The Nissen Fundoplication or stomach wrap was not always called by the name we know it today. In the original report entitled “A Simple Operative Correction for Reflux Esophagitis Dr Rudolph Nissen called this procedure “gastric fundoplication.”

This gentleman, dedicated surgeon, husband, and father is known throughout the world for his work with gastro-esophageal reflux, esophagitis and diseases of the esophagus.

Dr. Nissen was born in Neisse, Schlesien on September 9, 1896, retired in 1967 and died at Riehen|Basel on January 22, 1981 at the age of 84. Dr. Nissen’s life had many ups and downs, and during the rise of Hitler in the 1930’s Dr. Nissen without a doubt knew his fate and in 1933 was to leave his position at the Charité in Germany and end his medical career there.

All non-Aryan Doctors were told to resign their positions in hospitals as well as all those who were appointed to public positions. Hitler’s nationalist were in power and Nissen admitted he was scared to death. Nissen resigned his position saying he needed a vacation in Switzerland.

Not knowing what the future held for him, he took a position in Istanbul, Turkey and sought solace as Head of Surgery at the University of Istanbul in October of 1933. In 1937 Turkey was now economically and financially very dependent on Germany, this kind and gentle man was for the second time forced to leave his job in Turkey because of anti-Semitism and hatred of Jews by Hitler’s regime.

During his stay and his work in Turkey he was so loved by many of his patients that parents named their children Nissen because of the love, care, kindness, dedication and compassion he showed to his patients and their family.

He immigrated to the United States of America in 1939 where he found a position as a research fellow in Boston Massachusetts and also had to learn the English language. Later he obtained hospital privileges in New York to continue his surgical career at the Jewish Hospital and the Maimonides Hospital in 1941.

Dr. Nissen returned to Europe in 1952 after being elected to Chair the Department of Surgery in Basel, Switzerland. It was here in Basel that he set the basis for the surgical revolution and treatment for what we know today as Gastro-esophageal reflux disease (GERD).

Nissen was the first to remove part of the lung called a lobectomy and the first pneumectomy in a human. Dr. Nissen was well known for his work on patients such as Albert Einstein who had an abdominal aortic aneurysm, (a major large artery that swells up like a balloon and may burst if not corrected and carries blood to the lower part of the body) and Dr. Gustav Bucky, the American radiologist who had a hiatal hernia and a bleeding ulcer in an upside down stomach that was not in the abdomen but in the chest all treated successfully and all would become life long friends.

Originally, the symptoms of gastroesophageal reflux were attributed to the presence of a hiatal hernia (the stomach pushing up into the chest through the diaphragm) causing chest pain and burning of the esophagus. This was not recognized by the medical community as a serious problem until the 1930s and was not known to cause esophagitis until the mid 1940s.

One Dr. Philip Rowland Allison (1904-1974) a Thoracic (chest) surgeon from Leeds and Oxford England was the first to associate the symptoms of hiatal hernia to the occurrence of gastro-esophageal reflux. The operation Allison repair named after him (there was a lot of the symptoms returning after surgery) for his contribution to reflux surgery. Dr. Allison is given credit for initiating the modern era of anti-reflux surgery.

Dr. Ronald H.R. Belsey a thoracic Surgeon from Bristol England decided on an operation similar to the Nissen Fundoplication. Dr. Belsey Mark IV operation is a partial fundoplication by wrapping the stomach 270 degrees around the distal esophagus.

In 1937 while Dr. Nissen was the chief of surgery at the Cerrahpasa Hospital in Istanbul Turkey, Dr. Nissen operated on a 28 year-old man with a bleeding chronic ulcer of the distal esophagus moving into the diaphragm and pericardium. Nissen was to perform a transpleural stabilization as well as to resect the cardia and place the esophageal stump into the gastric fundus. To protect the two ends that were brought together (called an anastamosis) Nissen covered the esophago-gastrostomy with a stomach cuff or wrap called a gastroplication.

After surgery the man had no problems and Dr. Nissen published the operation in 1937. This man was to be seen by Dr. Nissen in 1953 and had not had any problems. This was to become the first part of the Nissen fundoplication though it was not called this for many years.

In 1946 while practicing in New York Rudolph Nissen was presented with a famous radiologist by the name of Gustav Bucky whom was 66 years old at the time and was suffering from severe dsypnea and chest pain that was caused by an upside-down intrathoracic stomach (the stomach was upside down and was partway in the stomach and the chest.

