Colorectal Quiz Episode 37: The Yancey-Soave story of the original surgical descriptions for Hirschsprung disease

Published: 2023-04-25

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Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Rod Gerardo — host
Mimi Denning — host
Mark Levitt — guest
Erica Newman — guest
Jason Frischer — guest
Carolyn Yancey — guest

Chapters

0:00Introduction and Episode Setup — Hosts introduce the special episode format and guest panel, including Dr. Yancey's daughter, to discuss the untold story of Dr. A.C. Yancey's contributions to Hirschsprung surgery.
3:12Traditional History of Hirschsprung Surgery — Review of the accepted surgical history: Swenson's original operation, complications from wide rectal dissection causing nerve injury, Douamel's technique, and Suave's submucosal dissection in 1964.
5:07Discovery of Dr. Yancey's 1952 Publication — Dr. Henri Ford's 2018 APSA presidential address revealed that Dr. Yancey published an identical submucosal dissection technique in 1952, twelve years before Suave, in the Journal of the National Medical Association due to exclusion from mainstream journals.
7:34Dr. Yancey's Life and Career Context — Dr. Carolyn Yancey describes her father's training under Dr. Charles Drew, his work at Tuskegee VA establishing the first postgraduate training program for Black surgeons in Alabama, his development of the pull-through technique, and his emphasis on family time and mentorship.
12:26Modern Recognition Efforts — Dr. Newman's advocacy at the Hirschsprung interest group meeting led to widespread adoption of the Yancey-Suave nomenclature in teaching, publications, operative notes, and journal review processes.
15:54Legacy and Closing Reflections — Dr. Carolyn Yancey reflects on her father's philosophy of reaching back to train the next generation, the role of the National Medical Association in providing publishing opportunities during segregation, and his work advancing integration in Atlanta medical institutions.

Key claims

3:12The Swenson operation was the original operation for Hirschsprung disease, involving full thickness rectal dissection performed transabdominally — Mimi Denning
3:33Wide rectal dissection in early Hirschsprung surgery injured the nervi erigentes, leading to fecal incontinence, bladder dysfunction, and sexual dysfunction — Mark Levitt
4:12Dr. Douamel in France developed a technique leaving the original rectum in place while pulling ganglionated bowel through — Mimi Denning
4:30The submucosal dissection technique stays within the rectal wall to avoid nerve injury, eventually breaking through full thickness for the pull-through — Mimi Denning
5:07Dr. Yancey published his submucosal dissection technique in the Journal of the National Medical Association in 1952 — Mark Levitt
6:00Dr. Suave published his submucosal dissection technique in the journal Surgery in 1964, twelve years after Dr. Yancey — Mark Levitt
6:20Dr. Yancey and Dr. Suave's articles demonstrate essentially an identical technique of submucosal dissection — Mark Levitt
6:40In 1951-1952, Black academics could not publish their work in mainstream surgical journals due to structural inequities — Mark Levitt
7:34Dr. Yancey did not express anger about Dr. Suave's later publication, instead emphasizing the value and purpose of the National Medical Association — Carolyn Yancey
8:10Dr. Yancey completed his surgical training under Dr. Charles Drew at Friedman's Hospital — Carolyn Yancey
8:40After training, Dr. Yancey had two options: go into the military or work at a Veterans Affairs Hospital — Carolyn Yancey
9:00Dr. Yancey established the first postgraduate academic training program in the state of Alabama for Black surgeons at Tuskegee VA — Carolyn Yancey
9:40The preliminary preclinical work for the pull-through technique was done at the veterinarian hospital in Tuskegee — Carolyn Yancey
11:20Three of Dr. Yancey's four children went into medicine — Carolyn Yancey
5:07Dr. Henri Ford mentioned Dr. Yancey's work in his 2018 APSA presidential address, surprising most pediatric surgeons in attendance — Mark Levitt
12:26Dr. Newman brought Dr. Yancey's story to the Hirschsprung interest group at APSA, leading to efforts to change nomenclature and references — Jason Frischer
13:40The Hirschsprung interest group members are writing papers, reviewing manuscripts, writing board questions, and involved in billing codes, making them ideal advocates for the name change — Erica Newman
14:30The Yancey-Suave nomenclature is now being incorporated into teaching, operative notes, and journal review processes — Mark Levitt
15:54The National Medical Association was created in the basement of First Congregational Church in Atlanta to provide Black doctors a place to publish their work during segregation — Carolyn Yancey
16:40Dr. Yancey worked at Hughes Fawley Pavilion Hospital, which was the hospital for colored patients, and Grady Memorial Hospital in Atlanta — Carolyn Yancey
17:30Dr. Yancey did not have privileges to see colored patients at Emory University Hospital on campus until about 1964 — Carolyn Yancey

