From Big Medical Encyclopedia

ABDOMINAL SURGERY (Latin abdominalis — belly; a synonym belly surgery) — the section of surgery studying an origin, diagnosis and methods of surgical treatment of damages and diseases of an abdominal wall and abdominal organs.

History A. x. — the considerable section of history of the general surgery (see Surgery). Mentioning of a laparotomy meets still B.C., in particular it was manufactured in Ancient India. In China the laparotomy was done by the surgeon Hua Tuo (141 — 203). In 14 century the French surgeon Guy de Chauliac did attempts of imposing of a continuous intestinal suture. In 1602 — on other sources in 1612 — F. Mathias made the first successful gastrotomy for removal of a foreign body. In 1826 A. Lembert offered a gray and serous intestinal seam, and Common people (V. Czerny, 1880) applied a two-row seam. In 1849 Mr. of Sediyo (S. E. Sediilot) for the first time, though is unsuccessful, imposed the gastric fistula for food at the person offered and developed in an experiment by V. A. Basov (1842). However broad development And. x. began only from the last quarter of 19 century thanks to development and deployment in practice of antiseptics (see) and asepsises (see) that gave the chance to develop various ways of operative measures on abdominal organs. If in the first half of 19 century at A. Velpeau and other surgeons herniotomy gave 50 — 80% of a lethality, then at the end of the last century already systematic operational treatment of belly hernias began and the main ways of herniotomy were developed. The gastric surgery begins to develop. In 1879 Mr. Pean and in 1880 Ridiger executed a resection of a stomach, however, from the death. On January 29, 1881 Billroth (T. Billroth) for the first time made a successful resection of a stomach concerning cancer, and in November, 1881 Ridiger made a resection of the gatekeeper concerning the ulcer penetrating in a pancreas and it laid the foundation for surgical treatment of a peptic ulcer of a stomach. In Russia the first resection of a stomach was made by M. K. Kitayevsky in 5,5 months after Billroth, but from the death. The first successful resection of a stomach in Russia was executed by N. V. Ekk (1882). In the subsequent the resection of a stomach with success was made V. A. Ratimov (1887), A. T. Bogayevsky (1888), etc. In 1886 — 1887 Geyneke, J. Mikulicz made a pyloroplasty at an ulcer; in Russia this operation was executed for the first time by K. Klein and A. D. Kni (1890) at a cicatricial pyloric stenosis after a chemical burn. In 1884 Connor made a gastrectomy (see) with a lethal outcome, and in 1897 Shlatter (S. of Schlatter) for the first time with success executed this operation for a carcinoma of the stomach, than laid the foundation for surgical cancer therapy of a body and proximal department of a stomach. The first gastrectomy in Russia was made

by S. P. Fedorov in 1902, but the first successful gastrectomy was executed in 1911 by M. Zykov. The resection of proximal department of a stomach in an experiment was developed by Levi (Levy, 1894), Biondi (A. Biondi, 1895), and at the person — Mikulich (1896), F. Voelcker, etc. In the USSR the first successful cardiectomy at cancer was executed by V. S. Levitte (1928). In 1881 Belflerom was made the first gastroenterostomy (at cancer of the gatekeeper), and in 1882 it was manufactured in Russia by N. D. Monastyrsky at cicatricial narrowing of the gatekeeper after a chemical burn. In 1884 Ridiger made a gastroenterostomy at the stenosing ulcer of a duodenum. In 1880 we will catch Mick the first attempt of sewing up of perforated stomach ulcer which ended with the death of the patient was made. Only in 1892 Heyzner for the first time made sewing up of a perforated ulcer with a favorable outcome. In Russia the first manufactured this operation P. X. Bathtubs (1897). In 1883 Kokher (T. Kocher) for the first time made mending of a bullet wound of a stomach with a favorable outcome. In 1902 Mr. of Keerly at perforated stomach ulcer with success made a resection it. Similar operation with success was manufactured by O. A. Yutsevich in 1906 in Russia. In treatment of a peptic ulcer the gastroenterostomy and a resection of a stomach long competed among themselves while at the XXIV All-Union congress of surgeons the resection of a stomach was not recognized as operation of the choice. On the XXIII International congress of surgeons in Vienna (1967) the question of surgical treatment of stomach ulcers and a duodenum underwent discussion again.

Now, except a resection of a stomach, conservative surgeries with vagisection and simultaneous antrectomy or a pyloroplasty began to be applied, is more rare a gastroenterostomy. Substantially also the equipment of a resection of a stomach changed, its main modifications were developed (see Billroth operation), and in 1956 — 1960 in the USSR various types of the staplers (UK7K-8, NZhKA-60, PKS-25, UTL-100, UKL-60 and UKL-40, SKA) which considerably simplified production of these operations were created.

