Evoking master surgeon Fernando Bonadeo Lassalle, MD

In Love with Medicine, with Argentina, and with Hospital Italiano de Buenos Aires

On August 20, Fernando died at home surrounded by his wife and lifetime mate, his children, and his grandchildren. The ongoing pandemic prevented deeply shocked friends and colleagues from saying goodbye to him in the HI Chapel, as it should have been, and from accompanying his remains to his grave.

The physician and his work

His primary goal was to do good to the patient as a whole. His actions were absolutely faithful to the Hippocratic Oath and the Declaration of Geneva of the World Medical Association. It could not have been otherwise for a believing Christian like him. He lived a happy and grateful life. I remember him telling me: “How lucky we are to be born in Argentina.” The Hospital Italiano de Buenos Aires was the right place for his professional development. He always worked there, full time.

After completing his residency program in 1969, he was invited to join what would be the original group of young doctors who, under the leadership of Enrique M. Beveraggi, MD, would have the mission of launching the modernization of the Department of General Surgery; it would move towards specialization and seek excellence without losing cohesion or atomization. That model certainly proved successful. Years later, Dr. Bonadeo became Chief of the renewed Department.

In the late 1960s, St. Mark’s Hospital in London was considered the best center for colorectal surgery worldwide. In 1969, excited by the project ahead -and leaving aside safer options-, Bonadeo did not hesitate to travel and complete his training, seeing surgeons like Alan Parks and Henry Thompson in action -whom he considered the best. He was also interested in the pathology aspects of rectal cancer with Basil Morson. In the mid-1970s, he returned to Argentina and started the adventure of creating the Coloproctology Section. That same year, I started to work in the hospital, and Fernando Bonadeo was my first Chief of Residents. In 1976, he invited me to work with him, and since then he has been my teacher, my chief, and my friend. I can proudly claim to have been his first disciple. Fernando was a tireless worker, with a strong willpower that I always wanted to have but never achieved. Based on a scientific, academic, teaching and ongoing self-evaluated concept, he set out the guidelines to be strictly followed by the members of the coloproctology team: 1) to make an exhaustive record of each patient including the procedures and tests performed, assess the outcomes, and share them in different forums and publish them; 2) to be aware of the outcomes of accredited Argentine and international centers, in order to compare them with their own; 3) to devote every effort to follow-up patients by specifically hired professionals; 4) to be constantly informed of the national and international medical and technological advances by reading reports, attending courses, congresses and other forums of discussion, and visiting leading medical centers. As a result of the comprehensive database, and given the high volume of patients at the Hospital Italiano, papers have been published and will continue to be published in the Argentine Academy of Surgery and other national and international forums and journals. As Fernando used to say, we must study, do, record, assess, read, and write. An example of Dr. Bonadeo’s scientific rigor and willingness is the use of perforated cards with more than 200 fields for the registry of oncology patients. They were difficult to complete and consult, but were useful until computers arrived. Hospital’s hepatologist Germán Welz, MD, had introduced Fernando to the use of those cards.

Fernando Bonadeo was an excellent, extremely skilled surgeon; calm and precise, he did not perform unnecessary maneuvers. As Ricardo Finocchietto pointed out, Fernando was one of those who made difficult things look easy. Fernando had a deep knowledge of all aspects of colorectal pathology, but stood out especially in rectal cancer surgery. The changes that took place during the 80’s were fascinating. The focus was on low anterior resection with sphincter preservation. The main disadvantage was the execution of the anastomosis. The emergence of the circular mechanical suture was an important step forward. In 1979, Bonadeo performed the first mechanical colorectal anastomosis in our hospital. In 1982 and 1984, R. J. Heald, an English surgeon, published two seminal works demonstrating how the rectum should be mobilized for surgery to have a low rate of local recurrence. He called it The ‘Holy Plane’ of Rectal Surgery. The technique required surgical skill and specialization, and it was adopted by Bonadeo and his group from the very beginning. It was striking to see him find the dissection planes, particularly in patients with unfavorable anatomy or large tumors. Surgery concluded with the macroscopic examination of the resected pieces with the pathologist, and sometimes continued with the subsequent microscopic examination. I remember that our first pathologist specialized in colon and rectum was Margarita Telenta de Beveraggi, MD. Fernando was also an expert in local resection techniques. His knowledge also included the interpretation of rectal cancer imaging, especially magnetic resonance imaging. He was also fully informed of the publications about the adjuvant and neoadjuvant therapies that we indicated to our patients. He encouraged multidisciplinary discussion of cases. He was inquisitive and stood firm in his convictions.