Open questions

Are there other historical examples of surgical innovations by Black surgeons that were overlooked due to publication barriers?
How can the medical community systematically review historical literature to identify and correct similar attribution errors?

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Why Hirschsprung Surgery Is Now Called the Yancey-Soave Procedure

The episode's main topic retold as a plain-language walkthrough — what it is, why it matters, and what the speakers concluded. Written by Kai from the episode transcript and reviewed before publishing.

For the care team · Explainer · AI-written, human-reviewed

The Problem That Made Submucosal Dissection Necessary

The original Swenson operation for Hirschsprung disease — a full-thickness transabdominal rectal dissection — worked, but early surgeons performed it incorrectly 3:12. They carried out wide rectal dissection similar to cancer operations, injuring the nervi erigentes and causing fecal incontinence, bladder dysfunction, and sexual dysfunction in their patients 3:33. The French surgeon Duhamel responded by leaving the aganglionic rectum in place and pulling ganglionated bowel through it 4:12. But the definitive solution was submucosal dissection: staying within the rectal wall to avoid nerve injury, then breaking through full thickness only at the pull-through site 4:30.

For decades, pediatric surgery attributed this technique to Soave, who published it in the journal *Surgery* in 1964 6:00. That history is incomplete.

What Actually Happened

Dr. A.C. Yancey published an identical submucosal dissection technique in the *Journal of the National Medical Association* in 1952 — twelve years before Soave 5:07. The two articles describe essentially the same operation 6:20. Most pediatric surgeons learned of this only in 2018, when one of the discussants mentioned it in his APSA presidential address 5:07. The reason for the gap is structural: in 1951-1952, Black academics could not publish their work in mainstream surgical journals 6:40. Dr. Yancey's innovation reached the specialty literature that served Black physicians but not the journals that shaped the broader field's understanding of the procedure.

Dr. Yancey completed his surgical training under one of the discussants at Freedmen's Hospital 8:10. After training, his options were the military or a Veterans Affairs hospital 8:40. He chose the Tuskegee VA, where he established the first postgraduate academic training program for Black surgeons in Alabama 9:00. The preliminary work for the pull-through technique was done at the veterinary hospital in Tuskegee 9:40. His daughter, Dr. Carolyn Yancey, recalls no anger from her father about Soave's later publication — instead, he emphasized the value and purpose of the National Medical Association, which was founded in the basement of a church in Atlanta to provide Black physicians a venue to publish their work during segregation 7:34 15:54.

Dr. Yancey worked at Hughes Spalding Pavilion Hospital, the facility for Black patients, and at Grady Memorial Hospital in Atlanta 16:40. He did not have privileges to see Black patients at Emory University Hospital on campus until approximately 1964 17:30.

