The German immigration to the state of Rio Grande do Sul (RS), Brazil, began in the 1920s. Between 1824 and 1922, 142 German colonies were created in Rio Grande do Sul, and it is estimated that, in this period, about 50 thousand Germans arrived in the state.

In this group of immigrants, Augusto Heinrich Rohde, Luiz Rohde's great-grandfather, arrived in 1857. On January 14, 1936, Luiz Rohde was born, the youngest son of Augusto Emílio and Erna Rohde, fruit of a union that generated eight children, in the locality of Paraíso do Sul, in the municipality of Cachoeira do Sul, 200 km from Porto Alegre (RS), in the central region of the state¹.

After an initial school education in his region, in Cachoeira do Sul, Luiz completed the high school and soon the inclination to study medicine arose. Since then, it could be noted in the young Luiz Rohde marks that would be perennial in his character and in the example he would set for all those who were his students in the future: discipline, rectitude, education, and concern for the well-being of all with whom he had the opportunity to know and relate to.

He studied medicine at Universidade Federal de Santa Maria, where he joined in 1955 and concluded in 1961, having been chosen valedictorian of the class. At the same institution, another characteristic of Rohde was already evident: in the graduation speech, he drew attention to the need for creating a local university hospital to improve the training of doctors. Therefore, very early on he had the vision of what would be most important for the education of medical students. After completing the medical course, he was accepted, by a public tender at the University of São Paulo (USP), in the state of São Paulo (SP), in the residency in General Surgery, from 1962 to 1964.

What is the feeling of the editors of a medical journal when it reaches the significant mark of 1,000 published new scientific articles?

On this occasion, the editors and reviewers looking back about what meant these 1,000 papers published in the period of 27 years, from 1986 to 2013, confirms that they worked very hard to reach this target. Let suppose, if each article has at least 1,000 words, 1,000 articles addressing all possible issues related to digestive surgery will reach a million words, and this amount certainly corresponds to an encyclopedia!

The first article published in 1986 was written by the creator and founder of the Brazilian Archives of Digestive Surgery (ABCD), Prof. Dr. Henrique Walter Pinotti, about surgeonpatient relationship¹. And in the presentation of a new journal he emphasized that: "This surgical breakthrough resulted in the publication of many scientific articles and editing books and journals. But even so, due to the majority of surgical patients are in Gastrointestinal Surgery area, there are few specialized sources to disseminate up the new information. For some time we have been considering publishing a journal dedicated to this specialty, with articles by Brazilian and foreign authors to be distributed abroad, as well as in Brazil. Since English is commonly used in medical and scientific specialties, would be published in both languages".

Professor Pinotti, in his speech at the beginning of the activities of the Brazilian College of Digestive Surgery (CBCD ) in 1988 emphasized that : "With education we not only inform, but we forge high level professionals, which can develop their knowledge, applying correctly their resources and thus able to benefit the patient. Knowing the limits of their competence, he will be able also to serve his patient avoiding the worst result of surgery, which is the iatrogenesis. Our College, in education, should develop the spirit that every person who wants to teach must have, and also finding the ones that want to learn. And the success achieved in the safe training can constitute stimuli for new frontiers of knowledge".

On April 14, 1913, Monday, the young surgeon of 36 years, Ernst Heller, assistant professor of Erwin Payr, Director of the Surgical Clinic of the University of Leipzig in Germany, while operating a patient with idiopathic achalasia of the esophagus, performed for the first time a cardiomyotomy extramucosal, leaving his enormous contribution to the history of esophageal surgery, in the 20th century¹.

Ernst Heller was born in 1877 and as a young surgeon had in its formation the influence of various known surgeons of the time, such as Gottstein and Heyrovsky. Between 1914 and 1918 he served as a surgeon in the first World War, in the front. He returned to Leipzig in 1918 as chief surgeon of Saint George County Hospital. In 1949 he became Professor at the University of Leipzig and died at the age of 87 on November 2, 1964, and published over 80 scientific papers during their academic life².

