Laparoscopic Hill repair

Abstract

Gastroesophageal reflux disease, with its attendant symptoms and complications of heartburn, esophagitis, dysphagia, and upper gastrointestinal bleeding, is the most common disorder of the upper gastrointestinal tract. The open Hill repair, which has been utilized in more than 2000 patients, is best defined as restoration of the anti-reflux barrier. The anti-reflux barrier includes the gastroesophageal valve, lower esophageal sphincter, and diaphragm. The Hill repair has now been done laparoscopically in 17 patients (10 men and 7 women) who have been entered into a detailed protocol, including pre-operative evaluation, intra-operative monitoring, and post-operative evaluation. Results have been excellent, with correction of reflux in all patients. Duration of follow-up ranges from 1 to 18 months, with a mean of 10.5 months. No mortality or serious complications have occurred. Extensive post-operative testing in 13 patients, including complete symptom evaluation, standard acid reflux testing, and 24-hour pH monitoring, has shown no recurrence of reflux; lower esophageal sphincter pressure has been restored to a mean of 28 mm Hg, and gastroesophageal valve status to grade 1. Because the laparoscopic procedure is similar to the open Hill repair, expectations for good long-term results are very high. (Gastrointest Endosc 1994;40:155-9.)