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INTRODUCTION

Surgeons continue to have brilliant ideas and use amazing technology to bring safe and effective surgery to people all over the world, but it was not always so. The evolution of surgery to its present state has taken at least 200 years, and surgery is still evolving. Each of the many abdominal operations surgeons now performed has its own special history, from the idea that spawned it to the present state of its art. Abdominal operations were brought to fruition by innovative surgeons who carefully planned them and had the courage to perform them and the wisdom to modify and improve them.

Although the histories of all abdominal operations are interesting, a broader view of abdominal surgery puts those stories into perspective. The broader view is best obtained by asking: What enabled abdominal surgery to evolve to its present state? What were the barriers to the evolution of abdominal surgery? How were the barriers overcome, and who overcame them? Although recognizing the individuals who developed and perfected individual operations is important, the perspective of this chapter is on how modern abdominal surgery came about and how it was enabled.

THE EARLY PROBLEMS

Prior to the middle of the 19th century, few operations were done with the expectation that the patient would live and be cured of the disease for which it was performed. The fundamental barrier was the excruciating pain caused by opening the abdomen and manipulating its contents, even when tempered by the administration of alcohol or derivatives of opium such as laudanum and morphine. Patients often died from postoperative bleeding, dehydration, or malnutrition. But it was infection that was the bane of surgeons. Infections followed almost all operations. Wound infection and peritonitis were the killers of patients who had abdominal surgery. Without antibiotics or even standardized methods of dressing infected wounds, the consequences of infection were disastrous. Except in a few isolated instances, physicians knew that surgery was not a realistic therapeutic option until infection, hemorrhage, dehydration, and malnutrition could be alleviated or eliminated. Remarkable progress was made during the second half of the 19th century, enabling surgeons to bring hope to a large number of patients with diseases or conditions that swiftly became amenable to surgery.

ANESTHESIA

The modernization of abdominal surgery was dependent on the patient’s loss of sensation, anesthesia, during the procedure. The development of anesthesia eliminated the cruelty of surgery and enabled surgeons to incise, manipulate, and suture tissue in a disciplined manner without the urgency and disorder that surrounded operations in the conscious patient.

Dr. Crawford Long was the first to use ether for general anesthesia, in 1842, but he did not report it until 1849.1 Meanwhile, in 1846, the Boston dentist William T.G. Morton demonstrated the use of ether as a general anesthetic in the amphitheater of the Massachusetts General Hospital in a ...

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