The contribution of Allison and Nissen to the evolution of hiatus herniorrhaphy

Even though it was not until 1950 that Barrett introduced the term "reflux esophagitis", this entity is now the most common disease afflicting the western world. Diaphragmatic herniation, recognized by Sennertus in 1541, was first repaired by Potemski (1889). Before World-War II, the condition was considered rare; symptomatology, as in external herniae, was ascribed to pinching of the stomach by the hernial ring. Only large protrusions, with signs of impending incarceration, volvulus, or strangulation, were operated upon. Modern understanding derives from studies of short, strictured esophagi. Because of endoscopic "gastric" biopsies in children, Findlay and Kelly considered them congenital "misplacements". However, Allison (1943), finding adults with ulceration and scarring, argued they were acquired. Later (1953) he concluded that the distal esophagus may be lined with metaplastic adenomatous epithelium which can harbor malignancy. His repair, reestablishing the crural pinchcock was, as pointed out by his countryman Collis (who in 1957 constructed a neo-esophagus from the Magenstrasse), inadequate. Nissen performed (1936) gastroesophagectomy in a case of peptic ulceration of the cardia. To avoid leakage he buried the anastomosis. Amazingly, 17 years later he learned that the patient had no reflux. He then successfully performed and reported (1956) fundoplication in a man and woman with gastroesophageal reflux disease. His operation remains the basis for surgical therapy today. Electronic Publication