Journal of the American College of Surgeons Volume 200, Issue 5, Pages 641-816 (May 2005) Centennial Perspectives 1. Adhesions • MISCELLANEOUS Page 641 2. Intra-abdominal adhesions • MISCELLANEOUS Page 642 3. Intraabdominal and Postoperative Peritoneal Adhesions • DISCUSSION Pages 643-644 Harold Ellis 4. Etiology/treatment varicose • MISCELLANEOUS Page 645 5. Etiology and Treatment of Varicose Ulcer of the Leg • DISCUSSION Pages 646-647 Robert L. Kistner Scudder Oration on Trauma 6. Changes in the Management of Injuries to the Liver and Spleen • ARTICLE Pages 648-669 J. David Richardson Original Scientific Articles 7. Impact of Work-Hour Restrictions on Residents’ Operative Volume on a Subspecialty Surgical Service • ARTICLE Pages 670-676 Ariel U. Spencer and Daniel H. Teitelbaum 8. Does Surgeon Frustration and Satisfaction with the Operation Predict Outcomes of Open or Laparoscopic Inguinal Hernia Repair? • ARTICLE Pages 677-683 Haytham M.A. Kaafarani, Kamal M.F. Itani, Anita Giobbie-Hurder, John J. Gleysteen, Martin McCarthy, Jr, James Gibbs and Leigh Neumayer 9. Perceptions and Predictors of Surgeon Satisfaction: A Survey of Spouses of Academic Surgeons • ARTICLE Pages 684-690 Lillian S. Kao, Erik B. Wilson and Kimberly D. Anderson 10. Characterization of Human Nasal Septal Chondrocytes Cultured in Alginate • ARTICLE Pages 691-704 Stanley H. Chia, Mark R. Homicz, Barbara L. Schumacher, Eugene J.-M.A. Thonar, Koichi Masuda, Robert L. Sah and Deborah Watson 11. GATA-3 Expression as a Predictor of Hormone Response in Breast Cancer • ARTICLE Pages 705-710 Purvi Parikh, Juan P. Palazzo, Lewis J. Rose, Constantine Daskalakis and Ronald J. Weigel 12. Fusion of the Planes of the Liver: An Anatomic Entity Merging the Midplane and the Left Intersectional Plane • ARTICLE Pages 711-719 Eric Savier, Jacques Taboury, Olivier Lucidarme, Kumiko Kitajima, Mehdi Cadi, Jean-Christophe Vaillant and Laurent Hannoun 13. Do Bone Marrow Micrometastases Correlate with Sentinel Lymph Node Metastases in Breast Cancer Patients? • ARTICLE Pages 720-725 Susan M. Trocciola, Syed Hoda, Michael P. Osborne, Paul J. Christos, Heather Levin, Diana Martins, Joshua Carson, John Daly and Rache M. Simmons 14. Invited Commentary • DISCUSSION Pages 725-726 V. Suzanne Klimberg 15. Reply • CORRESPONDENCE Page 726 Susan M. Trocciola and Rache M. Simmons 16. Cystadenoma and Cystadenocarcinoma of the Liver: A Single Center Experience • REVIEW ARTICLE Pages 727-733 David P. Vogt, J. Michael Henderson and Elaine Chmielewski 17. Safety of Carotid Endarterectomy in 2,443 Elderly Patients: Lessons from Nonagenarians—Are We Pushing the Limit? • ARTICLE Pages 734-741 Desarom Teso, Randolph E. Edwards, Jared C. Frattini, Stanley J. Dudrick and Alan Dardik Consensus Statement 18. Use of Magnetic Resonance Imaging in Breast Oncology • SHORT COMMUNICATION Page 742 Alan Dardik What's New in Surgery 19. What’s New in Cardiac Surgery • ARTICLE Pages 743-754 David A. Fullerton 20. What’s New in General Surgery: Critical Care and Trauma • ARTICLE Pages 755-765 Lena M. Napolitano Symposium 21. Introduction: Symposium on Surgery in the Elderly Patient, Part 2 • SHORT COMMUNICATION Page 766 James C. Thompson 22. Postoperative Delirium in the Older Patient • ARTICLE Pages 767-773 Luis F. Amador and James S. Goodwin 23. Common Orthopaedic Problems in the Elderly Patient • ARTICLE Pages 774-783 Michael J. Grecula and Mabel E. Caban 24. Anesthetic Pitfalls in the Elderly Patient • ARTICLE Pages 784-794 Donald S. Prough Collective Review 25. Schistosomal Portal Hyptertension • REVIEW ARTICLE Pages 795-806 Adeyemi O. Laosebikan, Sandie R. Thomson and Namasha M. Naidoo Images for Surgeons 26. Fibromuscular Dysplasia of the Carotid Artery • SHORT COMMUNICATION Page 807 Wei Zhou, Ruth L. Bush, Peter L. Lin and Alan B. Lumsden 27. Solitary Arteriovenous Malformation of the Small Intestine • SHORT COMMUNICATION Pages 808-809 Adnan Z. Rizvi, John A. Kaufman, Pamela Smith and Mark L. Silen Surgeon at Work 28. Percutaneous Cephalic Vein Cannulation (in the Deltopectoral Groove), with Ultrasound Guidance • ARTICLE Pages 810-811 Jack LeDonne Letters 29. Complete Esophageal Diversion: A Simplified, Easily Reversible Technique • CORRESPONDENCE Page 812 Paul D. Kiernan, John Rhee, Lucas Collazo, Vivian Hetrick, Betty Vaughan and Paula Graling 30. Reply • CORRESPONDENCE Pages 812-813 Kevin F. Staveley-O’Carroll, Seth A. Spector and Leonidas G. Koniaris 31. Voice Changes after Thyroidectomy Without Recurrent Laryngeal Nerve Injury • CORRESPONDENCE Page 813 Allen D. Hillel 32. Centennial Perspective on Burn Treatment • CORRESPONDENCE Page 814 Martin Allgöwer 33. Reply • CORRESPONDENCE Page 815 John F. Burke 34. The Role of Claude Bernard and Others in the Discovery of Horner’s Syndrome • CORRESPONDENCE Page 815 August L. Reader III 35. Reply • CORRESPONDENCE Page 815 Ian Ross Evidence-Based Surgery 36. gfedc Evidence-based surgery • MISCELLANEOUS Pages A41-A44 Continuing Medical Education Program 37. JACS CME-1 featured articles, volume 200, May 2005 • DISCUSSION Pages A45-A47 Vol. 200, No. 5, May 2005 Centennial Perspectives 641 642 Centennial Perspectives J Am Coll Surg CENTENNIAL PERSPECTIVES Intraabdominal and Postoperative Peritoneal Adhesions Harold Ellis, CBE, FACS (Hon), FRCS London, England Until the introduction of anesthesia and then antiseptic and patients usually do not report their groin hernias surgery allowed laparotomy to become a comparatively until they strangulate, the situation is reversed; strangu- common and comparatively safe procedure in the lated hernias are common, and adhesive obstruction is 1880s, intraabdominal adhesions were an uncommon rare. phenomenon and of little, if any, interest to surgeons. Since the beginning of the 20th century, truly enor- You will not find mention of them in the standard sur- mous attempts have been made to prevent the formation gical textbooks up to that time. of postoperative adhesions. Today, there are thousands In contrast, adhesions from inflammatory disease of references on both the clinical and laboratory aspects within the peritoneal cavity were well recognized at au- of this problem, which now represents a considerable topsy. For example, Thomas Hodgkin,1 in 1836, com- burden on our health services.5 mented on the matted bowel found at autopsy in pa- Attempts to prevent postoperative adhesions can be tients with tuberculous peritonitis and also on the classified into:4 tendency of adhesions to occur in the lower abdomen in A. Prevention of fibrin deposition, using citrate, hepa- patients dying of pelvic sepsis. rin (both topically and systemically), and dicumoral. With the advent of the era of abdominal surgery, Deaths from hemorrhage were reported in animals deaths from postoperative adhesive obstruction began to under laboratory conditions, and, more alarmingly, be reported. The first I have come across was by Thomas there were examples of bleeding and even deaths in 2 Bryant, of Guy’s Hospital, London, in 1872; he de- patients given intraperitoneal heparin. scribed a fatal case of small bowel obstruction from a B. Removal of fibrin exudates between damaged sur- band formed after removal of an ovarian cyst. The first faces. Attempts have been made to wash away or account of a laparotomy for adhesive obstruction I have dilute the fibrin using saline, hypertonic dextrose, traced was reported in the Lancet in 1883 by William and other solutions, or to digest or remove it with Battle,3 then a surgical registrar at St Thomas’s Hospital, pepsin, trypsin, streptokinase, and streptodornase. London. The patient, a 43-year-old woman, had bilat- Tissue plasminogen activator has been shown to be eral ovarian tumors removed 4 years earlier. highly effective in a rabbit model, but there have She was admitted with intestinal obstruction, was been no clinical reports of its use to date.6 found at laparotomy to have matted adhesions of termi- C. Separation of surfaces. A wide range of materials nal ileum to the region of the cecum, and had a terminal has been used to separate surgically traumatized vis- ileostomy performed. Sadly, she died 3 weeks later. cera. Each, in the past, had its advocates, proceeding Reading the careful notes, it appears likely that with even to clinical use, but most have later been shown to be noneffective, or even to increase the problem. modern intravenous nutrition, nasogastric suction, and Materials used in the past included saline, Ringer’s antibiotic administration, she might well have solution, dextran, gelatine, olive oil, paraffin, sili- recovered. cones, plasma, lanoline, polyvinyl pyrrolidine, and Up to the 1930s, strangulated hernias accounted for an amazing variety of membranes—amnion, fish the majority of small bowel obstructions. In more mod- bladder, carp peritoneum, calf peritoneum, oiled ern times, as elective repair of hernias becomes standard silk, silver or gold foil, and free grafts of omentum. treatment, and abdominal surgery so common, adhesive Of these barriers, only a membrane composed of obstruction accounts for about three-quarters of all cases hyaluronic acid and carboxymethylcellulose was of small bowel occlusion.4 Interestingly, in the Third shown to reduce adhesion formation in a clinical World, where abdominal surgery is fairly uncommon prospective randomized trial.7 More recently, a solu- © 2005 by the American College of Surgeons ISSN 1072-7515/05/$30.00 Published by Elsevier Inc. 643 doi:10.1016/j.jamcollsurg.2004.10.023 644 Ellis Intraabdominal Lesions J Am Coll Surg tion of icodextrin