The record of his first extramucosal cardiomyotomy was published in the journal Mitt Grenzgeb Med Chir, describing in detail the clinical case, the surgical technique employed including figures, the evolution of the patient and reviews about the disease¹^,² .

This is a briefing of original Heller´s report:

"In the first section of the Archiv für Chirurgie klinische 1913, described a Heyrovsky subdiafragmatic esofagogastric anastomosis that performed successfully in two cases of so-called "idiopathic dilatation of the esophagus". Shortly after the publication of this notice, came to the care of the surgical clinic of Leipzig, a patient with chronic saculiform cardiospasm and marked dilation of the esophagus, which seemed appropriate the surgical treatment for elimination of suffering. Under the impression of Heyroyvsky successes, I intend to perform the surgery in the same way. During the surgery, however, due to certain difficulties and after theoretical considerations, I ended up running a different intervention from the original plan, performing a cardioplasty extramucosal. In advance as I want to note that the functional point of view was very exceptionally satisfactory, and this change in the surgical procedure has, in my view, important practical advantage compared to the operational measures proposed and followed in the treatment of cardiospasm by esophageal dilatation, I wish allowing me to share briefly the case ....

Liver metastases are a frequent event in the course of colorectal cancer and some studies indicate them as the cause of two thirds of deaths from this disease. Treatment is complex and involves a range of therapeutic options that vary through behavior and timing of metastases diagnosis, as well as the background of the patient. The volume of medical knowledge published every year on this topic is on the rise, with information with different levels of evidence, coming as a torrent of data that daily challenges those involved in the care of these patients. These professionals, in turn, should belong to multidisciplinary teams able to evaluate together the best treatment options as well as their sequence, according to the specifics of each case.

These are the premises that supported the initiative to hold the First Brazilian Consensus of Multimodal Treatment of Liver Metastases from Colorectal Cancer, including, unprecedentedly in Brazil, the specialty societies involved in this care, namely the Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA), the Brazilian Society of Surgical Oncology (BSSO), the Brazilian Society of Clinical Oncology (BSCO), the Brazilian College of Digestive Surgery (BCDS) and the Brazilian College of Surgeons (BCS), also relying on the support of the Americas Hepato-Pancreato-Biliary Association (AHPBA). Experts from other areas were also involved in specific points of the discussion, such as radiologists, interventional radiologists and pathologists. The Consensus meeting was held on August 23, 2014 during the X International Symposium on Cancer of the Digestive Apparatus of CEPGIO / International Symposium BC-IHPBA / Postgraduate Course of AHPBA at A.C. Camargo Cancer Center in São Paulo.

Professor Edmundo lived all his moments intensely. He was not a man of mincing words; he would say what he felt and what he wanted, but always at the right time and in a fair, polite, and caring way.

People who do not take a stand, those who are reluctant, and those who wish to be okay with everything and everyone will certainly make few enemies, but they will also have few admirers, few friends, and, above all, very few followers. They will not form leaders.

More than students, doctors, and surgeons, Professor Edmundo formed eager citizens: citizens who seek better working conditions; citizens who are not satisfied with poor quality medicine, provided by uncommitted people; and citizens who do not accept to offer different treatment to public patients compared to private ones. He formed citizens who protest by working and setting examples; citizens who, in times of conflict, work twice as hard, so that the neediest population is not penalized; and citizens who do not resign and who propose changes. This is the profile of Professor Edmundo’s disciples.

He lived his professional life intensely. He studied cutting-edge Medicine at a public hospital in the Brazilian Northeast. His dedication, commitment, and care for patients who would come to the University Hospital of Universidade Federal de Pernambuco were with a true unanimity of work and seriousness. He would always say: “Be the first to arrive and the last to leave. If you do that, you will earn the admiration and respect of everyone.”

