Memoir recounts “golden age” of surgical innovation Dr. Wangensteen led at University of Minnesota

Owen H. Wangensteen, MD, FACS, who chaired the department of surgery, University of Minnesota, Minneapolis, for several decades and established the American College of Surgeons (ACS) Surgical Forum—now the Owen H. Wangensteen, MD, FACS, Scientific Forum—presented annually at Clinical Congress, remains a surgeon of great renown. Another highly esteemed surgeon and a champion of bariatric and metabolic surgery who trained under Dr. Wangensteen, Henry Buchwald, MD, PhD, FACS, has recently published a recollection of the heady days at the University of Minnesota and the important contributions Dr. Wangensteen and his attendings and residents have made to surgical care.

Surgical Renaissance in the Heartland: A Memoir of the Wangensteen Era chronicles Dr. Buchwald’s personal journey from Nazi-occupied Austria to New York, NY, and ultimately to Minneapolis and his professional career at the University of Minnesota—both forever changed under the guidance and tutelage of Dr. Wangensteen and the surgeons he recruited. Dr. Buchwald chronicles the culture of innovation that Dr. Wangensteen cultivated and how it led the scientific and clinical discoveries associated with the latter half of the 20th century.

Dr. Buchwald is professor of surgery and biomedical engineering and the Owen H. and Sarah Davidson Wangensteen Chair in Experimental Surgery Emeritus, University of Minnesota. He is the recipient of the 2019 ACS Jacobson Innovation in Surgery Award, presented by the College in recognition of his pioneering work and innovative research in metabolic and bariatric surgery.

Surgical innovation

Among his own innovations, Dr. Wangensteen proved that simple gaseous bowel distention, primarily from swallowed air, was the responsible agent for intestinal obstruction. Dr. Buchwald writes, “Most important, he invented nasogastric and nasointestinal suction, later referred to as ‘Wangensteen suction,’ performed by the ‘Wangensteen tube.’” This device evacuated intestinal gas and fluid, relieving the abdominal distention of a bowel obstruction, allowing patients to recover spontaneously or be adequately prepared free of sepsis for interventional surgery. “This innovation alone saved millions of lives” and “reduced the mortality of acute intestinal obstruction to below 3 percent” down from 40 percent in the 1930s, according to Dr. Buchwald.

The son of Midwestern farmers, Dr. Wangensteen transformed surgical education for aspiring surgical investigators, establishing a surgical residency with a mandatory seven-plus years—five years of clinical training, supplemented by two or more years in a basic science research laboratory coincident with the return to the classroom for a PhD in surgery and, whenever possible, an advanced degree in a basic science. By the end of his more than three-decade tenure as department of surgery chair in 1967, the graduates of his program included 38 department heads, 31 division heads, 72 program directors, and 110 full professors.

Among his other accomplishments, Dr. Wangensteen founded the journal Surgery in 1937; established the Society of University Surgeons in 1939; and, as noted previously, originated the ACS Surgical Forum in 1940.

University of Minnesota and advances in surgery

Much of the memoir focuses on three of Dr. Wangensteen’s most influential mentees and their impact on Dr. Buchwald’s professional development. These individuals included C. Walton Lillehei, MD, FACS, known as the father of open-heart surgery; Richard C. Lillehei, MD, FACS, a transplant surgeon; and, most significantly for Dr. Buchwald, Richard L. Varco, MD, FACS.

Dr. Varco was known as “the surgeon who other surgeons at Minnesota consulted on how to develop, reflect upon, and improve their concepts,” according to Dr. Buchwald. In many ways, Dr. Varco was the progenitor of Dr. Buchwald’s specialty. In 1953, Dr. Varco performed the first intestinal bypass operation to incite massive weight loss.

Dr. Buchwald describes Dr. Varco as an “insightful and complex technical marvel,” as well as a scholar, innovator, innovative thinker, teacher, and curmudgeon. While Dr. Buchwald was pursuing his research interests in cholesterol control to prevent cardiothoracic and vascular disease, Dr. Varco was developing the jejunoileal bypass operation for morbid obesity, taking more than 90 percent of the small intestine out of contact with food to reduce caloric consumption. Dr. Varco repeatedly asked Dr. Buchwald to start performing the procedure, but Dr. Buchwald refused. He wanted his name to be associated with his work in lipid and atherosclerosis management—not bariatric surgery. Furthermore, Dr. Buchwald had developed the partial ileal bypass for cholesterol control and was gaining recognition for that procedure.

At one point, Dr. Varco developed a condition that made it impossible for him to operate. He pleaded with Dr. Buchwald in 1966 to perform a jejunoileal bypass. Dr. Buchwald initially hesitated because of his focus on perfecting partial ileal bypass and his other research interests. Seeing a friend and mentor in need, Dr. Buchwald reluctantly yielded, and since 1966 his name has been associated with bariatric surgery.

“However, I have no regrets,” Dr. Buchwald writes. “Indeed, as I became more and more acquainted with the problem of morbid obesity and the unfortunate individuals suffering from this disease, the more grateful I was to Richard for forcing me to become involved, and very rapidly I became dedicated to the discipline.”

Dr. Buchwald also recounts his longstanding friendship with Ward O. Griffen, MD, FACS, past-chair, department of surgery, University of Kentucky, Lexington, and a leader of the ACS; both the Lillehei brothers; Jack Bloch, MD, FACS; and John P. Delaney, MD, PhD—all residents who trained under Dr. Wangensteen.

Surgical Renaissance in the Heartland: A Memoir of the Wangensteen Era is published by the University of Minnesota Press, Minneapolis.