The ancient technique of "gastrorrhaphy"

Abstract

Objective: The paper describes "gastrorrhaphy," deriving from the Greek words "gastir" meaning "abdomen" and "rhaphy" meaning "suturing," which was a technique used for the treatment of abdominal wounds.

Methods: The technique is described in detail in the texts of Celsus (first century A.D.) and in those of Galen (second century A.D.). Furthermore, references were found in Oribasius' texts (fourth century A.D.) and in the writings of two veterinarian doctors of the same period. We provide our drawings in order to elucidate the different techniques of suturing.

Results: Celsus described one method of "gastrorrhaphy" while Galen presented two different methods for this procedure. All three methods agree on the processes required: replacement of the prolapsed viscera, cleaning of the wound, and suturing. The difference in methods is in the way of suturing the wound; Celsus suggests stitches in layers. While Galen's first method refers to stitching of the peritoneum with the abdominal wall, his second method refers to stitching of similar structures, meaning peritoneum to peritoneum and abdominal wall to abdominal wall.

Conclusions: Celsus' method strongly resembles stitching in layers with cross-sutures, while both of the Galenic techniques of gastrorrhaphy are versions of the full-thickness sutures used nowadays. It should be stressed out that Galen's methods of "gastrorrhaphy" were used by Andreas Vesalius and Ambroise Paré many centuries later.