Early Achievements in Pediatric Surgery at Vanderbilt University Hospital: Rollin Daniel, Jr., and James Kirtley, Jr.

Vanderbilt University was the site of two important operations that have been largely overlooked in the history of pediatric surgery. In November 1943 Rollin Daniel, Jr., was the third surgeon in the world and the first in the South to have a newborn infant survive after primary repair of esophageal atresia (EA) with tracheoesophageal atresia (TEF; EA/TEF). Daniel's insight was to expose the anomaly from the right side of the mediastinum, the standard exposure where the aorta is in its usual left-sided position. For his own reasons, Daniel reverted to the more cumbersome left-sided approach used by Haight to finally achieve success. James Kirtley had the first long term survivor of repair of biliary atresia in January 1951, four years before Shigetsu Katsura's first successful operation in 1955, a procedure later identified with his junior associate Morio Kasai. Like Katsura Kirtley came about his operation from frustration at not finding a biliary remnant to which an anastomosis might be constructed. After surgery bile seeped through miniscule biliary ducts unintentionally disrupted during his dissection. Internal drainage into an opening into the duodenum sutured to the hilum at a second operation resolved his patient's jaundice. Kirtley's procedure anticipated the Kasai operation that became standard in the late 1960s. The pioneering operations established Vanderbilt University Hospital as one of the important centers for pediatric surgery during the peak years of innovation in pediatric surgery in the mid-twentieth century.