Raducan ID. The History of Abdominal Surgery: The Evolution of an Essential Branch of Medicine

Ionut Daniel Raducan

Review Article

Austin J Surg. 2025; 12(1): 1344.

The History of Abdominal Surgery: The Evolution of an Essential Branch of Medicine

Ionut Daniel Raducan*

Vasile Goldis Western University of Arad, Arad, Romania

*Corresponding author: Ionut Daniel Raducan, Vasile Goldis Western University of Arad, Arad, Romania. Email: dani_raducan@yahoo.com

Received: December 11, 2024; Accepted: December 31, 2024; Published: January 07, 2025

Abstract

Abdominal surgery, one of the most complex and demanding branches of modern medicine, has undergone a long and difficult journey from its origins to the sophisticated techniques used today. Surgical interventions on the abdominal cavity involve addressing vital organs such as the stomach, liver, pancreas, intestines, or spleen. The article traces the evolution of abdominal surgery from antiquity to the 20th century, focusing on the significant progress made in each period. In antiquity, abdominal surgery was rare and risky, limited by a lack of anatomical knowledge, anesthesia, and antisepsis. Egypt, Greece, and Rome made modest contributions to the treatment of hernias and other abdominal traumas. In the Middle Ages, abdominal surgery was influenced by Islamic medicine, particularly the works of Al-Zahrawi. Significant progress came in the 19th century, when the discovery of anesthesia by William Morton and antisepsis by Joseph Lister revolutionized surgical practices. The 20th century brought another revolution with the development of laparotomy and later laparoscopic surgery, which significantly reduced complications and recovery time for patients, laying the foundation for modern surgery.

Keywords: Abdominal surgery; Surgical techniques; Technological advances in surgery

Introduction

Abdominal surgery, one of the most vital branches of modern medicine, has undergone a remarkable transformation from its primitive roots to the highly specialized procedures we know today. Historically, abdominal surgery was fraught with risks due to limited knowledge of anatomy, lack of effective anesthesia, and the absence of antiseptic techniques. However, over the centuries, medical pioneers and technological advancements have revolutionized this field, making it one of the cornerstones of surgical practice. From early rudimentary attempts to treat hernias and trauma in ancient Egypt, Greece, and Rome, to the development of laparoscopic surgery in the 20th century, the history of abdominal surgery reflects the ongoing quest to improve patient outcomes and reduce surgical risks. This article explores the major milestones and figures that have shaped the evolution of this essential medical discipline [1].

The Evolution of Abdominal Surgery in Antiquity and the Middle Ages

Abdominal surgery is a branch of medicine that has undergone significant evolution throughout history, from rudimentary methods in antiquity to more sophisticated attempts in the Middle Ages. Although medicine and surgery were practiced in a limited form during these periods, advancements in understanding anatomy and surgical techniques were essential for the future development of abdominal surgery [2].

Abdominal Surgery in Antiquity

In antiquity, knowledge of the human body was limited, and abdominal surgery was rare and risky due to the high risk of infections and the lack of antiseptic techniques and anesthesia. Most surgical interventions were carried out by practitioners with limited knowledge of internal anatomy.

In Ancient Egypt, the Edwin Smith Papyrus, one of the oldest known medical texts, provides evidence of the Egyptians' surgical knowledge. Egyptian surgeons generally avoided abdominal interventions due to the high risk of infection and mortality, though they appeared to have attempted simple procedures to treat hernias or external abdominal trauma.

In Ancient Greece, Hippocrates, considered the father of medicine, contributed to the development of the humoral theory and encouraged more conservative approaches to abdominal diseases. Greeks avoided direct abdominal surgery, focusing instead on balancing bodily humors rather than invasive surgery. Nonetheless, limited evidence suggests that basic interventions were performed for treating hernias and other external conditions.

In Ancient Rome, Galen, one of the most influential physicians of the ancient world, expanded anatomical knowledge through animal dissections, as human dissection was prohibited. Although abdominal surgery was rare and extremely risky, the Romans developed more advanced surgical instruments and began using ligatures to control bleeding, a crucial step in surgical practice [3].

Abdominal Surgery in the Middle Ages

In the Middle Ages, European medicine largely relied on knowledge passed down from the Greeks and Romans, but it was also influenced by Arab and Islamic medicine. Surgery remained a last resort due to the high risks associated with infections and uncontrolled bleeding. Nevertheless, there were advancements in understanding anatomy and in the development of surgical instruments.

