From Heller to POEM (1914-2014): a 100-year history of surgery for Achalasia.

BACKGROUND: The year 2014 marks the 100th anniversary of Dr. Heller's description of the surgical treatment of patients with achalasia with a cardiomyotomy. This 100-year-old operation, which is today performed laparoscopically with the addition of a partial fundoplication, is considered the treatment of choice for patients with achalasia. PURPOSE: Our goals are to revisit the accounts from the beginning of the twentieth century in which surgeons tried to identify the pathophysiology of achalasia and proposed several operative techniques and to follow the evolution of the surgical treatment until modern days.

Tales from previous times: important eponyms in pediatric surgery.

The use of eponyms in medicine has a long and captivating tradition, which applies to pediatric surgery as well. Unfortunately, even though these eponyms are widely used, oftentimes the fascinating personalities and lives behind these names remain unrecognized or underappreciated, especially among residents, fellows and younger-generation pediatric surgeons. Therefore, in this article, we review 15 names that are frequently used as eponyms in modern pediatric surgery and hereby enlighten the personalities behind them. Given their particular frequency, we choose the following eponyms: Ramstedt pylorotomy, Nissen fundoplication, Murphy's sign and sequence, McBurney's sign and incision, Meckel's diverticulum, Kasai portoenterostomy, Ladd's procedure, Morgagni and Bochdalek hernia, Ravitch operation, Nuss procedure, Hirschsprung disease, Swenson pullthrough, Peña procedure and Wilms tumor. A detailed description of the historical importance of these personalities and their contribution to our field is given. Without the appropriate historical background, it is difficult for the current younger and next generation pediatric surgeons to grasp the full spectrum of the ongoing progress in our field. Therefore, our article conveys not only important insight into the past, but also provides young surgeons with an important historical perspective essential to understand the current and future developments in modern pediatric surgery.

Endoscopic management of gastroesophageal reflux disease: a review.

Gastroesophageal reflux disease is the most common esophageal disorder encountered in the United States. Gastroesophageal reflux disease symptoms are associated with a negative quality of life and increased healthcare costs and therefore require an effective management strategy. Although proton pump inhibitors remain the primary treatment of gastroesophageal reflux disease, they do not cure the disorder and can leave patients with persistent symptoms despite treatment. Moreover, patients are still at risk of developing such complications as peptic strictures, Barrett's metaplasia, and esophageal cancer. Although laparoscopic Nissen fundoplication has been the conventional alternative treatment for those patients who develop complications of gastroesophageal reflux disease, have intractable symptoms, or wish to discontinue taking proton pump inhibitors, investigators have persisted in developing a number of endoscopic approaches to the treatment of gastroesophageal reflux disease. The present report reviews the history of endoscopic treatments devised for the management of gastroesophageal reflux disease and explores the published data and outcomes associated with the latest approach-endoscopic fundoplication using the EsophyX2 device.

The life of Rudolf Nissen: advancing surgery through science and principle.

Rudolf Nissen (1896-1981) was a surgeon whose career began in Germany during the first third of the 20th century, a period of rapid progress in biomedical technology, during which neurosurgery, anesthesiology, and other specialties emerged. A protégé and later close colleague of thoracic surgery pioneer Ferdinand Sauerbruch (1875-1951), Nissen resigned from the Berlin Charité Clinic and left Germany in 1933, in response to the rise of Nazi fascism. Throughout his subsequent career in Istanbul, Turkey, the American cities of Boston and New York, and finally Basel, Switzerland, Nissen developed innovative surgical techniques, advocated for patient-centered medical education, and promoted surgical subspecialization. A lifelong proponent of clear scientific writing, Nissen expressed, in extensively published work, his philosophy that progress in surgery depends critically on rigorously applying the scientific method, upholding professional integrity, and respecting human dignity.

Rudolf Nissen (1896-1981)-perspective.

INTRODUCTION: Rudolf Nissen was one of the outstanding general surgeons of the last century. Between the years 1921 and 1933, he was the pupil and protégé of the famous surgeon Ferdinand Sauerbruch. He was nominated professor of surgery in 1930. Forced by the Nazi-Regime to resign his position, Nissen emigrated in 1933 first to Turkey and then in 1939 to the USA. Here, he held positions in hospitals at New York. Having been appointed to the Chair of Surgery at the University of Basle, Switzerland, he returned to Europe in 1952. Nissen was a critical prolific writer and excellent researcher, surgeon, and teacher. CONCLUSION: The first successful pneumectomy and lung lobectomy in man, as well as the description of surgical pathophysiology and treatment of gastroesophageal reflux disease, including hiatus hernia, are considered to be his most important pioneer work.

Laparoscopic upper gut surgery.

Australian surgeons have been prominent in the introduction, development, and consolidation of laparoscopic surgery of the upper gut. In doing this, some of the very best principles of surgical innovation have been in evidence: preliminary animal work in which to test hypotheses and techniques, followed by careful application and documentation in the clinical setting, randomized clinical trials and finally academic reporting and ongoing development. This review documents the introduction of laparoscopic surgery for gastroesophageal reflux, hiatus hernia, achalasia, gastroesophageal malignancy, obesity, and a range of emergency conditions in Australia. Those involved are regarded as world leaders in their field. A vital component of this success has been the close cooperation between surgeons and gastroenterologists within the Gastroenterological Society of Australia.

Rudolf Nissen (1896-1981): his contributions to surgery and his role in Turkey.

Eminent surgeon Rudolf Nissen performed innovative studies in surgery during his time in Turkey, to which he fled from Germany before the Second World War. This paper discusses Nissen's invaluable contribution not only to Istanbul University's surgical department but also to the universal field of surgery.

The history of hiatal hernia surgery: from Bowditch to laparoscopy.

