Nissen fundoplication: 70 years of a simple and brilliant idea in the surgical treatment of gastroesophageal reflux disease

Abstract

Rudolf Nissen published his first two cases in 1956, thus inaugurating the era of pathological gastroesophageal reflux surgery. The original fundoplication proposed by Nissen was initially associated with a gastropexy. Later, when the importance of hiatal hernia in the pathophysiology of the disease lost prominence, it began to be performed in isolation and was quickly adopted by other European and American schools, becoming the surgical treatment of choice for reflux esophagitis. From the 1970s onwards, with Nissen fundoplication increasingly used as the treatment of choice for gastroesophageal reflux and hiatal hernia, minor alterations were proposed to optimize results and reduce complications. Given this scenario, as we celebrate seven decades since the operation described by Rudolf Nissen, we are revisiting a principle rather than a technique: the permanent commitment to the critical evolution of surgical practice. Created as a result of his intuition and ingenuity, fundoplication is not static; it transforms, adapts, and improves in light of evidence and patient needs. Perhaps this is, ultimately, Nissen's greatest legacy: not just an operation, but a way of thinking about surgery as a restless, rigorous, and profoundly patient-centered procedure. This is the perspective we must focus on as we move forward, honoring the past without losing sight of the future.