Between December 7, 1985 and September 17, 1986, eleven terrorist bomb explosions took place in Paris. Thirteen people died immediately, 255 others were injured. Forty were treated on-site and were not hospitalized, 205 were subjected to triage and stabilization and were then hospitalized. These latter 205 patients are analyzed in this study. None of them died during transportation, and seven eventually died in hospitals. Forty-seven per cent of all victims suffered from multiple injuries. All deaths except one occurred in the polytraumatized group. The policy of subjecting victims of terrorist bomb explosions to triage and stabilization before hospitalization is compared to the so-called "scoop and run" technique, more generally applied in mass casualty situations. Its limitations and advantages are discussed.

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In war, the percentage of casualties with abdominal wounds on battlefields is near 20%. Roughly half of these casualties die almost immediately from bleeding. Wounding agents are most often either bullets or fragments from various detonating devices. Severity of pathology induced by these agents and prolonged lag time between injury and treatment constitute major differences between peace and war abdominal injuries. Since the means of diagnosis is unsophisticated in war, penetrating abdominal injury leads to systematic exploratory laparotomy, although 10% to 20% of explorations are negative. The management of colon lesions remains a controversial issue. In modern war surgery manuals, primary colon repair is not totally condemned and is generally considered acceptable, but under stricter criteria than in civilian practice. In abdominal war wounds, mortality rate dropped from 53% during World War I to 18-36% at the end of World War II. In Vietnam it went down near 10% in some limited hospital series. But other data collected during that conflict show a less rosy picture. Of 476 abdominal casualties, the total mortality reached 42%. The hospital mortality among the survivors was 11.5%. Death in cases where abdominal wound was the primary lesion was due to hemorrhage in 60%, sepsis in 25%, and pulmonary insufficiency in 15%. Survivors had an average of 1.8 injured organs.

Since 1950 the peacetime practice of civilian and military surgery has been characterized by increasing specialization and subspecialization. The surgical management of war wounds continues to require a solid foundation in general surgery training and experience, plus additional specific training in war surgery. Even the trauma specialist will face significant differences and difficulties treating war wounds in field hospitals. Neither military nor civilian surgical programs provide this training. This two-part essay identifies major characteristics of war surgery and explores the essential training and education required to prepare civilian and military surgeons for the practice of war surgery.

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Since 1950 the peacetime practice of civilian and military surgery has shifted from general surgery to increasing specialization and subspecialization. The surgical management of war wounds continues to require a solid foundation in general surgery training and experience, plus additional specific training in wartime surgery. Even the trauma specialist will face significant differences and difficulties treating war wounds in field hospitals. Neither military nor civilian surgical programs provide this training. This two-part essay identified major characteristics of War Surgery and explores the essential training and education required to prepare civilian and military surgeons for the practice of war surgery.

Combat trauma differs from its peacetime counterpart by involving a different spectrum of injuries, occurring in austere environments, dealing with mass casualties, and embodying inherent treatment delays. Thus, civilian trauma practices may be inappropriate in certain combat settings. A review of historical as well as current vivilian and military data is presented for four trauma topics (military antishock trousers, wound debridement, colon wounds, fluid resuscitation) in which civilian and military principles have clashed. The following recommendations are made. (1) Military antishock trousers are still useful in a combat setting. (2) Soft-tissue wound management should be directed by the wound rather than by the weapon. (3) Cautious avoidance of colostomy may be indicated in certain wartime colon wounds. (4) The majority of combat casualties require early vigorous fluid resuscitation. When civilian trauma experience challenges military dogma, it must be carefully considered before being applied to a combat setting.

Between 1975 and 1984, 39 patients with duodenal ulcer (DU) and stenosis causing gastric outlet obstruction were operated on with a proximal gastric vagotomy (PGV) and a duodenoplasty. This technique consists of a longitudinal incision made at the site of the duodenal narrowing, followed by a transverse suture. It enlarges only the narrowed duodenum but leaves the important pyloric ring intact. The mean observation time was 70 months (extremes: 18 months and 11 years). There was no operative mortality. The clinical results were excellent or good in 95 % of the patients (Visick I and II). After the operation no patient had symptoms of gastric retention, dumping or diarrhea. No recurrent stenosis has occurred. Only 1 patient (2.5%) developed a recurrent ulcer 5 years after the operation. It is concluded that duodenoplasty is a good operation in patients with stenotic DU. It corrects the narrowing and preserves the pyloric function. The combination of PGV and duodenoplasty in stenotic DU yields an incidence of ulcer recurrence comparable to that observed in our hands after PGV alone for nonstenotic DU (5/146 – 3.5%). It is assumed that the systematic control and treatment by duodenoplasty of every partial duodenal stenosis may have contributed to the low incidence of ulcer recurrence after PGV (6/185 – 3.2%) in our series by eliminating a possible residual stasis. This assumption remains to be proven.