Jean-Paul Chevrel (1933–2006)

April 1979, Paris. Under a mild drizzle, around 30 surgeons are gathered at the entrance of a small teaching arena at the Avicenne Hospital in Bobigny, Paris. They have been invited by Prof. Jean-Paul Chevrel—together with Prof. Jean Rives and a few other surgeons with a passion for hernia surgery and incisional hernias—with the aim of sharing techniques and ideas on the subject. The surgeons intend to rise to the challenges of the time: improving the rather disappointing results of abdominal wall surgery—then an underestimated discipline lacking recognition—as well as promoting it as a branch of surgery in its own right.

At the time, Prof. J.-P. Chevrel was 46 years old; on that particular day, with seven of his colleagues, he founded the Groupe de Recherche et d’Etudes sur la Paroi Abdominale (GREPA), which he would go on to direct fully, becoming its Secretary General until 1998, the year when GREPA was re-named the “European Hernia Society” (EHS-GREPA).

The EHS was born from the expansion of the initial GREPA to the whole of Europe, following scientific meetings held in Reims (Profs. Rives, Flament, Palot and Delattre), Milan (Prof. Trivellini), Naples (Prof. Corcione) and Palermo (Prof. Mandala), Paris (Prof. Alexandre) and Cologne (Prof. H. Troidl).

Indeed, the initial circle of French and foreign surgeons interested in the abdominal wall quickly grew to include Italians (Profs. Corcione and Bocchi), Spaniards (Prof. Hidalgo Pascual, Congress of 1999), Germans (first under the impulsion of Prof. Troidl (1998) and then of Prof. Schumpelick), followed by Dutchmen and Britons, with the magnifying impact of yearly Congresses federating an ever growing number of participants.

Strong friendships were born between J.-P. Chevrel, other members of the GREPA and American surgeons with a keen interest in the abdominal wall—introduced to each other by Jean Rives and René Stoppa—including Profs. Wantz, Gilbert, Nyhus, Read and Deysine, who were invited to, and took part in all GREPA Congresses. In Miami in 1997, the American Hernia Society (AHS) was founded, by emulation and on the model of the GREPA. In 2005, the most recent heir of the GREPA was born from the initiative of Profs. Chowbey, Ma and Lomanto, namely, the Asia–Pacific Hernia Society or APHS.

This evolution was the work of J.-P. Chevrel, our friend and an innovative surgeon, who sadly passed away on 21 May 2006. In this spirit of international friendship and collaboration and successful reunions, we want to pay him the very great homage he deserves.

In order to evoke the exceptional career of J.-P. Chevrel, one must abandon the sombre and solemn sentiments, however immense is our sorrow for having lost him, as he would have disliked starchy sadness. On the contrary, he was a permanently active, merry, creative and brilliant man, elegant, friendly and seductive, as well as a happy husband and the proud father of four daughters.

We could not pay him the tribute he deserves without mentioning the brilliant surgeon he was known to be, thanks to his great involvement in visceral and abdominal wall surgery and to his role as a dynamic and respected Head of Unit. He also was a passionate teacher, elegant, learned, and warm towards his family, his students and his friends of all nationalities. None who knew him could forget the quality of his anatomy lectures, perfectly orchestrated according to the pace learned from his master, Prof. Delmas, or the exceptional quality of his blackboard and chalk drawings. Behind the academic persona also appeared the keen yachtman he used to become at weekends; we imagine him now, wrapped up in his boat’s sail, the EHS-GREPA’s banner on the background of the yellow and red front page of the journal Hernia, which he created.

J.-P. Chevrel was born on the 7th of April, 1933, in Cauderan, Gironde (France), the son of an army pharmacist and a pharmacist mother: these origins probably accounted for his taste for fine wines, beautiful houses, the ocean and sailing.

He studied medicine at the Faculty of Medicine of Paris. In 1960, after succeeding at the competitive entry examination, he was appointed Interne des Hôpitaux de Paris, an envied title, and went on to achieve a difficult education in surgery under the supervision of distinguished surgeons such as Profs. Lucien Léger, J.L. Lortat-Jacob and René Gosset.

He was drawn to anatomy at an early stage (anatomy was then considered the key subject of study for the future elite of surgery) and entered the prestigious Laboratoire d’Anatomie de la Faculté Paris V directed by Prof. Delmas, where we worked together under the amicable supervision of a great anatomist, Prof. J. Hureau.

He successfully passed all competitive examinations, was promoted to the position of Attaché-Assistant and then Prosecteur d’Anatomie at the Faculty, another title much sought after and, at the time, a true door-opener for physicians with an ambition for an academic career in university hospitals.

Chef de Clinique-Assistant of the hospitals from 1965 to 1968, he brilliantly passed the Concours d’Agrégation des Universités in 1969 and became Assistant-Head of Prof. Rouvillois’ Surgery unit. He finally became a full-fledged professor in 1979.

From 1974 to 1999, the year when he was entitled to retire and became Professeur Honoraire, he directed the General and Digestive Surgery unit of the Avicenne Hospital, one of the best hospitals in Paris, attached to Paris XIII University.

J.-P. Chevrel was a member of 16 scientific societies, including the Société Anatomique de Paris, the Société d’Anthropologie de Paris, the Société Nationale de Gastroentérologie, the Association Française de Chirurgie and the Collegium Internationale Chirurgiae Digestivae.

He was one of the founders of the Société de Radio-Chirurgie Viscérale, created by Prof. Rives.

In 1979, he founded the GREPA and remained its Secretary General for the next 20 years.

In 1998, he presided over the birth of the European Hernia Society.

He was a founding member of the Society of Chirurgie Endocrinienne, created by Prof. Proye in1988.

He was also a founding member and Secretary General of the European Association of Clinical Anatomy from 1988 to 1999.

He was a member with tenure of the Académie Nationale de Chirurgie.

All these titles give a good idea of the surgical and academic activities of J.-P. Chevrel, who taught the students of Paris XIII University as well as those of the Certificats d’Etudes of Surgery in Paris and Clermont-Ferrand and General Anatomy and Organogenesis in Paris.

J.-P. Chevrel was also an Expert for the courts of Bobigny and for the National Supreme Court of Appeal (Cour de Cassation), where he was highly regarded by judges for his detailed reports, often feared for their impartiality.

From early on, J.-P. Chevrel was a prolific writer and published many papers; the list of his works is particularly rich and mainly centred around his areas of interest and excellence: anatomy, and general and digestive surgery, as well as abdominal wall surgery.

He signed more than 400 published papers in international and French journals, of which 125 are available nowadays from “PubMed”.

I cite only the most famous of his research papers on anatomy: Venous drainage of the thyroid (1965); Development of the meso- and metanephros in 13 and 20 mm human embryos (1965–1968); Arterial vascularisation of the bile duct, the venous drainage of the pancreas and gastric pedicle grafts (1993); Tracheal replacement (1999); Anatomy of the linea alba (1996).

Among his works on parietal and other pathologies were: Hartmann’s operation (1982); The surgery of bile duct lithiasis (1987); Crohn’s disease (1991); and, among his numerous original papers on abdominal wall pathology: his “classic” description of his personal onlay technique in ventral hernias with prostheses (1979, 1983, 1996), his classification of ventral hernias (1998 and 2001), his work on the use of glues and on the treatment of neuralgias after hernia surgery, a subject on which he returned many times starting from 1991.

J.-P. Chevrel was the author of numerous original treaties and followed a true parallel career as an editor.

He started in 1965 with a book on surgical symptomatology (Maloine, ed.), after which he published a surgery treaty (Masson, ed., 1968), an abridged General Anatomy (Masson, ed., 1974), which was re-published seven times, and a well-known original treaty of abdominal wall surgery (Traité princeps de Chirurgie des parois de l’Abdomen, Springer, Springer, ed., 1985) prefaced by L.M. Nyhus and published in English in 1986 and in Japanese in 1990.

In 1990, together with J.B. Flament, he published an important report on incisional hernias (Masson, ed.). He also edited yearly monographs (Bruneau, ed.) of the work presented at GREPA meetings in Bobigny since 1980, with titles such as: Umbilical pathology, Incisional hernias, Classification of hernias, and Diaphragmatic hernias and pelvic floor. He later went on to direct a collection of four books on Clinical Anatomy (Springer).

In 1997 he was the true creator of the journal Hernia and remained its editor-in-chief until 2001; he always stressed the importance of the quality of the publications, with critical peer review and the help of several successive co-editors, his friends V. Schumpelick, R. Bendavid, C.J. Philipi, R.J. Fitzgibbons and A. Kingsnorth.

From 1985 to 2000, he also held the position of chief-editor of the journal Surgical and Radiological Anatomy (Springer) and had been a co-editor of the Chinese Journal of Clinical Anatomy since 1988.

Listing his published works, however, does not illustrate well enough the true influence and the relentless activities of J.-P. Chevrel.

He travelled all around the world at the invitation of numerous universities, making countless presentations at conferences and enticing surgeons to take more interest in abdominal wall surgery—a subject that long remained poorly known in all its complexity and evolution.

