Owen Harding Wangensteen

In the 1930s, Wangensteen attended to numerous cases of small bowel intestinal obstruction. In around 80% of cases adhesions resulting from previous abdominal operations were the cause of the obstruction. These could often present months to years after the original operation. The standard treatment was to divide the adhesions with further surgery and create a temporary enterostomy. When, as was usually the case, this was performed as an emergency, many patients died.[6]

By 1932, Wangensteen reported that suction via a nasogastric tube was as successful in relieving distension as surgical decompression. A year earlier, he tested and proved on an animal model, the hypothesis that it was swallowed air that caused the gaseous distension in the obstructed intestines. He argued that a tube placed into the stomach to remove the swallowed air in the stomach before it entered the intestines, would be just as effective as enterostomy, but without the accompanying morbidity and mortality. He passed a tube through the nose of a very unwell 72-year-old lady who was admitted with acute intestinal obstruction. Once the tube reached the stomach, he attached a suction device to remove swallowed air and stomach liquid, relieving the distension and resulting in relief of pain. She had surgery to relieve the bowel obstruction and recovered. The technique became known as 'Wangensteen suction' and was introduced into surgical practice around the world.[6] Studies demonstrated that the 44% mortality rate for patients treated for intestinal obstruction between 1917 and 1928 declined to 20% in the years 1927–1937.[6]

The technique became, and remains, standard practice for the initial management of small bowel obstruction in the context of previous abdominal surgery. A major systematic review in 2008 demonstrated that the suction technique introduced by Wangensteen was successful in 65% to 81% of patients with small bowel obstruction without peritonitis, avoiding the need for surgery.[9]

Maurice Visser estimated that by 1944 the technique had saved over 100,000 lives and by the time of Wangensteen's death in 1981, had saved over one million.[10]

For this innovative work the Academy of Surgery awarded him one of the highest American surgical honours, the Samuel D. Gross prize.[6]

Wangensteen continued work on prevention of intestinal obstruction. He was especially concerned that the powder on surgeon's gloves predisposed to the formation of adhesions. He warned glove manufacturers of its dangers and conveyed the importance of the removal of powders from surgical gloves.[6] Subsequent animal studies[11] and clinical studies[12] confirmed Wangensteen's suspicions that powdered surgical gloves could lead to adhesion formation. The use of such gloves was banned in Germany, then in the UK[13] and banned by the Food and Drugs Administration in the US from January 2017.[14]

Under Wangensteen's leadership the surgical training program at Minnesota gained a national and then an international reputation. He used the Socratic method of teaching, making his trainees enquire, question and engage in dialogue to find answers to some of the most challenging surgical problems of the day. He encouraged his trainees to observe and to trust their observations. His teaching ability earned him a Faculty Fellowship in his name, The Wangensteen Faculty Fellowship.[2]

He was one of the first generation of full-time chairs of surgery in the US and was a pioneer of incorporating mandatory research into American surgical training programs.[1] Much of the research which he supervised was in basic sciences and he became adept at raising funds to support these projects.[6]

He remained chief of surgery at the University of Minnesota for 37 years and attracted many surgical trainees including international trainees. Many of these became pioneers themselves, particularly in the field of heart surgery. These included F. John Lewis who in 1952, led the team which performed the world's first successful open-heart surgery using hypothermia, C. Walton Lillihei who introduced the technique of cross-circulation for open heart surgery, Richard DeWall who introduced the bubble-oxygenator style heart-lung machine,[15] and Frederick S. Cross who refined and popularized the rotating disk oxygenator.[16][17] Two of Wangensteen's trainees pioneered the introduction of heart transplantation, Norman Shumway who developed the technique and Christiaan Barnard who performed the world's first heart transplant.[3][18]

Wangensteen's commitment to surgical training was extended beyond Minnesota when in 1939 he founded the Society for University Surgeons. This allowed surgeons in training to present and discuss research results. It provided a forum where young surgeons could learn about the work of their peers in other institutions. This national society helped strengthen the scientific base of American clinical surgery.[10][19]

His innovative ideas inevitably led to his being involved in dispute and controversy. On one occasion the university dean, Richard Scammon, recommended that Wangensteen be demoted or dismissed. Powerful backing from two of his early supporters Elias Potter Lyon, the former dean, and William J. Mayo prevented this from happening.[6][10]

Richard F. Edlich described him as "the greatest surgical educator of the 20th century."[6] The success of his teaching and training methods is demonstrated by the careers of his trainees. Of these 38 became the department chairs, 31 accepted positions as division heads of their departments, 72 were directors of training programs, 110 became full professors, and 18 had appointments as associate professors.[6]

Wangensteen was an active member of the American College of Surgeons (ACS) and served as its president between 1959 and 1960.[2] In February 1947 he was instrumental in establishing the Surgical Forum at the annual meeting of the ACS. The aim of the forum was to "provide an opportunity to the younger surgical group for the presentation of the results of original clinical and experimental research".[19] This brought together surgical trainees involved in research with one of the largest gatherings of surgeons in the world, encouraging communication and the sharing of ideas.[2] Wangensteen hoped that it would also allow "a number of young, well trained surgeons their first opportunity of a hearing before a national surgery organization" and in that way improve their communication and presentation skills.[10][19] All abstracts presented to the forum were, and still are, published in the Journal of the American College of Surgeons (JACS), so giving many young surgeons their first opportunity to have their research published.[19] The forum abstracts are judged on the basis of their originality, contribution to knowledge, the quality of the methodology, and impact and the best win the Excellence in Research Award.[20] The forum continues at each ACS annual meeting, now titled the Owen H. Wangensteen Scientific Forum.[21]

Amongst Wangensteen's other contributions to surgery were practices in cancer surgery and the understanding of gastrointestinal tract disorders including appendicitis. Other procedures he developed included those for the treatment of gastric cancer and ulcers.[6][18]