In the 1980s, an important decision was that some of the members of the coloproctology sector should be able to perform diagnostic and therapeutic colonoscopy. Dr. Ojea Quintana and me trained and built a team with the Gastroenterology Service. This union persists today.

In the mid-1990s, with the support and approval of Bonadeo, Guillermo Ojea Quintana, a brilliant and seasoned surgeon, was interested in the rescue treatment of pelvic recurrence rectal cancer, closing the circle. He built a growing multidisciplinary team to treat patients with pelvic extension of neoplasms from other organs and to perform surgery for peritoneal carcinomatosis.

In 1995, Fernando and I attended a congress of the Brazilian Society of Coloproctology and the ALACP, in São Paulo. We attended Henry T. Lynch’s presentations about hereditary colorectal cancer, and saw the need to develop this topic in our sector. Back in Argentina, Bonadeo called Dr. Carlos Vaccaro, the youngest in the team and with a good research profile, who did a great job. That was the beginning of the Hereditary Cancer Program, which now has institutional status and international level.

The secretary of the sector was another successful and fundamental choice of Fernando. Mrs. Alicia Adrover not only was efficient in the administrative task but also cared for the patients their families with humane, compassionate and helpful treatment. She also took care of us, the physicians of the sector.

The physician as academic and teacher

He worked very hard as Full Member of the Argentine Association of Surgery (AAC). He served the Board of Directors, he was the director of the Annual Course and directed courses of the Argentine Congress and other courses organized by the AAC. He was named Master Surgeon and Member Emeritus. In the 1991 Argentine Congress of Surgery, one of the lectures was “Advances in the diagnosis and treatment of colorectal cancer”. Being appointed Lecturer is the highest honor that can be bestowed on a surgeon in Argentina. Fernando was not eligible because he was part of the Board of Directors, and regulations at that time did not allow it; therefore, I was chosen. I was very happy to represent the Coloproctology Sector of the Hospital Italiano de Buenos Aires. In his greatness, Fernando never regretted that fact; on the contrary, he showed complacency.

As a Full Member of the Argentine Society of Coloproctology, he was Lecturer at the Argentine Congress, and he was appointed Master Surgeon. Internationally, he was member of the American Society of Colon and Rectal Surgeons, and an honorary member of several institutions. His postgraduate teaching activity was intense, and he gave many lectures in courses in Argentina and abroad. Many residents learned surgery with him, and many colleagues from Argentina and from abroad came to watch his surgeries. One of his most important teaching contributions was the implementation of the International Course on Colorectal Surgery of the Hospital Italiano in 1986. This year, the event celebrates its 18th edition, and it has always been attended by renowned national and international guests. At the time, the course introduced a novel didactic model based on short presentations (15-20 minutes) that, of course, required to be carefully prepared by the speakers. The method was a replica of the one used in the course on Colorectal Surgery at the University of Minnesota, considered the best at that time and directed by Stanley Goldberg, MD.

Fernando was President of the Argentine Academy of Surgery, the discussion forum where Fernando presented more works in times of many treatment changes in colorectal conditions -and therefore of divergent opinions-, and supported his assertions with the results obtained by the sector that he was leading.

An enviable life

Santhat Nivatvongs, MD, from the University of Minnesota and the Memorial Hospital in New York once told me: “Fernando would have excelled in any Department of Colorectal Surgery in the United States”. Fortunately, he never thought of leaving the Hospital Italiano in Buenos Aires. He did everything he intended to do and he did it well, both in his medical and family environments. He was respected, listened and admired due to his professional and human value. Indeed, he was a simple, affable and educated man. He aroused empathy in those who treated him. In moments of relaxation, he promoted a pleasant atmosphere and used turns of phrases of rural origin, remnants of his adolescence. A significant place for him was the city of La Cumbre, in the province of Córdoba, where his father.s family used to go on vacation. It was there that he met young Ana Meincke; they got married, and lived together all his life. They had a large and wonderful family. Whenever he had some spare time on vacation, he used to play golf. He was also a good golfer, reaching 1 handicap in his youth. Undoubtedly, La Cumbre was his place in the world.

Fernando, your work will continue to bear good fruit. It will remain in the hands of your disciples with your same mystique, who will keep it alive in future generations. Surely, you will also have a special place in Heaven after doing so much good on Earth.