Dr. Bucky did not want to go through the normal approach for surgery for his problem because they would cut you across your chest to make a thoracotomy and Dr. Bucky knew the tremendous risk of this approach. Dr. Nissen instead of the transthoracic approach he used a transabdominal reduction for Dr. Bucky's problem of paraesophageal hernia. To prevent the recurrence Dr. Nissen also did a gastropexy. Dr. Bucky did well and had no problems for more than 15 years. Dr. Nissen said he was even surprised at the results of the operation and how easy it was to perform. Nissen wrote in 1961:

Subsequently, this operation was performed from time to time on elderly patients with hiatal hernias of both types, in sure knowledge that this minor intervention (requiring only a few minutes to perform) could safely be used even for elderly and poor-risk subjects. This was the second step to the Nissen Fundoplication.

In 1952 Nissen accepted the position Chairman of the Department of Surgery at the University of Basel in Switzerland. Leaving the United States was hard but this position offered him the opportunity to teach and do research as well as surgery, to work in a reorganized department of surgery in a modern facility, belonging to one of the most prestigious universities in Europe dating back to the Middle Ages and to speak his mother tongue German and to return to his homeland and the mountains that he loved so dearly.

In 1954 Nissen saw a patient who had severe Gastro-Esophageal Reflux Disease and he planned the first anti-reflux operation while at the Basel Hospital in Switzerland. This patient did not have a hiatal hernia on x-ray so a simple gastropexy did not seem to be the right operation. Nissen decided to do an operation similar to the one he did years earlier in Turkey on a 28 year-old patient who had bleeding and chronic ulcers of the lower esophagus, called a gastroplication without the resection of the cardia.

Dr. Nissen formed a fold at the front and back of the stomach wall and brought both ends to each other and sewed them at the lesser curvature side of the cardia. The results were a total success and most important could be reproduced in his next patient. These were the first two planned plication operations for treatment of gastroesophageal reflux disease and were published in the Schweizer Medizinische Wochenschrift medical journal in 1956.

The operation that Nissen developed is used all over the world for gastro-esophageal reflux disease. Today Gastro-Esophageal Reflux Disease (GERD) is the single most common foregut disorder in all of Western societies with tremendous socioeconomic impact.

The Nissen Fundoplication also had problems such as partial or total dysphagia or gas bloat syndrome and the inability of patients to be able to burp and or vomit. Only a few patients suffered from these side effects, but the slipped Nissen and the post Nissen fundoplication syndrome were written about most often and their problems.

Many surgeons modified what Nissen had described. Dr. Mario Rossetti was one of many surgeons to make their own modification to the Nissen Fundoplication operation. Dr. Rossetti was also a student of Dr. Nissen. Dr. Rossetti used the anterior wall of the gastric fundus only and the Rossetti modification of the Nissen fundoplication gastroplasty was accepted with its evident advantages and ease throughout the world.

Dr. J. Rudiger Siewert also made modifications to the Nissen Fundoplication with the surgical removal of the muscle at the distal (lower part of the esophagus) end of the esophagus that resulted in the total destruction of the anti-reflux mechanism, but could be restored by a loose fundoplication. This showed that the function of the fundic wrap worked without the action of a tight valve.

Dr. Phillip E. Donahue and Dr. Thomas Charles Bombeck from Chicago in 1977 made their contribution to the Nissen Fundoplication with the completion of the floppy fundoplication by introducing the idea of the “ opening pressure” which showed that a bigger or wider fundoplication is just as effective or good at suppressing or stopping reflux as the tight wrap is.

Dr. Thomas R. DeMeester while at the University of Chicago was thought to be the first to look at the relationship between disturbed food passage after operation for fundoplication and vagus damage. Dr. DeMeester introduced the use of Teflon strips to be sewn to the plicated folds and stabilize the wrap. He is acknowledged with his work of pH monitoring and bile reflux.

Babies born with a tracheoesophageal fistula and or esophageal atresia have long been known to suffer after surgery from gastro-esophageal reflux. Gastro esophageal reflux is very difficult to control in young infants and the use of the Nissen Fundoplication has saved babies suffering from this all over the world.

There are thousands of babies who have had this operation, and the parents whom I have heard from say over and over how this operation has changed the entire family’s lives for the better by giving the children a relatively normal life and easing the tremendous stress that had been on the parents.

There are more babies born each year with gastro-esophageal reflux disease than with esophageal atresia and or tracheoesophageal fistula. Almost all of these babies at some time who are born with either gastro-esophageal reflux disease or esophageal atresia with or without tracheoesophageal fistula have some form of the Nissen fundoplication and the results of the operation have stood the test of time with few complications and or failures.

The follow-up on all of these babies born with esophageal atresia and or tracheo-esophageal fistula and the Nissen fundoplication will continue to be of interest to our International Esophageal Atresia Team of parents and we will try to provide everyone with information on any new modification to the operation or any new operation to correct gastro-esophageal reflux.