Abdominal Surgery

by

Sally Frampton

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0009

Introduction

Abdominal surgery has taken many different iterations over time and place. Ancient and early modern surgical tomes contain scattered references to operations in which the peritoneal cavity was opened, as well as the practice of minor abdominal operations. Surgery of the battlefield has also been an important contributor to knowledge, through which innovations in treating abdominal injuries have developed. Abdominal surgery acquired new importance in the middle of the nineteenth century, when it began to be practiced with greater frequency. In particular, the establishment of the “ovariotomy” operation to remove diseased ovaries enabled confidence to grow that patients could survive the full-scale opening of the abdomen without invariably fatal results. Implicit in the burgeoning practice of abdominal surgery was the challenge of organ removal—its risks, its value, and the ethics of doing so. The move into the abdomen also sharpened distinctions in the performance of surgery according to national context. In early-19th-century England, for example, the move into the abdomen was perceived by some doctors as an unwelcome importation of radical French philosophies of medical practice. The colonial context to abdominal surgery is no less important. Surgeons framed the entry into the abdomen as another tangent of the ‘civilizing’ potential of western medicine and its dominance over disease. Historians have, however, been attentive to critiquing these narratives borne from the late-19th-century surgical profession. Evidence suggests that procedures like caesarean section were occurring free from western influence in the nineteenth century, in regions such as East Africa. Thus while globally systems of medicine outside of the West have traditionally been less focused on invasive surgery, care must be taken not to assume abdominal surgery is a wholly Western invention. The late nineteenth century also saw developing work in organ reimplantation which progressed in the middle of the twentieth century into substantial innovation in major transplantation surgery. Laparoscopic surgery signaled another key development in the 1980s, drawing on a growing trend for minimally invasive medicine. It generated new dialogues around postoperative regimes of care, for the rationale for laparoscopic surgery, as it began to be popularized through patient demand in the 1980s, was often premised upon health economics, and its radical potential to minimize the need for a long hospital stay after ‘routine’ surgery. The normalization of laparoscopic surgery and reduction in open surgery has transformed the experience of undergoing an operation for many patients and has expanded into a wide range of specialties, including bariatric surgery—another field of practice focused on the abdomen. But that is not the end of the story. New challenges have been raised around the need for reskilling in abdominal surgery in light of the decreasing use of open procedures, especially where these remain an essential tool, particularly in trauma cases. Thus many of the long-standing discourses in the history of abdominal surgery around risk, skill, and technical innovation are still pertinent today.

General Overviews

There remain relatively few scholarly overviews of abdominal surgery, despite its central role in the overall development of surgery. Wangensteen and Wangensteen 1978 provides one of the earliest overviews of the field. Coauthored by a surgeon, it is largely focused on technical developments. The overview Frampton 2018 provides a summary of its practice through the lenses of medical, social, and gender history. Li 2015, an account of anatomy and surgery in Chinese medicine, is not an overview of abdominal surgery per se but is important in helping think through how abdominal intervention is culturally framed and interpreted through differing concepts of anatomy.

• Frampton, Sally. “Opening the Abdomen: The Expansion of Surgery.” In The Palgrave Handbook of the History of Surgery. Edited by Thomas Schlich, 175–194. London: Palgrave Macmillan, 2018.

  DOI: 10.1057/978-1-349-95260-1_9

  An overview of the history of abdominal surgery, with a focus on its historiography. Attention is paid to the development of progressivist accounts of abdominal surgery in the nineteenth century which saw surgeons use historical accounts of their craft as a means of professional leverage. It also looks at how discourses of gender history have intervened in these narratives.

• Li, Jianmin. “Anatomy and Surgery.” Translated by Michael Stanley-Baker and Vivienne Lo. In Routledge Handbook of Chinese Medicine. Edited by Vivienne Lo and Michael Stanley-Baker, 206–215. London: Routledge, 2015.

  Essential reading for an overview of how anatomy and surgery have been configured in Chinese systems of medicine, arguing that Chinese surgical practices were enveloped in their own “anatomical gaze.” Highlights the importance of the spleen within surgical and “external medicine” practices of traditional Chinese medicine, noting the practice of spleen surgery performed by 2nd-century doctor Hua Tuo.

• Wangensteen, Owen H., and Sarah D. Wangensteen. The Rise of Surgery: From Empiric Craft to Scientific Discipline. Folkestone, UK: Dawson, 1978.

  A classic of the field, the Wangensteens’ voluminous text covers in great technical detail a wide range of procedures from the history of surgery, including numerous ones from abdominal surgery such as enterostomy (an operation to create a stoma through the abdominal wall) and gastrojejunostomy (when a connection between the stomach and part of the small intestine is surgically constructed).