The history of hiatal hernia surgery: from Bowditch to laparoscopy

Review article: from 1906 to 2006--a century of major evolution of understanding of gastro-oesophageal reflux disease

BACKGROUND

Our understanding of gastro-oesophageal reflux disease has undergone significant changes over the last century.

AIM

To trace the rise in understanding of gastro-oesophageal reflux disease and highlight remaining areas of uncertainty.

METHODS

Literature review.

RESULTS

In 1906, Tileston published his observations on 'peptic ulcer of the oesophagus'. Winkelstein, in 1934, first correlated symptoms of heartburn with acid regurgitation and reflux oesophagitis. In 1946, Allison described hiatus hernia as a causal factor in the development of gastro-oesophageal reflux disease. In 1958, Bernstein and Baker showed a direct relationship between oesophageal acidification and heartburn in patients with gastro-oesophageal reflux disease, irrespective of endoscopic findings, leading to the recognition of non-erosive gastro-oesophageal reflux disease. In the 1980s, continuous recordings of the lower oesophageal sphincter showed that episodes of reflux were related to transient relaxations of lower oesophageal sphincter tone. There is now increasing recognition that gastro-oesophageal reflux disease arises from the interaction of several anatomical and physiological factors. A turning point in the medical treatment of gastro-oesophageal reflux disease came with the introduction of the first proton pump inhibitor, omeprazole, in 1989.

CONCLUSIONS

Future efforts need to identify the multifactorial interactions of gastro-oesophageal junction anatomy and physiology in patients with gastro-oesophageal reflux disease. Increased understanding of the disease will guide development of new therapies.

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As a contribution to International Physics Year (2005), we performed a historical study of Einstein's final years and the diseases that required surgical treatment. Because of the particular circumstances of the age, two of the most famous surgeons of the time, Rudolph Nissen and Frank Glenn, as well as the well-known radiologist, Gustav Bucky, came together with Albert Einstein over the abdominal aortic aneurysm that ended his life in April 1955. We discuss little known or hitherto unpublished data and anecdotes about the physicist's final surgical disease.

Influence of new technologies on thyroid surgery: state of the art

The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between 1873 and 1910. In general, the essential objectives for thyroidectomy are conservation of the parathyroid glands, avoidance of injury to the recurrent laryngeal nerve, an accurate hemostasis and an excellent cosmesis. In the last 20 years, major improvements and new technologies have been proposed and applied in thyroid surgery; among these are mini-invasive thyroidectomy, new devices for achieving hemostasis and dissection, regional anesthesia and intraoperative neuro-monitoring.