Boston University Surgical Service Seventeenth Annual Seminar

SEPTEMBER

The

American

Journal

1971

of Surgery VOLUME NUMBER

122 3

Symposium on Controversy in Surgery Boston University Surgical Service Seventeenth Annual Seminar

Introduction Current practice becomes obsolete in the face of new technological concepts, new drugs, and a changing disease spectrum. We must constantly appraise everything we do to be sure our results are the best possible for our patients. Annual analyses of operative results often pick up weak spots, even in procedures of definite value. Why do some surgeons obtain better results than others? Perhaps it is the preoperative care, timing of the procedure, team back-up, operative technic, or the postoperative care. To answer these questions and to examine the results of others, we have brought some experts to this Symposium to reappraise a few of our current practices. The trend has been away from thyroid surgery, so much so that current resident staffs may be untrained in this field of surgery. Has the pendulum swung too far? Are we neglecting some patients? Therapeutic portacaval shunt now appears to be a proved entity in the treatment of bleeding from esophageal varices caused by portal hypertension. Nevertheless, the price is occasionally paid in poor liver function and hepatic encephalopathy. Can modifications of the surgical procedure adequately decompress portal hypertension and esophageal varices and yet maintain good liver flow? Rheumatologists are reluctant to advise surgery for their patients. Is this justified? What can surgery offer the patient with crippled hands? Most surgeons now avoid primary tendon repair in “no-man’s land” in favor of delayed tendon

From the Boston University Surgical Service, Boston City Hospital, and Department of Surgery, Boston University School of Medicine, Boston University Medical Center, Boston, Massachusetts.

Volume

122, September

1971

grafting. Is this always necessary? Are tendon graft results that good? Could we shorten the return to work by immediate surgery in selected cases. We all believe now that toxic megacolon requires immediate resection. This has given better results than the previous “hands-off” policy. But is not the mortality too high and should we not look for other procedures ? When is an ischemic limb unreconstructable by vein grafting? How far should we go to avoid amputation? How long a survival can be expected from such measures? Is a leg more important than a life? The Miles abdominoperineal resection is one of the few time-proved procedures for cure of cancer of the rectum. Are there any alternatives to avoid colostomy and yet save the patient ? Urinary tract infection in the younger patients is an important pediatric problem. Is it always due to ureteral reflux? Should all ureteral reflux be repaired ? Probably nowhere is the trend for innovation more progressive than in the design of our new operating room suites. Yet how much is mere advanced technology? How much is really necessary in view of the high cost of such technological advances? How much is necessary for the safety of our patients? We would like to thank the participants of this Symposium for the time and effort involved in presenting their experience and preparing a manuscript for publication in this Journal. JOHN J. BYRNE, MD

Boston, Massachusetts

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