[Surgical dogmas throughout history]. / Chirurgische Dogmen im Wandel der Zeit.

This article is a historical analysis of the role of dogmas and dogmatic thinking in surgery from the great pioneers and teachers of surgery of a hundred years ago to the present time. Medical knowledge applied schematically creates security and may benefit many patients, but when simplification and standardization degenerates into rigid dogma, creative thinking will be obstructed and the development of innovative concepts becomes difficult. In the old times of the 19th and early years of the 20th century, dogmas usually originated from the teaching of great and prestigious pioneers of surgery. Nowadays, dogmatic thinking may come as practice guidelines, protocols of consensus conferences and even from the interpretation of the results of prospective randomized studies. The author illustrates these thoughts by a number of examples taken from the history of surgery over the last one hundred years: The controversy between Sauerbruch's (under)pressurized chamber and the concept of intratracheal positive pressure ventilation and its influence on the development of thoracic surgery during the first half of the 20th century, the role of serendipity and undogmatic thinking in the development of damage control surgery towards the end of the 20th century, the fascinating history of two operations which kept their position as gold standard for almost a century, i.e. Halsted's radical mastectomy for breast cancer and the Miles operation for cancer of the rectum.

Septic complications after biliary tract stone surgery: a review and report of the European prospective study.

We report a prospective, controlled study of the incidence of septic complications following biliary tract stone surgery. This study included a total of 280 patients operated on in eight hospitals in various European countries. In this study the computer program "Surgery" was used. Of 280 patients, 77 (27.5%) were male and 203 (72.5%) were female. The age ranged from 20 to 92 years (mean 54.8 years); 78.9% of the cases corresponded to clean-contaminated surgery; 85% of the patients received antibiotic prophylaxis with cefazolin. Twenty-one patients developed postoperative septic complications (7.5%) of which 12 (4.3%) were wound infections; five patients (1.8%) had intra-abdominal infections. The wound infection rate was 3.2% in clean-contaminated surgery, 7.7% in contaminated and 20% in dirty (p < 0.02). In laparoscopic cholecystectomy the global rate of septic complications was 3.6% vs. 12.6% in open cholecystectomy (p < 0.01); 2.4% and 6.3% wound infection respectively. The mean age of patients who developed postoperative septic complications was 61.5 years and 54.2 years old who did not develop any complications (p < 0.03). The duration of the postoperative period was 5 days in patients without infection and 13 days in patients with infection (p < 0.0001). Two patients died, one of them (0.4%) caused by sepsis. In addition to the European prospective study, a review of the problems of sepsis in biliary surgery was carried out.

Nervous control of migratory myoelectric complex of the small bowel.

The effects on the migratory myoelectric complex (MMC) of transplantation of small bowel loops were investigated in miniature swine with chronically implanted bipolar electrodes. Four experimental models (A--D) were studied. In groups A and B, jejunal loops were either interchanged in sequence or transplanted to the ileum with preservation of intact neurovascular pedicles. In groups C and D, bowel segments were totally isolated and replanted in situ (group C) or as modified Thiry-Vella loops (group D). Weekly records of fasting myoelectrical activity were then taken. Group A and B animals showed reintegration of the transplanted bowel segments into a normal MMC sequence after a remodeling period. The replanted bowel segments of groups C and D displayed MMCs throughout the study period. The in situ replanted segments of group C were reintegrated into the normal sequence after a delay of 3--4 wk. These results indicate that the organization of the MMC is not solely determined by the extrinsic nervous system.