I also took an active part in this movement; I experienced, together with J.-P. Chevrel and all the founding members of the GREPA, with J. Rives and R. Stoppa, the difficulties of promoting the use of prostheses in abdominal wall surgery. After the 1970s and until the good results reported by the Shouldice team in hernia cure, the proportion of relapses after inguinal hernia cure was well over 20%, and over 40% for relapses of incisional hernias after herniorrhaphy.

Although the GREPA had reported good results with non-absorbable prostheses, due to the lack of randomized controlled study results, most surgeons were only won over to the use of prostheses 10 years later, in 1990, following the first laparo-surgical cures.

From that moment on, the industry saw the opportunity and started developing prostheses of various textures, shapes and forms, either synthetic or biological, as well as multiple and varied means of fixation (sutures, staples, glues).

This rapid expansion of abdominal wall surgery—carrying true surgical as well as global economical stakes—and the advances it brought, allowing considerable savings, were in great part due to the work and personality of J.-P. Chevrel as well as to the GREPA’s team and to our common Master, Prof. Jean Rives, who taught us this surgery as well as the indications for pre-peritoneal prostheses and the concept of “incisional hernia disease”.

The international diffusion of this branch of surgery was a result of the contagious passion Jean-Paul put into promoting the knowledge of the abdominal wall, and of his friendships with numerous foreign surgeons, European, American, North-African, Chinese, Indian, Australian, etc.

His relationships and his meetings with Profs. R. Bendavid, J. Wantz, L.M. Nyhus, A.I. Gilbert, R.J. Fizgibbons and P. Amid, to cite only a few, doubtless led to the creation of the AHS.

The very productive collaboration of his wife Jeanne Chevrel, his good relationship with Springer, the permanent and fruitful collaboration of V. Schumpelick and the help of R. Bendavid and C.J. Filipi all led to the birth, in 1997, of the journal Hernia, which became the prestigious organ of publication common to the EHS and AHS.

J.-P. Chevrel also inspired the joint EHS/AHS meetings, in a spirit celebrating the universality of abdominal wall surgery. In 1995 he and R. Bendavid organized a first joint meeting in Toronto, later followed by the London 2006 meeting put together by A. Kingsnorth.

All who knew J.-P. Chevrel fell under the charm of his original and very endearing personality. Despite his sometimes misleading style and laid back cowboy allure, he was, as a matter of fact, a man of the utmost intellectual precision, a relentless worker, tenacious in his goals and a generous man who, nonetheless, expected only the best of those he lived and worked with.

He was much liked by his staff—the physicians, anaesthetists, nurses, secretaries and colleagues of the Research Laboratory he directed in Bobigny.

He was warm towards his patients, who worshipped him, and had a pronounced taste for teaching, whether in the operating room, where he demonstrated with exact gestures the importance of patience and precision, or in the teaching arena at the University, where he was much admired by his students for his talent for drawing, a gift that made him a perfect candidate for teaching anatomy.

His physical stamina was legendary; his leisure time was always filled with activities: surrounded by his loved ones, he would seek out nature and the ocean, go to his country house, cultivating his elegant and handsome physique. His house/refuge on the Ile de Ré and his latest boat summarized who he actually was: a complete man, adept at “beaconing” his own life and satisfied—once he was done with his work, the honours and the social whirl that came with it—with a humble place to live in simple happiness with those he loved.

We all know that for several years now, J.-P. Chevrel had been suffering from a very severe lesion that was causing him terrible pain and had kept him away from our last meetings.

For more than 6 years, he battled against an implacable disease with a courage that held the admiration of his friends and family; he always kept smiling and he remained selflessly heroic throughout an impressive number of operations and chemotherapy cycles. He passed away suddenly. A few days earlier, he was still sailing his boat and making plans about the future; a future he always believed in...

To his former wife Bernadette, to his daughters Stéphanie, Anne, Julie (my goddaughter) and Tessa, to his grand-children, to his wife Jeanne, I express my greatest compassion and that of all those who were his friends, colleagues, students: his wider family. We share their deep sorrow.

I want to say how very much we all admired J.-P. Chevrel: the friend I have lost and with whom I have come a long way since the time we were preparing for the Agrégation, the great surgeon who illustrated and embodied surgery and, more specifically, abdominal wall surgery, through his work and his personality, without borders.

All who knew him will remember him as an exceptional colleague, innovative, always young in mind and filled with the spirit of enterprise, listening to all, always ready to create a new journal, to initiate a new meeting, to seduce us all with a new idea.