ROMANIAN CONTRIBUTIONS TO THE SURGERY OF THE RECTUM-THOMA IONESCU

1. ROMANIAN
CONTRIBUTIONS TO THE
SURGERY OF THE
RECTUM
Authors: Dr. Sinziana Ionescu, Prof.Dr.E.Bratucu
Bucharest Oncology Institute, Romania

2. THOMA IONESCU
1860-1926
 Anatomist
 Surgeon
 University professor
 Politician

3. TH . ION ESC U 1 8 9 5
 Internationally renown facts
 Retroperitoneal internal hernias (1890)
 Author in Poirier’sTreaty of Anatomy (1894)
 Tubercular hernia (1891)
 Suture of the abdominal wall– Prof. Schauta (1899)
 Surgery of the utero-adnexial suppurations (1897)
 The exclusion of the pylorus from the duodenal circuitus (1907)
 Extended lombo aortic evidation of the lymph nodes in cancers of the
uterine cervix and of the body of the uterus (extended Wertheim)

4. F O U N D E D B Y T H O M A I O N E S C U
 Archives De Sciences Medicales”(1896/Paris)
 Romanian Journal Of Surgery (1897)
 Romanian Surgical Society (1898)

5. ROUMANIA –AROUND 1998: printed stamp in Romania,
illustrating the founder of the Romanian Surgical Society Thoma
Ionescu

6. THE MESORECTUM
 It represents the continuation of the ileo-pelvic mesocolon, being
the most caudal part of this structure and containing the blood and
lymph vessels and nerves that approach or leave the rectum.
 This mesorectum confers a relative mobility to the rectum,
mobility which disappears at the level of S4 where the presacral fascia
and the rectum’s fascia propria fuse

11. PA ST A ND PR ESENT IN THE SURGERY OF
THE R ECTUM
 total mesorectal excision (TME) for rectal tumours was introduced
in 1982 by Heald et al. and has led both to a 5% de crease of local
recurrences 5 and 10 years after the operation when compared with
cases treated with conventional surgery, and to an increase of survival
up to five years estimated in 80% of all cases.
 Therefore, even nowadays fascia recti constitutes the frontier
between the curative resection and the palliative one in the cancer of
the rectum

12. “ t h e w i n g s o f t h e r e c t u m ” t h e r e c t u m ’ s
l a t e r a l l i g a m e n t s
 Lateral ligaments of rectum which are formed by the
condensation of pelvic fascia
 And contain the middle rectal artery or accessory
middle artery which must be intercepted in case of
surgery of the rectum in order to prevent bleeding

13. DIMITRIE GEROTA
 He was an anatomist, radiologist, urologist
 He described the renal fascia and a method to
obviate lymph vessels
 He described the retrorectal lymph nodes
with importance in surgical oncology of the
rectum as all invaded lymph stations plus one
must be decollated
(1867-1939)

15. G E ROTA A N D B R A N C U S I
W H E R E M E D I C I N E A N D A R T M E E T
 Gerota was also Brâncuşi's teacher and
supervisor at the Bucharest School of Arts.
When Brâncuşi was a student in Bucharest, he
produced an 'écorché' (flayed man), of which six
plaster replicas still exist, two in apparently the
original shape and four which have been
modified/'cosmetised'.
 Brancusi Constantin (1876-1957)

16.  "ACKNOWLEDGEMENT: This paper is supported by the Sectoral
Operational Programme Human Resources Development (SOP HRD)
2007-2013, financed from the European Social Fund and by the Romanian
Government under the contract number POSDRU/107/1.5/S/82839",