Few public servants had the dedication that Professor Edmundo showed throughout his university life. I followed this dedication closely. For over 20 years, I assisted in all the private surgeries performed by him, always after 7 p.m. There were countless times that we left the surgery in a private hospital and went straight to the University Hospital, as the surgery lasted until dawn. Nothing, absolutely nothing, could compromise Professor Edmundo’s work schedule at the University Hospital.

Henrique Walter Pinotti was born in São Paulo to Italian immigrants. He began attending the Hospital das Clínicas of the Medical School of the University of São Paulo (FMUSP) when he was admitted to the Medical School, in 1950, participating in the Clinical Gastroenterology Service as an academic trainee under the guidance of the then head, Professor José Fernandes Pontes. He went through all sectors of the specialty, having contact with the pathophysiological and clinical bases of gastroenterology, deciding on surgery on the eve of his graduation, in December 1955. Then, he was selected as a second-year resident physician of the Department of Surgery of the Hospital, a position held until May 1958. During those years, he also attended the Department of Pathological Anatomy as a volunteer.

He was granted his first academic title in March 1959, when he was appointed by Professor Alípio Corrêa Netto, upon recommendation of Professor Arrigo Raia, Teaching Assistant of Surgical Clinics. Later, in 1960, he was appointed FMUSP Assistant.

Since then, he had the opportunity to monitor the activities and absorb the teachings of renowned surgeons, notable school leaders, such as Benedito Montenegro, Edmundo Vasconcellos, Eurico da Silva Bastos and, especially, Alípio Corrêa Netto, from whom he received great encouragement for his university career, as well as from his followers, Euryclides de Jesus Zerbini and Arrigo Raia, with whom he enjoyed a close and long-term relationship.

He presented his Doctoral Dissertation at FMUSP in 1964 and became an Associate Professor, by public official examination, in Surgical Clinic in 1967, and the dissertations of both programs were related to Megaesophagus.

In 1968, a new academic order was established: the chairs were extinguished and Departments were created. Disciplines and departments were established; the former, in fact, are specific teaching programs, and the later, the bunion of related disciplines. At that moment, the Discipline of Digestive Surgery was established at FMUSP, as well as the respective Digestive Surgery Division at the Hospital das Clínicas, to house surgeons specialized in this area from the former chairs.

He always sought to follow the specialty in its entirety, performing activities in all areas. With the structuring of this Discipline, he assumed, from 1974 onwards, the Head of the Esophageal Surgery Service, where he promoted great development to Brazilian esophagology.

Complete tumor resection in the liver is the only chance to obtain long-term survival in patients with hepatic tumor or metastasis from other primary cancers. In patients with a large load of tumor within the liver, multiple strategies have been employed to improve resection, especially when a small liver remnant is expected. Staged hepatectomies, in which the surgeon perform partial resection in one side of the liver, and after four to six weeks proceed with the resection of the other side, and strategies to induce hypertrophy of the future liver remnant that include percutaneous portal vein embolization or intraoperative portal vein ligation, have also been largely employed by specialized liver surgery teams.

Hans Schlitt from Regensburg, Germany developed a new procedure, called liver bi-partition, for the first time by chance, in 2007. Planning to perform an extended right hepatectomy in a patient with hilar cholangiocarcinoma - being the future cholestatic liver remnant too small to sustain the patient postoperatively - he decided to perform intraoperatively only a selective hepatico-jejunostomy on the left biliary system, dividing the liver parenchyma along the falciform ligament, thereby completely devascularizing segment 4. Finally, the right portal vein was ligated to induce hypertrophy on segments 2 and 3. On the 8^th postoperative day was performed a CT scan and observed a huge hypertrophy of the remnant liver. Recently, de Santibanes and Clavien² proposed the acronym "ALPPS" for Associating Liver Partition and Portal vein Ligation for Staged hepatectomy. The ALPPS procedure has become an advance that represents an important tool to surgically induce fast liver hypertrophy.¹ ² ³

In any business relationship - contracts, provision of services or outsourcing -, the contracting party (public or private) has the sacred duty and the full right to audit. The control and evaluation is vital sector for the zeal, care, probity, proper application of funds dispensed to purchase inputs, procedures execution and personnel payment.