OBJECTIVE: This review addresses the historical evolution of hiatal hernia (HH) repair and reports in a chronological fashion the major milestones in HH surgery before the laparoscopic era. METHODS: The medical literature and the collections of the History of Medicine Division of the National Library of Medicine were searched. Secondary references from all sources were studied. The senior author's experience and personal communications are also reported. RESULTS: The first report of HH was published in 1853 by Bowditch. Rokitansky in 1855 demonstrated that esophagitis was due to gastroesophageal reflux, and Hirsch in 1900 diagnosed an HH using x-rays. Eppinger diagnosed an HH in a live patient, and Friedenwald and Feldman related the symptoms to the presence of an HH. In 1926, Akerlund proposed the term hiatus hernia and classified HH into the 3 types that we use today. The first elective surgical repair was reported in 1919 by Soresi. The physiologic link between HH and gastroesophageal reflux was made at the second half of the 20 century by Allison and Barrett. In the midst of a physiologic revolution, Nissen and Belsey developed their famous operations. In 1957, Collis published his innovative operation. Thal described his technique in 1965, and in 1967, Hill published his procedure. Many modifications of these procedures were published by Pearson and Henderson, Orringer and Sloan, Rossetti, Dor, and Toupet. Donahue and Demeester significantly improved Nissen's operation, and they were the first to truly understand its physiologic mechanism. CONCLUSION: Hiatal hernia surgery has evolved from anatomic repair to physiological restoration.

Nissen laparoscópico: nuevo acceso retrogástrico para liberar el fundus, análisis de la disfagia postoperatoria / Laparoscopic Nissen: new approach through posterior phrenogastric ligament, analysis of postoperative disfagia

Antecedentes: Desde que Dallemagne presentó en 1991 el tratamiento laparoscópico de la enfermedad por reflujo gastroesofágico (ERGE), numerosos autores han observado, a pesar de los excelentes resultados y ventajas, un aumento de la disfagia postoperatoria. Objetivos: Dilucidar causas de disfagia postoperatoria; comprobar si la válvula realizada con el fundus, liberado por sección del ligamento frenogástrico posterior, mejora la disfagia; proponer un nuevo acceso retrogástrico. Lugar de aplicación: Hospital Público y práctica privada. Diseño: Estudio transversal analítico. Material y métodos: Desde julio de 1993 hasta diciembre de 2001 se intervino por laparoscopía 234 pacientes con ERGE. Clasificación de Savary: grado 1, 2 y 3: 193 (82,47 por ciento), grado 4: 5 (2,13 por ciento) y grado 5: 36 (15,38 por ciento). Se incluyen para su análisis: Grupo A) 96 pacientes en los que se realizó Nissen-Rossetti, Grupo B) 118 pacientes en los que se seccionó el ligamento frenogástrico posterior por acceso retrogástrico realizando Nissen. Se analiza la disfagia en ambos grupos. Resultados: Excelentes y buenos 91/96 (94,79 por ciento) pacientes en el grupo A y 115/118 (97,45 por ciento) en el grupo B. Se prsentó disfagia en 31/96 (32,29 por ciento) en grupo A y 7/118 (7,29 por ciento) en grupo B (p<0,001). Conclusiones: 1) La funduplicatura se debe realizar con las caras posterior y anterior del estómago en forma pareja y simétrica para evitar su rotación. 2) No se aconseja la técnica de Nissen-Rossetti. 3) La sección del ligamento frenogástrico posterior fue fundamental para la liberación de la cara posterior del fundus. 4) El acceso retrogástrico facilitó la sección del ligamento frenogástrico posterior

André Toupet: surgeon technician par excellence.

André Toupet is best known for the posterior fundoplication that bears his name, currently used for the treatment of gastroesophageal reflux disease (GERD) or completing Heller's myotomy and subject today to intense discussions. This was not different in 1963, when Toupet proposed his technique at a time when the Nissen fundoplication was emerging as the treatment of choice for GERD. Behind the procedure, we discover a man with great surgical talent and meticulous attention to technical details who opposed criticism with hard work and strong family values.

Rudolf Nissen's years in Bosphorus and the pioneers of thoracic surgery in Turkey.

Rudolph Nissen is one of the most distinguished pioneers in thoracic surgery, well known for his pneumonectomy operation performed for the first time in surgical history. He migrated to Istanbul like most of his contemporary colleagues, avoiding the fascist regime in Germany in the 1930s. He was enthusiastically welcomed in Turkey and appointed as the Chief of the First Surgery Clinic in Istanbul University in 1933. He worked with discipline and in cooperation with his Turkish colleagues, such as Ahmed Burhaneddin Toker, Fahri Arel, Dervis Manizade, and others, who were to become the leading authorities of general thoracic surgery in Turkey. During his 6 years of residence and working in Istanbul, he contributed highly to the practice of general and thoracic surgery. He had to leave for the United States in 1939 for treatment of his lung abscess due to a retained bullet from World War I. He stayed in New York and later in Basel until his death. He was presented an honorary professorship from Hacettepe University, Ankara in 1973.

Minimally invasive surgical techniques for the treatment of gastroesophageal reflux disease.

Open antireflux surgery produces good long-term control of disease, but new interest in the surgical management of gastroesophageal reflux disease has been stimulated by the introduction of minimally invasive techniques to perform standard antireflux procedures. In the past some scepticism existed among gastroenterologists who quoted the poor surgical results they had seen. These bad results, however, were largely due to inappropriate surgery in poorly worked-up patients or antireflux surgery performed by inexperienced surgeons. Since the introduction of minimally invasive surgery for gastroesophageal reflux disease, excellent results have been reported with over 5 years of follow-up. The most common and successfully used laparoscopically antireflux procedures are reviewed and results analyzed.