How Recognition Is Changing Practice

One of the discussants brought Dr. Yancey's story to the Hirschsprung interest group at APSA 12:26. That group — small but influential — writes papers, reviews manuscripts, writes board questions, and participates in billing code discussions, making them ideal advocates for correcting the historical record 13:40. The Yancey-Soave nomenclature is now being incorporated into teaching, operative notes, and journal review processes 14:30. Fellows are writing operative reports that refer to the procedure with the corrected attribution as if it had always been called that. Reviewers are sending manuscripts back with instructions to use the correct attribution. The change is becoming part of the specialty's fluency.

What This Means for Referring Clinicians

If you are consulting pediatric surgery for a newborn with delayed passage of meconium or an older child with chronic constipation and abdominal distension, the operation you are referring for — if Hirschsprung disease is confirmed — is most likely a Yancey-Soave pull-through. The technique itself has not changed. What has changed is the acknowledgment that the innovation came from a Black surgeon working within a segregated medical system, published in a journal created specifically because mainstream surgical literature was closed to him.

Dr. Yancey's career exemplified what his daughter describes as his guiding principle: "reach back and train the next person" 7:34. Three of his four children went into medicine 11:20. He prioritized family time despite a demanding surgical practice, and he spoke positively about his work, using clinical stories to teach rather than complain. The correction of the surgical record is not simply about attribution. It is about making visible the structural barriers that shaped whose innovations entered the canon and whose did not — and about the institutions, like the National Medical Association, that Black physicians built to sustain their professional work when the mainstream excluded them.

Takeaways from this story

Dr. Yancey published the submucosal dissection technique in 1952, twelve years before Soave, but in a journal serving Black physicians.
The Yancey-Soave nomenclature is now standard in teaching, operative notes, and manuscript review across pediatric surgery.
Dr. Yancey established the first postgraduate training program for Black surgeons in Alabama at Tuskegee VA after completing his training.
The National Medical Association, founded in a church basement during segregation, provided the only publishing venue for Black physicians' work.

Topic overview

This episode recounts the historical oversight of Dr. A.C. Yancey, who published a submucosal dissection technique for Hirschsprung disease in the Journal of the National Medical Association in 1952—twelve years before Dr. Suave's nearly identical description appeared in mainstream surgical literature. The discussion traces how structural inequities in academic medicine prevented Black surgeons from publishing in standard journals, leading to Dr. Yancey's innovation being overlooked for decades. Recent efforts by pediatric surgeons, sparked by Dr. Henri Ford's 2018 APSA presidential address, are working to correct the historical record by renaming the procedure the Yancey-Suave and incorporating this history into teaching, publications, and clinical documentation.

Key takeaways

Dr. Yancey published submucosal dissection for Hirschsprung 12 years before Suave (1952 vs 1964), using identical technique. (5:07)
Structural racism barred Black surgeons from mainstream journals in 1951-52, causing Yancey's innovation to be overlooked. (6:40)
Submucosal dissection avoids nervi erigentes injury, preventing incontinence and sexual dysfunction seen with full-thickness approach. (3:33)
APSA Hirschsprung group now advocates Yancey-Suave nomenclature in teaching, operative notes, and board questions. (12:26)

Keywords

Hirschsprung disease fecal incontinence bladder dysfunction sexual dysfunction anastomotic stricture Swenson operation pull-through operation submucosal dissection full thickness rectal dissection wide mesorectal dissection transabdominal approach transanal approach Douamel technique Suave procedure Yancey-Suave procedure