To assist in this thorny, but necessary task, there are several instruments as analysis of historical series, protocol obedience and/or guidelines, virtual audits by sampling or, then, permanent in person auditing.

The regulatory team is authorized to question certain procedures, and must have the authority to call the patient to clarify the need of exams that helped in the treatment indication, with the ethical prerogative to contact the applicant professional and discuss unclear aspects. Should call for enlightening conversations doctors who take very different approaches from the usual curve of a control group.

They should be analyzed by the agent that pays for treatment, items on the quality of material to be made used, to avoid arguments that the material of the brand "X" is much higher than brand "Y", forcing, directing the patient to a particular supplier, throwing him against the health plan. It should be established that if certain material is unreliable, ANVISA/MS must be notified to banned it from national use. But, the acting person must be responsible enough to sign the declaration and to have proof about the complaint.

In 1981, he obtained the title of Adjunct Professor of FMUSP, and in August 1982, with the retirement of Professor Arrigo Raia, upon recommendation of the Board of the Department of Surgery, he held the position of Professor of the Discipline of Digestive Surgery of FMUSP. Subsequently, on recommendation of the same Board, he was appointed Technical Director of the Digestive Surgery Division of Hospital das Clínicas and its services: surgeries of esophagus, stomach, and small intestine, liver and portal hypertension, colon, rectum, and anus. In 1984, after a memorable civil service competitive examination, he was appointed Full Professor of Digestive Surgery at FMUSP.

A prominent event took place in 1986, with the establishment of the Department of Gastroenterology of the FMUSP, on the initiative of Professors Agostinho Bettarello and Henrique Walter Pinotti. This event was important for the national and international history of clinical and surgical Gastroenterology and also for teaching students, residents, and graduate students, as well as for conducting scientific and care-related research with the integration of surgeons, gastroenterologists, endoscopists, and nutrologists.

In his memorial, the following stand out: 590 publications in national and international journals; 26 awards; 46 films or videos and countless lectures at national and international congresses and courses; 191 book chapters and seven books, among which stand out Tratado de Cirurgia do Aparelho Digestivo, Acesso ao Esôfago Torácico por Transsecção Mediana do Diafragma, and Filosofia da Cirurgia (Textbook of Surgery of the Digestive System, Access to the Thoracic Esophagus by Median Diaphragm Transection, and Philosophy of Surgery)²^,³^,⁴^,⁵^,⁶^,⁷^,⁸^,⁹.

In 1973, he was founder, together with Professors Arrigo Raia, Joaquim José Gama-Rodrigues, Marcel Cerqueira Cesar Machado, and Angelita Habr-Gama, of the Digestive Surgery Update Course (Curso de Atualização de Cirurgia do Aparelho Digestivo - Gastrão), the most important in Digestive Surgery in Brazil. He has always been intensely dedicated to this course, especially during his tenure. It is also noteworthy, in 1974, the creation of the Continuing Course in Gastroenterology (Curso Continuado em Gastroenterologia), periodically administered in 10 annual sessions, on Saturdays, for doctors from the State of São Paulo and Brazil.

In 1986, he created the Brazilian Archives of Digestive Surgery (ABCD) with several surgeons from Hospital das Clínicas and Brazil, which later became the official scientific agency of the Brazilian College of Digestive Surgery (CBCD). This spirit of national union concerning the specialty also enabled, in 1988, the idealization and foundation of the Brazilian College of Digestive Surgery (CBCD), gathering specialists from all over Brazil. It was registered with the Brazilian Medical Association, the Brazilian Federal Council of Medicine, and competent bodies, with the specific determinations for obtaining the degree of specialist, in addition to the recognition of medical residency in the specialty by the National Medical Residency Commission (CNRM)¹.