With introduction of an asepsis began to develop urgent And. x., especially in connection with the doctrine about appendicitis (see). In 1884 Mr. R. Kronlein in Germany and Mahomed in England for the first time made appendectomy. In Russia the first successful appendectomy was manufactured by A. A. Troyanov (1890). In 1888 Mr. Mack-Berney (S. of McBurney) proved indications to early an acute appendicitis operation. In 1905 at a congress of the German surgeons to [W. Korte] and in 1909 in Russia at the IX congress of surgeons (G. F. Tseydler, etc.) philosophy of early operation at an acute appendicitis were defined.

In 1618 F. Hildanus removed stones from a gall bladder, however systematic cholecystitis operations begin to make only since the end of 19 century. The first cholecystectomia is made by Langenbukh (S. Langenbuch) in 1882 N. V. Sklifosovsky made a so-called ideal cystifellotomy, operated the patient with an echinococcus of a liver, made a resection of a liver concerning a new growth. However only in 20 century in Germany Kerr (N. of Kehr), in the USA of Mayo (S. Mauo), in Russia S. P. Fedorov began to manufacture widely a cholecystectomia and other operations on the bilious ways and a liver.

Operative measures on a pancreas began to make only in the second half of 19 century. In 1882 Mr. N. Bozeman and Gussenbauer (S. of Gusscnbauer) with success operated patients with a cyst of a pancreas, same year F. Trendelenburg made a pancreatectomy concerning sarcoma, in 1887 N. D. Monastyrsky for the first time imposed with a positive take holetsistoyeyunoanastomoz at a tumor of a head of a pancreas. In 1899 Halstead made operation at cancer of a faterov of a nipple with a favorable outcome. In 20 century of operation on a pancreas of steel already daily, especially in connection with surgical treatment of acute pancreatitis. Detailed studying of the endocrine device of a pancreas allowed to operate with success of patients with an insuloma and ulcerogenic adenoma of a pancreas.

For 19 and 20 centuries much attention was paid to treatment of peritonitis (see), its especially common forms giving to a crust. time, despite use of antibiotics, high percent of a lethality. At the XXIV International congress of surgeons (1971) the modern methods of treatment of peritonitis which allowed to lower considerably a lethality at this serious illness underwent extensive discussion. Development And. x. in wartime allowed to improve results of treatment of wounds of abdominal organs. Progress And - x. in recent years it is connected with use in clinical practice of hemotransfusion and blood substitutes, effective antibacterial drugs, including antibiotics, and also with improvement of the technology of interventions.

Modern development of medicine is characterized by further specialization that is shown by gradual isolation of new sections A. x. So, owing to features of diagnostic methods and surgical treatment from And. x. are allocated in independent sections: operational gynecology (see), urology (see). Diagnosis and methods of treatment of diseases of vessels of an abdominal cavity belong to the section of vascular surgery; owing to need of complex treatment of malignant new growths of abdominal organs it is tended to allocation them in the section of oncology (see).

Detailed development of diagnostic methods and treatment a disease of a rectum led to allocation from And. x. proctologies. Need of use of a number of special diagnostic methods and feature of conservative and surgical treatment of bodies went. - kish. a path are the reason of isolation of gastroenterology (see).

Specific weight and value A. x. in health care are very big, especially if to consider a large number of surgical diseases of abdominal organs at which acute management is necessary. It demands from each surgeon of knowledge of bases of diagnosis and the operational equipment in various sections A. x. Progress modern And. x. are considerably caused by the fact that in diagnosis of diseases of abdominal organs along with traditional clinical, radiological and laboratory methods special diagnostic receptions are used: a peritoneoskopiya (cm), a puncture biopsy of a liver, a transumbilikalny venoportografiya, a splenoportografiya (see), a transdermal transhepatic holangiografiya (see) and a holangnomanometriya, the selection angiography of branches of a ventral aorta, a limfografiya (see). Considerable success in diagnosis of diseases of abdominal organs was achieved also thanks to implementation in clinical practice of endoscopic methods with use of a fiber optics (see Gastroscopy, Duodenoskopiya, Kolonoskopiya, Endoscopy).

The most topical issues And. x. were constantly discussed in the press and at surgical forums (see the tab.).

Teaching And. x. in the USSR it is led at departments of faculty and hospital surgery without allocation her to a separate course.

The bibliography — see to St. Surgery .

V. S. Mayat.