Jean Rives

JR died on a sad “Good Friday” on 6 April 2012. For me, JR was more than a mentor—he was like a father.

I met him for the first time in June 1968, after my nomination in the Reims University Surgical Residency Program. For 20 years, I have never been far from him—I was with him in his office, in the OR, in the scientific meetings, etc. He taught me everything I know, when I was his Resident, Assistant Professor, Professor..., and even in 1988, when I became Chief of Surgery after he retired (Fig. 1). He had no children, and I think that his assistants were like a family for him and for Monique, his wife.

Fig. 1

Jean Rives 1988 “before he retired”

When he died, he was 90 years old, but a few weeks before his death, he was still writing essays on philosophy. He always had a very clear mind, and we had long phone calls: after his retirement, he never attended a medical conference, but he wanted to know what was going on in our department (he was very attentive to his ex-co-workers) and in the world of surgery (Fig. 2). Up to the last days (Fig. 3) (I called him on 28 March 2012), he kept his sharp intelligence and his love of writing, of music and of the sea (he had sailed all over Mediterranean sea with his friend Stoppa).

Fig. 2

Jean Rives 1992

His career began in Algiers where his father, a Medical Doctor himself, was established. JR did not speak very often of this period, which is now recognised by the French Government as a wartime! But, despite the difficult conditions of this period, he was a very inventive surgeon and published many interesting papers on digestive surgery, especially on the treatment of duodenal ulcers (everyone of his assistants has performed so many times the “crown omentoplasty for perforated duodenal ulcers”). Of course, as he was working in a Mediterranean country, he published many papers on hydatic cysts (the subject of his thesis).

He made the choice to leave Algiers in 1962 and was appointed as a Professor of Surgery, Chief of the University Surgical Department, in 1964 at Reims University Hospital, where I became his resident 4 years later; he had founded a School of Surgery, with his first assistants, H. Nicaise and B. Lardennois.

A true, renowned School of Surgery (something new in a city where 4 years earlier there was only a medical school, since the French Revolution had suppressed the old University, probably to punish Reims for hosting the coronation ceremonies of kings of France) is now well known and celebrated all over the world, since we have been his messengers, with JP Palot, JF Delattre and also F. Corcione, one of the most celebrated surgeons from Naples and M. Colledan, head of the Liver and Lung Transplantation Unit in Bergamo. Young surgeons came to Reims from around the world, and many of them are still good friends.

Fig. 3

Jean Rives 2009

JR was a magnificent surgeon, but he was also a wonderful anatomist, and his drawings of human gross anatomy were the best I have ever seen, even among “professional teachers of anatomy”. For 3 years, he trained me (everyday, including Sundays and holidays!) and all I can do with a blackboard and a chalk, I owe to him. Every time I am invited to give a lesson of anatomy “designata in directa”, as our Italian friends say, I think of this wonderful tool he had placed in my hands!

He was, as everyone knows, a “founding member” of GREPA, created in 1979 by J. P CHEVREL, and pioneering parietal surgery with many others such as R. STOPPA, J.H. ALEXANDRE, who was one of his first residents when he served as “chirurgien des hôpitaux à la Faculté Française de Médecine d^‘Alger”.

The “Groupe de Recherche et d’Etudes sur la Paroi—GREPA” was renamed EHS (European Hernia Society), in 1998 in Köln, to become a more international society. Jean Rives had already retired when the American Hernia Society and the Asia Pacific Hernia Society were created, but the names of their founding members appeared very often in our telephonic or live discussions!

How did he become interested in abdominal wall surgery? It is very simple!

When he arrived in Reims, he did not receive a warm welcome, and later, he told me that “I had nothing to do, so I worked hard!”

And, between 1962 and 1966, he published, on a despised subject “Parietal Surgery” (at that time, it was not considered as noble enough for “great surgeons”), many papers, especially in the French Encyclopédie Médico-Chirurgicale. He himself did all the drawings and illustrations, for he could design like a professional. It is interesting to remember that Raymond Read had translated in English the paper on “treatment of inguinal hernias”. Raymond became a friend and visited us many times in Reims.

