What is needed to become a good surgeon?

This lecture has been delivered as a part of the RBSS-BAST symposium 'What does it need to become a good surgeon'. The lecture relates to the evolution that has taken place over the last decades in relation to the training in surgery. It also gives some hints to younger colleagues how to make a successful career in surgery.

Actinomycosis, a rare and unsuspected cause of anal fistulous abscess: report of three cases and review of the literature.

Primary perianal actinomycosis is rare. Sporadic cases, with lesions varying in extent have been reported. The infection is caused by the bacterium Actinomyces, which often is a saprophyte.

[Hierarchical structures in European countries].

The current form of organization and structure dates from the beginning of the 20th century, but now developments show a trend toward teamwork, where work, power, and authority are evenly distributed among several persons and carried out correspondingly. According to a survey of 11 out of 16 countries in Europe, large surgical institutions are organized according to the hierarchic principle. In Austria, Belgium, and the Netherlands both types of organization exist, and only in Luxembourg, Ireland, and Great Britain does the cooperative system exist.

The importance of magnetic resonance imaging in the diagnosis and treatment of diffuse lymphangioma.

In this study, we will investigate the importance of MRI in the diagnosis and treatment of diffuse lymphangioma. Twenty-nine patients with lymphangiomas were treated at the U.Z.

Surgery in Belgium.

To fully understand the present state of surgery in Belgium, it is necessary to know the structure of the Belgian State, the type of education, the statutory health insurance system, and the professional bodies representing surgeons. One of the most important problems is the excessive number of physicians, which recently led to the establishment of limits on the number of candidates receiving medical certification. Surgical training modalities are described and the results of a retrospective study concerning the quality of training are detailed.

[Current status and future prospects for specializing in surgery in united Europe].

Specialisation within surgery is unavoidable, as it is in other disciplines. Motives and drawbacks are mentioned. The current situation in Europe is confused.

Anal sphincter reconstruction with the gluteus maximus muscle: anatomic and physiologic considerations concerning conventional and dynamic gluteoplasty.

Myoplasties have acquired an important place in anal sphincter repair. The use of the gluteus maximus muscle for sphincterplasty was reported initially in 1902. However, in 1952, the gracilis sphincterplasty became more popular because of the accessibility of this muscle.

Primary leiomyosarcoma of the diaphragm.

Primary leiomyosarcoma of the diaphragm is extremely rare and only five cases have so far been reported. In the early stages clinical signs are scarce and diagnosis is difficult. The advent of MR-imaging has helped in detecting the origin of a diaphragmatic tumour and its relationship to the adjacent tissues.

Neurovascular intact muscle transposition for anal sphincter repair. Experimental model and experience with dynamic pacing.

Purpose: To study muscle behavior for anal sphincter repair, radiologic, manometric, and histologic techniques in a dog animal model have been used. Special attention was given to the problem of resting length of the transposed muscle.

Methods: The semitendinosus muscle of the dog could be transposed successfully to create a new anal sphincter based on an intact neurovascular pedicle.

Perineal repair of procidentia recti with a silastic sling.

Several operations have been proposed to correct complete rectal prolapse (1, 2, 3, 4). Perineal approaches in patients with rectal prolapse are recognized as less strenuous on the general health of the patient than abdominal methods of repair. This has led to the use of perineal procedures for elderly and debilitated patients.

Epidermoid cysts of the spleen.

Primary nonparasitic splenic cysts are very rare. Clinical manifestations vary but are often not very typical. Ultrasound and computed tomography are of use for establishing diagnosis.

[Functioning of the tube stomach following esophagus resection for carcinoma].

A retrospective study was made of the functional results of the tube stomach created in 80 patients after oesophageal resection because of carcinoma to restore the continuity. The study concerned patients who had survived the operation for longer than 18 months without indications of tumour recurrence or metastases and of whom clinical and endoscopical data of 3 months and one year after the operation were available. The functional results of the tube stomach may be regarded as good because one year postoperatively 86% of the patients were classified as excellent or very good according to the modified Visick classification.

Chronic anemia secondary to side-to-side distal small bowel anastomosis.

Occult intestinal bleeding was diagnosed in a patient who underwent a distal small bowel resection. The resection was required for small bowel obstruction. She developed iron deficiency anemia four years later.