New ‘Surgical Innovation’ as a Revolution

Accessible online at: www.karger.com/journals/dsu What promoted this brief commentary is the great enthusiasm with which surgeons welcomed the use of circular stapler in the management of hemorrhoids. Clearly, many thousands of patients were subjected to this procedure, worldwide, before the emergence of solid scientific evidence to document its shortand long-term advantages, efficacy, and safety. Let me thus reflect on surgeons’ attitude to any new ‘surgical innovation’. Surgeons – as all human beings – express a few limited patterns of attitude. One could compare a surgical ‘innovation’ to a political revolution (e.g., the French, the October in Russia, or that of the National Socialists in Germany during the 1930s). To simplify matters, let me identify six main patterns of attitude. The ‘revolution’ in our case will be the ‘anal stapling procedure’ (ASP), also known as PPH (procedure for prolapsed hemorrhoids) [1, 2].