as laparoscopic approaches, caused a paradigm shift in the management of gallstone disease. However, symptoms persist in 10-40 % of successfully operated patients. Reviewing monographs, textbooks, and articles published during the last 300 years, several important factors emerge as likely contributors to limited or poor treatment responses. Early on, clinicians recognized that cholelithiasis is quite common and thus often an incidental finding, especially if patients present with vague or atypical symptoms. Consistent with these observations, patients with such atypical symptoms are less likely to benefit from cholecystectomy. Similarly, lasting improvements are more reliably seen in patients with symptoms of presumed biliary origin and documented gallstones compared to individuals without stones, an important point in view of increasing rates of surgery for biliary dyskinesia. While cholelithiasis can cause serious complications, the overall incidence of clinically relevant problems is so low that prophylactic cholecystectomy cannot be justified. This conclusion corresponds to epidemiologic data showing that the rise in elective cholecystectomies decreased hospitalizations due to gallstone disease, but was associated with a higher volume of postoperative complications, ultimately resulting in stable combined mortality due to gallstone disease and its treatment. These trends highlight the tremendous gains in managing gallstone disease, while at the same time reminding us that the tightening rather than expanding indications for cholecystectomy may improve outcomes.

[The death of Ignatius Loyola]. / De quoi Ignace de Loyola est-il mort?

A recent examination of a bilioportal fistula led us to suspect a link between this case and the death of Ignatius of Loyola. Realdo Colombo, professor of anatomy, eviscerated Ignatius prior to his embalming In his book De re anatomica, published in 1559, he wrote that he extracted stones from the portal vein of the venerable Ignatius. Before his death, Ignatius suffered from epigastric pain and fever (Monumenta historica societatis Jesu). Colombo latin text is difficult to interpret and the data are meager. Other possible causes of Ignatius' death include gastroduodenal ulcer, tuberculosis and hyperparathyroidism, but despite of rarity bilioportal fistula is the best guess.

[Duodenal intubation: present view (on the occasion of the 100th anniversary of duodenal intubation)].

The paper presents the proceedings on the Symposium on the Occasion of the 100th Anniversary of Duodenal Intubation" at the 9th Congress of the Scientific Society of Gastroenterologists of Russia. Particular emphasis is laid on the significance of the clinical and experimental studies-based scientific discovery made by V. A. Galkin and A. S. Chechulin--the Galkin-Chechulin effect (the 1957 priority) for the detection and treatment of prestone stages of cholelithiasis. The steps for improving the bile examination techniques at duodenal intubation (V. A. Galkin, L. S. Korzyuk, V. A. Maksimov, A. A. Ilyechenko) are described. Duodenal intubation as the method of choice for bile examination is proposed to be included into the mandatory diagnostic standards.

Breve historia del tratamiento de la litiasis vesical / Brief history of vesical lithiasis management

La litiasis vesical es una de las patologías más antiguas que conocemos. La historia de su tratamiento ha sido motivo de controversia en diferentes momentos. Desde las primeras tallas vesicales de Egipto o la India, hasta la litotricia de nuestros días se han producido muchos tratamientos intermedios. El objetivo de este escrito es conocer de manera somera algunos de estos logros y sus autores así como el desarrollo de los materiales que han contribuido a conseguirlo (AU)

Stones of the bladder are one of the oldest illness that we know. History of its treatment has been cause of discussion in different moments. Since first treatments in Egypt or India, until our extracorporeal shock waves lithotritia (ESWL), there have been many intermediate treatments. The objective of this work is to know a little about some of these advances and their authors, as well as the instruments that have made it possible (AU)

[Surgery of cholelithiasis: from past to present]. / Khirurgiia zhelchnokamennoi bolezni: ot proidennogo k nastoiashchemu.

Development of surgery of cholelithiasis is regarded. Classic surgical interventions on the gall bladder and bile ducts in complicated disease (acute cholecistitis, jaundice, cholangitis), postcholecistectomy syndrome, surgical trauma of the bile ducts are substantiated. To 1980s modern views on pathogenesis of the disease have been formed. However, unresolved problems of surgical policy, traumatism of open surgeries in complicated forms of the disease (postoperative lethality in acute cholecistitis was 37% and over) made results of treatment unsatisfactory. Correction of policy's problems, application of mini-invasive procedures, diapeutic approach and precision technique opened up-to-date period in surgery of cholelithiasis. It permitted to reduce postoperative lethality in acute and chronic course of the disease to 0.08 - 0.1%.

Classification and nomenclature of gallstones revisited.

Over the decades, there has been a great deal progress in the understanding of gallstones owing to the continuous efforts aimed at elucidating their pathogenesis. An optimal classification system is needed because the etiology, pathogenesis, clinical features and treatment can be different according to the classes. Currently, two systems are widely used: one from the National Institutes of Health (NIH)-International Workshop on Pigment Gallstone Disease held in 1981 and the other from Gallstone Research Committee from the Japanese Society of Gastroenterology in 1984. However, some stones cannot be classified into either of these categories. In addition, several terms have been not been clearly defined. In several aspects, both systems need to be reevaluated. This paper reviewed the classification systems and terms that are currently used for gallstones, and raises several points that need to be reconsidered. In the near future, large scaled prospective studies on gallstones need to be carried out on the basis of the external color, chemistry, cutting surface, etc. Only when these studies are completed can an ideal classification system for gallstones be expected.

[History of surgery for cholelithiasis: from the era of cholecystostomy to laparoscopic surgery].

Since Stalpert von der Wiel first incised the abdominal wall for bile drainage in a patient with an intraabdominal abscess due to gangrenous cholecystitis with calculi in 1684, the problems inherent in the treatment of cholelithisiasis have received attention from surgeons working in this field. However, the major event was the development of the technique of cholecystectomy by Langenbuch in 1882 opening a new era in surgery for cholelithiasis. Subsequently numerous advances were made in cholecystectomy, choledochotomy, choledochoenterostomy, and sphincteroplasty associated with progress in the diagnostic techniques and instrumentation necessary to perform surgery for cholelithiasis. However, the outcomes of these methods were criticized, and they were gradually abandoned due to development of minimally invasive endoscopic or laparoscopic surgery. The development of laparoscopic cholecystectomy revolutionized the history of biliary surgery. In the 21st century, the best treatment will be available to all patients with the use of ultramodern technologies such as telesurgery and robotic surgery.