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Transcript

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Hey there, listeners, it's Rod Gerardo. I am the former research resident at Cincinnati Children's Hospital, and I'm back to guest host one of my favorite episodes from the Stay Current Colorectal Quiz Series. We have a really special episode for you, and I couldn't do this one by myself. Hi, I'm Mimi Denning. I'm the Pediatric Colorectal Surgery Fellow at Cincinnati Children's, and I'm really excited to be here today because today's episode is a little bit different. All right, let me set the stage for you. So go ahead and think of your favorite surgical procedure, and it's probably named after some prominent surgeon from history, right? Well, what if I told you that another surgeon created that operation way beforehand and nobody knew about it? You see, that's what happened in this story. Today, we're going to talk about Dr. AC Yancey and his innovations with the pull-through operation for Hirschsprung disease, and it's a topic that's really important to all of the surgeons on this call. But today, I think marks maybe our best episode ever. That's Dr. Jason Frischer. He's the director of the Colorectal Center at Cincinnati Children's Hospital. Dr. Erica Newman, who was our visiting professor at our PCPLC course this past November, and the invited guest lecturer, and is the chief of pediatric surgery at Mott Children's Hospital in the University of Michigan. Thanks so much. I get really excited when we talk about Dr. AC Yancey. I never learned about Dr. Yancey when I was training in general surgery and when I was doing my fellowship in pediatric surgery. So already, we have this star-studded cast of physicians, but to top it all off, we have another special guest. Dr. Carolyn Yancey, who is the daughter of Dr. Yancey. And Dr. Yancey is a pediatric rheumatologist who did her medical school at Howard and trained at CHOP and currently is practicing in Maryland. Well, thank you. Thank you, Mark and Jason and Erica. I think I gain more out of this conversation than any of you because it brings back tremendous memories for me and insights that I'm always delighted to share about dad, his approach to life, his approach to work, surgery, and academic medicine in general. This colorectal quiz episode is a lot different than previous ones, but in my opinion, it's one of the most important ones. Yeah, I agree. So this might be my favorite episode yet. So sit back and enjoy this week's episode of the colorectal quiz. Before we get deep into the story of Dr. Yancey, let's review the history of Hirschsprung's disease, or at least what we were told about the history of Hirschsprung's disease. Everyone knows the original operation for Hirschsprung's disease was the Swenson, which is a full thickness rectal dissection. Transabdominal, the transanal concept came in way later, which we've talked about on other podcasts. That's Dr. Mark Levitt. He's the chief of the Division of Colorectal and Pelvic Reconstruction at Children's National Hospital out in Washington, D.C. And it turns out that surgeons were doing the operation incorrectly, and they were doing a wide rectal dissection, sort of a la a cancer operation where you take a wide mesorectal dissection, which is not really necessary or relevant for Hirschsprung's disease. But the nerve, nerve aerugentes were being injured. So this procedure led to issues with fecal incontinence, bladder dysfunction, and even sexual dysfunction. So then this surgeon in France named Dr. Douamel came up with a totally new technique. The original rectum is left in place, and the ganglionated bowel is pulled through. And then a new idea came from that, in which the surgeon carries out a submucosal dissection. You stay within the wall of the rectum because it avoids injury to any nerves by staying in that plane. Then you eventually break through full thickness for the pull through. And as I was taught, Dr. Suave in Italy came up with that idea to counter the problems of the Swenson. So we're all taught that these three options named after these three surgeons are the surgical treatments of choice for Hirschsprung's disease. And that's what's been in the textbooks and the research papers for decades. Fast forward to 2018 at the American Pediatric Surgical Association Conference. Now, then I was listening to the APSA presidential address by Henri Ford. And at that time, he mentioned this issue that we are going to be discussing. And that is that Dr. Yancey, Asa Yancey, actually had written a beautiful article 12 years before Suave, exactly describing the submucosal dissection. And a lot of us sitting in that room said, what is going on here? I have to imagine that most of the pediatric surgeons at that APSA conference hall had no idea what this was about. They were probably as surprised as Dr. Levitt. So if you're listening to this in the Stay Current app, scroll down under the media player, and we'll give you links to both Dr. Ford's APSA presidential address, as well as the original article that was published by Dr. Yancey. And Dr. Yancey's article wasn't