Swenson described the first operation for Hirschsprung disease in the 1940s, which involved a full thickness rectal dissection. To respond to complications related to the dissection adjacent to the rectal wall, several surgeons came up with alternative approaches. Duhamel in 1956 published his technique whereby he left behind the original rectum and mated it to a pulled through segment of colon. A submucosal dissection leaving behind the external rectal wall was the next idea – and this was published by two surgeons. The one we know best is Soave, who published his approach in 1964. Dr. Asa Yancey 12 years earlier, in 1952, published the submucosal technique for Hirschsprung disease ultimately in the Journal of the National Medical Association. He had been denied publication in the most widely read journal of his day because of the color of his skin. This podcast discusses this aspect of pediatric surgical history and promotes a new way to honor both surgeons for their contributions.
APSA and the quest for significance: Addressing health disparities at home and abroad: https://www.jpedsurg.org/article/S0022-3468(18)30615-8/fulltext [jpedsurg.org]
Dr. Ford's presidential address: https://pubmed.ncbi.nlm.nih.gov/35487794/ [pubmed.ncbi.nlm.nih.gov]
Type: podcast · 20 min · posted 2023-04-25 Canonical: https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597 ## Chapters - [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=0) Introduction and Episode Setup - [3:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=192) Traditional History of Hirschsprung Surgery - [5:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=307) Discovery of Dr. Yancey's 1952 Publication - [7:34](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=454) Dr. Yancey's Life and Career Context - [12:26](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=746) Modern Recognition Efforts - [15:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=954) Legacy and Closing Reflections ## Statements - "The Swenson operation was the original operation for Hirschsprung disease, involving full thickness rectal dissection performed transabdominally" — Mimi Denning (clinical) [3:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=192) - "Wide rectal dissection in early Hirschsprung surgery injured the nervi erigentes, leading to fecal incontinence, bladder dysfunction, and sexual dysfunction" — Marc Levitt (clinical) [3:33](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=213) - "Dr. Douamel in France developed a technique leaving the original rectum in place while pulling ganglionated bowel through" — Mimi Denning (clinical) [4:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=252) - "The submucosal dissection technique stays within the rectal wall to avoid nerve injury, eventually breaking through full thickness for the pull-through" — Mimi Denning (clinical) [4:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=270) - "Dr. Yancey published his submucosal dissection technique in the Journal of the National Medical Association in 1952" — Marc Levitt (clinical) [5:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=307) - "Dr. Suave published his submucosal dissection technique in the journal Surgery in 1964, twelve years after Dr. Yancey" — Marc Levitt (clinical) [6:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=360) - "Dr. Yancey and Dr. Suave's articles demonstrate essentially an identical technique of submucosal dissection" — Marc Levitt (clinical) [6:20](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=380) - "In 1951-1952, Black academics could not publish their work in mainstream surgical journals due to structural inequities" — Marc Levitt (epidemiological) [6:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=400) - "Dr. Yancey did not express anger about Dr. Suave's later publication, instead emphasizing the value and purpose of the National Medical Association" — Carolyn Yancey (opinion) [7:34](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=454) - "Dr. Yancey completed his surgical training under Dr. Charles Drew at Friedman's Hospital" — Carolyn Yancey (epidemiological) [8:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=490) - "After training, Dr. Yancey had two options: go into the military or work at a Veterans Affairs Hospital" — Carolyn Yancey (epidemiological) [8:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=520) - "Dr. Yancey established the first postgraduate academic training program in the state of Alabama for Black surgeons at Tuskegee VA" — Carolyn Yancey (epidemiological) [9:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=540) - "The preliminary preclinical work for the pull-through technique was done at the veterinarian hospital in Tuskegee" — Carolyn Yancey (clinical) [9:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=580) - "Three of Dr. Yancey's four children went into medicine" — Carolyn Yancey (epidemiological) [11:20](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=680) - "Dr. Henri Ford mentioned Dr. Yancey's work in his 2018 APSA presidential address, surprising most pediatric surgeons in attendance" — Marc Levitt (epidemiological) [5:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=307) - "Dr. Newman brought Dr. Yancey's story to the Hirschsprung interest group at APSA, leading to efforts to change nomenclature and references" — Jason Frischer (epidemiological) [12:26](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=746) - "The 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" — Erika Newman (opinion) [13:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=820) - "The Yancey-Suave nomenclature is now being incorporated into teaching, operative notes, and journal review processes" — Marc Levitt (epidemiological) [14:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=870) - "The 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 (epidemiological) [15:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=954) - "Dr. Yancey worked at Hughes Fawley Pavilion Hospital, which was the hospital for colored patients, and Grady Memorial Hospital in Atlanta" — Carolyn Yancey (epidemiological) [16:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=1000) - "Dr. Yancey did not have privileges to see colored patients at Emory University Hospital on campus until about 1964" — Carolyn Yancey (epidemiological) [17:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-37-the-yancey-soave-story-of-the-original-surgical-descriptions-for-hirschsprung-disease-6597?t=1050) ## Transcript 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. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai