Indian Journal of Thoracic and Cardiovascular Surgery 1989-90; 6:51

Staplers of Yore Sot.oMo~ VICrOR KH KRISHNAMURTHY AMIT BANERJEE

The modern day usage of stapling devices which have revolutionised oesophageal, bronchial and gastrointestinal anastomotic techniques, was con- ceived in ancient India by Sushruta (6th Century B.C.). In Sushruta Samhita" (Chikitsasthana § Chapter 14, regimen 17) one finds the following s t l t ra:

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This terse sutra (regimen) describes the use of pincers of black ants as staplers for repairing intestinal wounds. Translated, it reads as follows: "Diseases of the abdomen (udara roga) requiring surgical treatment are baddha guda (obstructed rectum) and parisravi (intestinal perforation). Preoperative anointment and fomentation of the

abdominal wall is followed by slitting open the belly below the navel, four fingerwidths to the left of the hairy midline. In cases of intestinal obstruction, inspection of the bowels, four fingerwidths at a time, is recommended to facilitate removal of the cause of obstruction (stone, bezoars or impacted faecal matter) per rectum. The intestines are then smeared with honey and ghee before repositioning and closure of the abdominal wound. In cases with parisravi, lavage of the peritoneal cavity is followed by careful inspection of the gut and location of the intestinal tear. The edges of the wound are meticulously approximated and a row of black ants made to bite them. As soon as each ant bites the wound, its body is clipped away leaving the heads with pincers holding the torn edges in position. This is followed by closure of the abdominal wound, dressing with liquorice and' black earth and nursing care. The patient is then made to sit in a bath containing oil or ghee and is allowed only a milk diet".

The instruction given is quite clear and the indication for the use of ants specific though the art of conventional suturing was well known to Sushruta. Four varieties of suturing techniques, viz., vellitaka (winding), gophonika (sling-like), tunnase- bani (continuous) and rijugranthi (interrupted) are described. The threads for suturing available included fine threads of flax, hemp or other vegetable fibres from Indian flora such as ashwantaka, guduchi or marva, hair bf tail of beasts like horses etc. Even the needles available for suturing (round, three- sided and curved like a bow) are well-described (Sushruta Samhita-Sutrasthana Chapter 25, regimen 3-29).

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