In Islamic medicine, surgeons such as Al-Zahrawi (Abulcasis), a renowned Arab physician, significantly advanced abdominal surgery. Al-Zahrawi described various surgical techniques and developed new surgical tools, such as needles and forceps, to treat hernias and other abdominal conditions. In his treatise Al-Tasrif, he describes the use of sutures to close wounds and even techniques for treating gallstones, a common abdominal ailment.

In Medieval Europe, medical and surgical knowledge was limited in the early Middle Ages, but with the rise of universities and the rediscovery of ancient texts, surgery began to develop. For example, Rogerius, an Italian surgeon, wrote Practica Chirurgiae, a surgical manual in which he describes simple procedures for treating hernias and other external abdominal conditions. Medieval surgeons also began developing techniques for draining abdominal abscesses and treating wounds caused by weapons [4].

Progress in Antiseptic and Anesthetic Techniques

Even though antiseptic techniques and effective anesthesia did not exist in the Middle Ages, medieval doctors began to use plants and rudimentary anesthetic substances to reduce pain during surgeries. Additionally, empirical techniques for controlling bleeding, such as cauterization, contributed to the success of some abdominal surgeries [5].

19th Century: The Pioneers of Modern Abdominal Surgery

The 19th century marked a revolution in abdominal surgery, thanks to fundamental discoveries and the courage of pioneers who paved the way for new surgical treatments . This period was characterized by significant advancements in surgical techniques, as well as in understanding the causes of infections and methods to prevent them. The introduction of anesthesia and antisepsis for the first time allowed surgeons to perform more complex abdominal surgeries with much higher success rates [6].

The Discovery of Anesthesia and Its Impact on Abdominal Surgery

By the mid-19th century, one of the greatest challenges in surgery was the lack of anesthesia, which made any surgical intervention extremely painful and limited in duration. In 1846, William T.G. Morton performed the first public demonstration of ether as an anesthetic in Boston. This moment revolutionized the entire field of surgical medicine, including abdominal surgery, offering surgeons the possibility to perform longer and more complex operations without putting patients at risk from extreme pain. Anesthesia paved the way for complex abdominal surgeries, such as appendectomies, which were introduced for the first time at the end of the century by Charles McBurney. Before the discovery of anesthesia, mortality rates following abdominal interventions were very high due to unbearable pain and the associated shock [7].

The Introduction of Antisepsis

Another defining moment in the development of modern abdominal surgery was the introduction of the concept of antisepsis, thanks to the work of British surgeon Joseph Lister. In 1867, inspired by Louis Pasteur’s germ theory, Lister demonstrated that using carbolic acid (phenol) during surgeries could prevent infections. Until then, postoperative infections were the primary cause of mortality following abdominal surgeries. The introduction of antisepsis drastically reduced infections, allowing surgeons to perform more risky abdominal interventions, such as intestinal resections and surgeries for obstructions [8].

The Development of Appendectomy

Another pioneer in abdominal surgery was Reginald Fitz, who, in 1886, first described the role of appendix inflammation in cases of appendicitis. The appendectomy, the surgical removal of the appendix, became a standard procedure at the end of the 19th century, perfected by Charles McBurney, who proposed the oblique incision, now known as McBurney’s point, used to locate the inflamed appendix. This procedure significantly contributed to reducing mortality caused by acute appendicitis and marked an important moment in the history of abdominal surgery [9].

Hirschsprung’s Disease, a congenital condition characterized by the absence of ganglion cells in segments of the large intestine, was first described in 1888 by Danish physician Harald Hirschsprung. This leads to severe intestinal obstruction, requiring surgical intervention to remove the affected portions of the intestine [10,11].

Hernias and the First Surgical Treatments

Surgery for hernias also saw significant progress during this period. Eduardo Bassini, an Italian surgeon, is considered the pioneer of modern inguinal hernia repair. In 1884, he developed a method that involved suturing different muscle and aponeurotic layers to strengthen the abdominal wall. This method had a huge impact on hernia surgery and significantly reduced the recurrence rate of hernias [12].

Surgical Interventions for Intestinal Obstructions and Biliary Diseases

In the second half of the 19th century, interventions for intestinal obstructions and biliary diseases became more common due to advancements in surgical techniques and instrumentation. Theodor Billroth, a German-Austrian surgeon, was one of the pioneers of gastric resection for treating stomach cancer and severe ulcers. Billroth is recognized for performing the first partial gastrectomies in the 1880s, paving the way for complex interventions in the gastrointestinal area.

