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Nissen Fundoplication

Other Known Aliases – none

Definition – wrapping of the fundus of the stomach around the lower esophagus to re-enforce the LES and prevent esophageal sliding.

Clinical Significance – this type of surgery can be performed open or laparoscopic to treat GERD with a hiatal hernia when medical management fails. Traditionally, a Nissen is a complete 360-degree wrap, and there are several variations of this procedure that involve incomplete wrapping on various sides of the esophagus.

History – Named after Rudolph Nissen (1896-1981), who was a Jewish-German surgeon who received his medical doctorate from the University of Freiburg in 1921. His medical studies were interrupted by the first World War where he served on the front lines in a medical corp. It was during his service where he would suffer a gunshot to the lung, which would plague him for the rest of his life. He would go on to serve in various surgery departments in Munich, Berlin, and Istanbul where he would become the head of the surgery department in 1933. It was here that he resected an esophageal ulcer from a 28yo patient that required him to remove portion of the lower esophageal sphincter in the process. He decided to wrap a portion of the stomach around the lower esophagus to strengthen the sphincter and the patient reported greatly improved reflux symptoms. It wasn’t until 1955 when he reflected on this case and performed the procedure on two patients for reflux esophagitis and published the results in 1956. Of note, he also operated on Albert Einstein in 1948 to wrap his AAA with cellophane (which was the treatment at the time).

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References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Up To Date. www.uptodate.com
6. Nissen R. [A simple operation for control of reflux esophagitis]. Schweiz Med Wochenschr. 1956;86(Suppl 20):590-2.
7. Ellis Jr., FH. The Nissen Fundoplication. Ann Thorac Surg. 1992;54:1231-1235.