Postoperative disease: evolution of the concept.

Abstract

Leriche's La Maladie post-opératoire was described in 1934 as a specific and general reaction to surgery whose systemic symptoms could'nt be understood by the clinical appraisal alone. A laboratory analysis would be necessary. According to Leriche the syndrome could be observed also on other non-surgical trauma. Leriche's concept was ignored by the anglo-saxonic literature but a new scientific approach to the same problem came from Harvard. Walter Cannon with his concept of homeostasis and Henderson, Gamble, Peters and Van Slyke with their definition of the chemical anatomy of the organic fluids and their quantitative analysis, opened the way to Francis Moore's concept of surgery and trauma as metabolic problems. This new biological basis, and the broad enlargement of its spectrum to the whole body, gave a new scope to the surgical practice. Surgery must now be considered as an integrated process, a succession of phenomena defined as pre-operative, per-operative and post-operative representing, nevertheless, a true continuity. To its understanding the post-operative phase cannot be separated from the other phases. La maladie post-opératoire cannot be defined as an unity: there are several post-operative diseases. But the surgical patient must be considered always in the totality of his elements: the somatic or anatomical, the metabolic or physiological and the psychic, forming a complete unity. A global vision versus the old local vision of surgery. This enlarged concept of surgery enables the surgeon to have an intellectual approach similar to that of the physiologist.