He was member of several national and international Medical Societies, notably the Brazilian Medical Association, the Brazilian Federation of Gastroenterology, the Brazilian College of Surgeons, the American College of Surgeons, the International Society of Diseases of the Esophagus, and the International Association for Gastric Cancer. In particular, his activities at the International Society for Diseases of the Esophagus (ISDE) are noteworthy, where he was president of the 2001 World Congress, held in São Paulo, Brazil.

He made numerous study trips inside and outside the Country. In Brazil, he participated in congresses, courses, and medical conferences in most states, visiting its main medical and university centers, where he had the opportunity to learn about the problems related to regional clinical pathology, medical assistance, professional issues, scientific research, and especially medical education.

He received numerous honors, including the title of Doctor Honoris Causa of the University of Goiás (Brazil), University of Coimbra (Portugal), and University of Milan (Italy).

He became Professor Emeritus at the Medical School of the University of São Paulo in 2000.

For those who knew and related to Prof. Pinotti, he was an authentic leader, who showed great dedication to undergraduate education, in particular by creating a center for educational training in surgery for fourth-year students, the so-called grupo dos Zezinhos (“group of Zezinhos”), who carried out their undergraduate research by instrumenting their surgeries and participating in clinical discussions. It is also worth noting his dedication to the 71 HCFMUSP Digestive Surgery residents trained under his guidance and to the 26 private Service residents at Hospital Nove de Julho. He actively participated in graduate studies advising 57 surgeons and several assistants, including the authors of this text.

We thank him on behalf of all of them, quoting his own words: “The mission for which we set ourselves has been achieved, the climax generates a state of tranquility as we have culminated in one of the fundamental actions of the University Professor of Surgery, which is to transmit what he knows.”

Pancreatoduodenectomy is the treatment of choice for patients with benign and malignant disease of pancreatic head. Classic pancreatoduodenectomy was described by Whipple originally and included distal hemigastrectomy. Pylorus-preserving pancreatoduodenectomy (pylorus-preserving) was popularized in the late 1970s for benign disease and it included full preservation of the pylorus. However, delayed gastric emptying after pylorus-preserving is a frustrating complication. Its incidence varying from 19% to 61% in previous series and it results in discomfort, prolonged length of stay and increases the risk of respiratory complications. Delayed gastric emptying contributes to increased hospital costs and decreased quality of life. There has been no evidence from prospective studies and meta-analyses to indicate the superiority of pylorus preserving in terms of quality of life or delayed gastric emptying²^,⁴^,⁵^,⁷.

More recently, and mostly in Japan since the late 1990s, subtotal stomach-preserving pancreatoduodenectomy (stomach-preserving) in which the pyloric ring and 2 cm of the distal stomach only is removed with preservation of about 90% of the stomach has been performed for pancreatic head disease. This surgical procedure was associated with fewer postoperative complications. After stomach-preserving, many recent studies have been carried out comparing the two techniques²^,⁶^,⁸. Subtotal stomach-preserving pancreatoduodenectomy was adopted in 2011 at the Department of Hepato-pancreatobiliary Surgery, Federal University of Maranhão, Brazil.

Delayed gastric emptying is a very important complication and needs to be minimized in patients who undergo pancreatoduodenectomy for malignant disease. Many factors were reported in the pathophysiology of this complication after pylorus-preserving. Pylorospasm caused by operative disruption of the vagal nervous system and vascular supply with antropyloric ischemia may play a main role²^,⁷^,⁹. As for prophylactic management of pylorospasm due to denervation after pylorus-preserving, some operative technique has been described. The most common are: a) mechanical dilatation of the pylorus ring, b) pyloromyotomy, c) preservation of the right gastric artery, gastroduodenal artery and all innervation along the lesser curvature of the stomach and proximal duodenum, and d) low doses of erythromycin in the unfed period with preservation of the right gastric artery²^,⁷.