Historical landmarks in operations on the colon--surgeons courageous.
OBJECTIVE
The nearly 300-year history of surgery of the colon is replete with creative daring among surgeons who conquered the challenges of operating on this highly contaminated organ, housed in the sacrosanct peritoneal cavity.


METHODS
Alexis Littre's suggestion in 1710 that a colostomy may be successful in treating an infant with imperforate anus began an evolutionary process of extraperitoneal colostomy for obstructing carcinomas, and then, an intraperitoneal approach, which enhanced surgical evaluation of the tumor and optimal placement of the stoma. Reybard's introduction of sigmoid resection in 1823, followed by post-Lister contributions of Mickulicz, Paul, Murphy, Miles, Hartmann, and other 19th- and early 20th-century surgeons, paved the way for current successes in colon surgery.


RESULTS
The morbidity and mortality, which still accompanies surgery on the colon, often results from a failure of today's surgeon to apply those principles so meticulously documented by colon and rectum surgery historians.


CONCLUSIONS
The individual, who performs a Miles abdominoperineal resection, a Hartmann procedure, or any other of the classic operations on the colon, gains much by studying the original philosophy and technique of these pioneers in the field.
Cotlar
Alvin M
AM
Department of Surgery, Keesler Medical Center, Keesler Air Force Base, Mississippi, USA.