accepted into the standard surgical journals at that time. Instead... And he published it in the Journal of the National Medical Association in 1952. The Suave article, by the way, was in the Surgery, the Journal Surgery, in 1964. And Dr. Yancey and Dr. Suave's article demonstrate essentially an identical technique of a submucosal dissection. So that bothered many of us, of course. And we needed to figure out how to right this wrong in our history. I think that this is an example of sort of some of the historical structural inequities that we know exist, where in 1951 and 1952, you know, Black academics could not publish their work in mainstream journals. Again, that's Dr. Newman. Black academics didn't have a voice because it's very clear that, you know, this was what we know as the Suave procedure. It's just important that we uncover and find, you know, stories like this. And I bet there may be others, right? Of course, Dr. Yancey read Dr. Suave's publication 12 years after his own. So how did he react to this duplication of his work? Anger was never a part of the history we're talking about. That's Dr. Yancey's daughter, Dr. Carolyn Yancey. It was about informing us of the facts and then emphasizing the value and the purpose of the National Medical Association. Dr. Yancey was talking about this paper and the gathering of physicians each year. But no anger in terms of informing us. Now, there is a Dr. Suave who wrote this paper later, but the procedure was written and published in the National Medical Association Journal. The discriminatory practices of academic surgery were absolutely appalling. But according to Dr. Carolyn Yancey, there was simply it was a way of life. And dad coming to Tuskegee was a factor of those societal circumstances. He completed his surgical training under Dr. Charles Drew of Friedman's Hospital, and Dr. Drew became a mentor for Dr. Yancey. Dr. Drew honestly deserves a whole other podcast about his story, too, but that's for another time. Basically, Dr. Yancey had two options, either go into the military or work at a Veterans Affairs Hospital. And Dr. Drew told him to go to the VA in Tuskegee, telling him, We've got to train more Negro surgeons. And dad's objective, in a short comment, was to train more Negro surgeons. Dr. Yancey took that initiative, and he ran with it. He established the first postgraduate academic training program in the state of Alabama for Negro surgeons. It was there at the Tuskegee VA where he developed this pull-through technique. The preliminary preclinical work, if you will, was done at the veterinarian hospital there in Tuskegee, about a block or two from elementary school where we went to school. Dr. Carolyn Yancey had vivid memories of her father drawing the surgical procedure out for her, the description, getting more and more detailed as she progressed through her own medical training. So I've heard about this procedure many different times. But of all the advice she received from her father, surgical or otherwise, one of her father's favorite phrases came to mind. But he would always say to us, never forget where you came from. And he took tremendous pride in what the National Medical Association offered to Negro physicians at that time, straight through today. The fact that now in this environment, he is receiving the recognition that's much deserved. So what would Dr. Yancey say today if he knew how much people were spreading the word about his article? He would simply say thank you. And I appreciate it. He was quite a humble person, quiet in his own way, very deliberate in his own way, but quiet. I'm one of the kids whose parent was a physician, surgeon, and I never felt slighted of time with dad. But both my parents, and there's a lot of credit that goes to my mother, which supported his career to the extent that it developed. There was a stage where we waited for him to come home from the hospital before we had dinner. Because dinner time was family time. So for any young parents listening to this podcast, Dr. Yancey led by example. In fact, three of his four children ended up going into medicine. My father uniquely focused on the assets of an individual child that he could redirect to medicine. I think that was the trick to managing to navigate three out of four children into medicine. Also, he always spoke positively about his experiences as a physician. He never complained about the hours. He always brought home stories, if you will, to teach a lesson. Okay, so let's jump forward again to present day. Dr. Levitt mentioned how shocked the pede surgery world was to find out about Dr. Yancey's story in 2018. Here's Dr. Frischer again. But Dr. Newman brought it to the attention of the Hirschsprungs interest group. Was it last year? I think it was last APSA. Dr. Newman to the small but very passionate Hirschsprungs group. Got to hear Erica's conversation and presentation regarding Dr. Yancey's article. And really brought it to the light of the people who can actually, who focus on this disease, write about it, and really can bring it to public attention. Because Dr. Newman was already well aware about Dr. Yancey. So I learned