Medieval Islamicate Surgery and the Evolution of Ascites Management: Early Principles of Patient Selection, Controlled Drainage, and Postoperative Care

Ascites management is currently guided by well-established surgical principles, including careful patient selection, controlled fluid removal, and prevention of circulatory dysfunction during paracentesis. Although framed in modern physiological terms, these principles have conceptual roots in earlier medical traditions. This study re-examines the surgical management of ascites within the medieval Islamicate medical tradition, encompassing medical cultures and scholarly practices that developed in societies shaped by Islamic civilization, rather than referring solely to religious doctrines or institutions. The study focuses on operative reasoning rather than historical description. Primary sources, including Avicenna’s Canon of Medicine , Rhazes’ Al-Hawi , Haly Abbas’ Kamil al-Sina’ah , and Albucasis’ Al-Tasrif , were analyzed thematically to identify underlying surgical principles. These findings were contextualized in relation to earlier Greco-Roman writings, particularly those of Paul of Aegina, and compared with contemporary clinical concepts in ascites management. The analysis demonstrates that medieval Islamicate physicians developed a coherent framework for ascites intervention based on 4 core principles: (1) strict patient selection prior to surgery, (2) gradual and controlled fluid evacuation, (3) recognition of physiological tolerance and operative risk, and (4) structured postoperative care. Despite differences in theoretical background, these principles closely parallel modern concepts in large-volume paracentesis, including prevention of paracentesis-induced circulatory dysfunction and risk stratification before intervention. Rather than constituting isolated historical techniques, these writings reflect an early form of physiology-guided surgical judgment. This reframing highlights the continuity of operative principles across medical history and underscores the relevance of classical Islamic medical literature to contemporary surgical decision-making.