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Invited Critique
June 2010

Better Is the Enemy of GoodComment on “Five-Year Follow-up of a Multicenter, Double-Blind Randomized Clinical Trial of Laparoscopic Nissen vs Anterior 90° Partial Fundoplication”

Author Affiliations

Author Affiliations: Department of Gastro-intestinal Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.

Arch Surg. 2010;145(6):557. doi:10.1001/archsurg.2010.92

This pearl is usually imparted to a trainee attempting to add perfection to an adequate operation. Trying to create perfection has plagued antireflux surgery more than most operations, ever since Harrington1 published the first series of diaphragmatic hernia repairs (28 patients) in the Archives in 1928. Allison reported his anatomical repair in 1945, then Nissen experimented with several techniques over 25 years, initially favoring Allison's technique, then gastropexy, before settling on fundoplication in the 1960s. Belsey, Hill, Rosetti, and Toupet all tried to make a good operation better, while Angelchik tried to invent a new one. However, the biggest redefinition of outcome resulted from the introduction of laparoscopy.

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