During this same period, significant progress was made in biliary surgery. In 1882, Carl Langenbuch performed the first cholecystectomy, a procedure to remove the gallbladder, opening a new chapter in the treatment of gallstones and other biliary conditions. This surgical innovation greatly improved the management of biliary diseases, reducing complications and improving patient outcomes [13].

Further advancements in abdominal surgery led to advanced resection techniques for treating Hirschsprung’s Disease, which saved the lives of children affected by this congenital condition, who otherwise would have suffered from severe intestinal obstruction and life-threatening complications [14].

20th Century: Laparotomy and Laparoscopic Surgery

The 20th century marked a revolution in the field of abdominal surgery with the introduction of innovative technologies and new surgical techniques that completely changed the approach to abdominal interventions. Two of the most important developments were laparotomy and laparoscopic surgery, which significantly improved the safety and efficiency of surgical interventions [15].

Laparotomy: A Direct Approach to the Abdominal Cavity

Laparotomy, a procedure that involves making a large incision in the abdominal wall to access the abdominal cavity, became a standard practice in the early decades of the 20th century. Before the development of modern imaging methods, laparotomy was often used for surgical exploration, allowing surgeons to identify and treat various abdominal conditions, such as intestinal obstructions, acute appendicitis, or biliary diseases.

Although laparotomy was highly effective for diagnosis and surgical intervention, it required a long recovery period for the patient and posed a higher risk of complications, including infections and severe postoperative pain. Despite these drawbacks, laparotomy was a crucial step in the development of modern abdominal surgery, allowing surgeons to address complex conditions directly in the abdominal cavity [16].

Laparoscopic Surgery: The Minimally Invasive Revolution

The introduction of laparoscopic surgery in the second half of the 20th century marked a major technological leap in abdominal surgery. The first successful laparoscopic cholecystectomy was performed in 1987 by Philippe Mouret in France, signaling the beginning of a new era in minimally invasive surgery. Laparoscopic surgery uses thin instruments and a video camera to visualize the abdominal cavity, allowing surgeons to perform operations through small incisions just a few centimeters in size.

Initially, laparoscopic surgery was used for relatively simple procedures, such as cholecystectomy (gallbladder removal), but as technology advanced, the range of laparoscopic procedures expanded to include complex treatments, such as hernia repairs, appendectomies, and even oncological surgeries.

Technological Progress and Advanced Laparoscopy

The development of laparoscopic surgery was made possible by advances in video technology and specialized surgical instruments. High-definition imaging systems and robotic instruments, such as the da Vinci Surgical System, allowed surgeons to perform much more complex and precise procedures, extending the applicability of laparoscopy to oncological surgeries and even bariatric surgery for treating severe obesity.

Laparoscopy revolutionized abdominal surgery by reducing the size of incisions, which led to faster recovery times, less postoperative pain, and a lower risk of infections. The precision offered by laparoscopic techniques also improved outcomes in the removal of tumors and complex procedures involving the gastrointestinal tract [17].

Impact on Modern Surgery

Laparoscopic surgery has revolutionized modern surgical practices, becoming the preferred method for many abdominal surgeries due to its significant benefits for patient safety and recovery. Today, in many hospitals, laparoscopic surgery is considered the gold standard for numerous abdominal procedures, and its techniques continue to evolve with the introduction of new innovations, such as robot-assisted surgery. With the development of robotic surgery and further advances in minimally invasive techniques, abdominal surgery is becoming even more precise and efficient, offering improved outcomes for a wide range of conditions, from hernias to complex oncological resections. These innovations are shaping the future of abdominal surgery, providing safer and more effective treatment options for patients [18].

Conclusion: Lessons from the History of Abdominal Surgery

The history of abdominal surgery is an example of medical evolution based on the courage, innovation, and tenacity of surgeons and scientists. From the rudimentary attempts of ancient Egyptian physicians to the sophisticated techniques of today, this discipline has seen significant progress in terms of safety, efficacy, and clinical outcomes.

In the modern era, abdominal surgery is not only an essential branch of medicine but also a field in constant transformation, ready to embrace new technologies and medical discoveries that will shape the future of surgery.

Abdominal surgery from antiquity and the Middle Ages was limited due to a lack of anatomical knowledge and basic medical technologies, but it laid the groundwork for future developments. Despite the significant risks, the progress made by doctors in these periods contributed to the development of the surgical techniques we know today, paving the way for modern abdominal surgery.