Three techniques have been developed during this period:

• 1. Midline approach of inguinal hernias, either unilateral or bilateral with placement of a “supple mesh” in the pre-peritoneal space. This technique was, later on, popularised by R. Stoppa in France and G. Wantz in USA under the name of GPRVS (giant prosthetic reinforcement of visceral sac).

• 2. Trans-inguinal approach of groin hernias, with placement of a Mersilene™ mesh stitched to the Cooper ligament (in more recent years, V. Schumpelick gave the name of trans-inguinal pre-peritoneal prosthesis—TIPP or technique de Rives). This operation was considered a difficult one, and that is the reason why we developed, with JP. Palot and JF. Delattre, the concept used in the PHS mesh, with the pre-peritoneal mesh stabilised and without any difficulty by the superficial one.

• 3. Retro-muscular prosthesis for the cure of huge incisional hernias. But his interest went further than purely surgical questions, and he developed the concept of “eventration-maladie” with all the consequences: muscular, respiratory and cutaneous. According to him, his best paper was “Trophic ulcers of the skin in giant incisional hernias”, which I was honoured to present in Istanbul during the 2010 EHS meeting.

It is essentially thanks to him and to GREPA that utilisation and vulgarisation of prosthesis were accepted in France and maybe in Europe: when Hans Troidl organised, in 1995, the first German meeting on meshes, less than 10 % of hernias were treated by a prosthesis in Germany.

JR contributed to the birth of a new vision of parietal surgery, passing from a minor and despised speciality to a major and respectable surgery.

Jean Rives had very creative ideas, not only in Surgery, but also in “around” surgery.

To my knowledge, he was the first to organise “Professional Travels” through American hospitals with a group of prestigious French university surgeons, mainly from Paris and Lyon. We may not be able to understand, in 2012, how innovative it was in 1972, 40 years ago! But, for many of these “big men” of the French surgery, it was probably the first time they visited USA and especially 15 or 20 American hospitals, from Boston, New York, Houston, San Francisco and LA (Francillon, Maillet, Saubier, Cerbonnet, Le Brigand, Stoppa and Nardi were in this group).

Another idea issued from his creative mind was linked, in the 1970s, to the birth of ultrasound exploration: he thought that surgeons had to know how to use an ultrasound machine, especially for percutaneous drainage of abdominal collections. He sent us to learn in France as well as in USA, and our team was the first to publish a cohort of 500 abdominal collections, drained percutaneously, by surgeons, under ultrasound control. RIVES had created a society dedicated to the relationship between Surgery and Radiology: the “Société de Radio-chirurgie Viscérale”. For many years, there were meetings that were appreciated, bringing together Surgeons, MDs and Radiologists. Unfortunately, it is not so easy to use a CT scan than a US machine, and the surgeons had to share the treatment of abdominal abscesses with their radiologists friends.

He missed the Laparoscopy Revolution and, in 1988, he told us (JF Delattre, JP Palot and me) that we were crazy! But, with the honesty that was one of his characteristics, he came back 1 or 2 years later, to tell us that we had been right for promoting this technique in our department.

Throughout his professional life, he was like a tree giving new branches, almost every year: with a very acute vision of the future opportunities, he sent his assistants to train in Paris, Strasbourg, Tours, Marseille, etc. in specialities that did not exist in our hospital, contributing to the nomination of Professors and to the creation of Surgical Departments in Vascular Surgery, Urology, Cardiac Surgery, Ophtalmology, Endocrine Surgery, etc.

He was a Master

Life was not always easy with him: he trained us like “commandos” and I remember one of his favourite sentences: “If the soldier is more frightened by the sergeant than by the enemy, he will win when facing the enemy”.

Jean Rives was a good sergeant.

JB Flament with contributions from JH Alexandre and JP Palot