[The long and difficult birth of symphysiotomy or from Severin Pineau to Jean-Rene Sigault]

Jean-René Sigault and his assistant Alphonse Le Roy first performed in Paris symphyseotomy on the 1st of october 1777 and thereby successfully delivered Madame Souchot. This patient had a rachitic pelvis with an antero-posterior diameter of 6.5 to 7 centimeters and had previously given birth to four dead children. In fact symphyseotomy had been advocated in 1597 by Séverin Pineau after his description of a diastasis of the pubis on a hanged pregnant woman and Ambroise Paré approved Pineau. The operation was performed many times after Sigault's report but was opposed by the famous French obstetrician Jean-Louis Baudelocque. The discussion was so bitter that the Parisian physicians became divided in two groups, cesareans and symphyseans. Symphyseotomy, as a result of poor technic and its use in unsuitable cases, soon fell into disrepute and was forgotten until 1863 when Morisani, in Italy, performed it again. The procedure was reintroduced in France in 1891 by Pinard, very impressed by the demonstration of the visiting Spinelli. Pinard, Farabeuf and Varnier described an "open sky" technic based on a precise anatomic study. At the same time, in 1893, Gigli, in Italy, performed a new operation called pubiotomy praised before in 1786 by Aitken in Edinburgh. It consisted in severing the pubic bone to one side of the symphysis by means of the "Gigli saw". In fact, cesarean section was the operation chosen in almost all the cases by the obstetricians, symphyseotomy and pubiotomy being generally discarded in view of their many complications: hemorrhage, urinary fistulas, walking troubles... A simple new method of symphyseotomy was described in 1920-1924 by Enrique Zarate of Buenos-Aires called "subcutaneous partial symphyseotomy" which respects the superior ligament and a part of the inferior ligament of the symphysis. Accurately realised, it is little dangerous and is still used sometimes in difficult cases in some remote countries.