Colon Surgery Has Aged Well

“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.”

Left hemicolectomy - Next! Photo by Flickr user Steve Thornton

That’s how Dr Alvin M. Cotlar began his 2002 treatise on the history of colon surgery, published in the Journal of Current Surgery. His record begins in 1710, with a French surgeon who examined the body of a baby who died from complications of imperforate anus. “He suggested that a deliberate colostomy might be done, bringing both ends out through an abdominal incision, with the proximal end a permanent anus.”

We can only imagine the experience of patients who underwent colostomies and ilesotomies as treatment for both diverticulitis and cancer throughout the 18th- and 19th centuries. Without antibiotics and anesthetics, the outcomes had to be no less than grim.  Dr. Cotlar quotes one surgeon’s wry observation of seven colorectal surgeries with dismal outcomes: “Facts are always useful, and if none of them deserve to be regarded as guides to success, at least some have value as a warning against failure.”

Things had improved a little – but not much – by 1925, when today’s 85 year-olds arrived on the scene. Dr. Fred Rankin of Lexington, Ky.  observed that surgery for diverticulitis was “unquestionably more difficult from the standpoint of technique and immediate mortality, than malignancy.”

What would these surgeons have made of two studies presented at the annual meeting of the Society of Gastrointestinal and Endoscopic Surgeons, (SAGES) which found that patients in their 80s could not only survive colorectal and paraesophageal hernia surgery, but do so with less than a cup of blood loss, an incision barely 4 inches long, and a hospital stay of  jsut a few days? Since I didn’t have any 110-year-old surgeons to provide perspective, I asked my 90-year-old dad.

He described his 1943 inguinal  hernia operation at Wright-Patterson Air Force Base – one of the first ever to use mesh in a repair. At a vigorous 23 years old, my dad still spent more than 2 weeks recuperating in the hospital.  Last year -when he was 89 – Dad had a hernia recurrence, this time bilateral. He was treated at our local outpatient surgery unit, home with a couple band aids on his belly barely 12 hours after he set foot in the door.

My dad clearly is a fine example of the point both SAGES studies eloquently drive home: Age need not be a barrier to laparoscopic surgeries that can improve health even in some of our oldest patients. While laparoscopy may not yet be quite up to Dr. McCoy’s Star Trek surgery, it’s still fine enough to earn Spock’s salute: Live long and prosper!

— Michele G. Sullivan (on Twitter: @MGsullivan)

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Filed under Family Medicine, Geriatric Medicine, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology, Primary care, Surgery, Uncategorized

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