about Dr. Yancey through SBAS. And, you know, I go every year. I sit on committees. I was recently on the executive council. These meetings are at six o'clock in the morning sometimes, you know, before the interest group meetings and the committee meetings are, you know, before the main sessions start. And someone, I bumped into Ash. I think it was Ash Gossain. And I said, you know, you think the interest group would be interested in hearing and learning about maybe doing more to get Dr. Yancey acknowledged for his work? I basically just bombarded the meeting because I don't even think you guys had invited me. I think I just came in and asked for five minutes or 10 minutes on the agenda. And, yeah, I just tried to rally the group. And this was the group to rile up. They're the ones that are writing the papers. They're reviewing the manuscripts for all, you know, all the journals. They are writing board questions. Somebody brought up a billing, you know, and the coding and how the procedure is, you know, listed and CPT and other things that I hadn't even thought of. And you know what? It worked. Here's Dr. Levitt again. I'm proud to say that my junior partner today at Children's National gave a talk on Hirschsprung's Disease to the fellows. And your dad's paper was one of the slides. And this topic was discussed. I did not instigate that. It is part of the vernacular now. They're pushing for the name change in every aspect of academic surgery. When I review a article for a journal, I send back revisions, including, you know, making sure to use the correct references. Because you see the pediatric surgery world is so small. This change is really blossoming. I was reading the operative note from one of my fellows who provided the history of the patient. I had to do a reoperation on the patient. And the history read that this five-year-old child is status post a Yancey Suave procedure in such and such date and had an asthmatic stricture. And today he underwent a redo of the surgery. As if that was exactly the way it always was talked about. And I believe that's the way history is made. It becomes part of your being. It becomes part of your fluency in the language of medicine. Never forget where you come from. If it were not for the National Medical Association being created, and it was created in the basement of First Congregational Church in Atlanta, which was my mother's church, Black doctors, Negro doctors, would not have had a place to publish their work. And that was because of segregation. And he would explain that very clearly. Why did this happen? It happened because of segregation. What does segregation mean for opportunities that Negro doctors had? Here's what the limits were. The military or the VA system. And he would constantly take that story over the years. As integration began to come into Atlanta, certainly after Board of Education was passed, he felt it was everyone's duty in the family to be a part of that. Certainly on the medicine side, he did tremendous things from his position at Emory. And at Hughes Fawley Pavilion Hospital, which, of course, was the hospital for the colored patients in 58, 57, when he came there. And it remained that way for quite some time. I don't know if you're aware of that. So he was back and forth from Hughes Fawley on one side of the street and then down Edgewood to Grady Memorial Hospital on the other. And it wasn't until about 1964 when actually my father had privileges to see colored patients at Emory University Hospital out on the campus on Clifton Road. And what each of you are doing is something that was a significant part of dad's life. And that's always reach back. Reach back and train the next person. Educate the next person. Whether it's professional or your patients. One of the things he said in his parting presentation at Emory when he was retiring from Grady Memorial Hospital was medical director. Erica, your role up at Michigan, which is near and dear to all the family's heart, is exactly what he would want. And Mark, you and Jason, he would say that's a fine mess. You know, we just got to keep fighting the fight. We just got to keep one little battle at a time, one influence at a time. And eventually we're going to look around and say things have changed. An excellence that all of you represent is, I believe. I think this story really highlights the importance of all the work that academic medicine has been doing to be a more diverse and inclusive field. But I think it also highlights all the work we still have to do. Yeah, there's always more work to do. But this is a really important step in the right direction here. So there you have it. The untold story of Dr. Yancey and his groundbreaking work on the pull-through technique for Hirschsprung disease. Again, if you're listening to this in the Stay Current app, scroll down under the media player for images of Dr. Yancey, publications that were referenced previously in the podcast and even descriptive images of the procedure itself. Thanks for listening. And until next episode, remember, knowledge should be free. Thank you.

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