LAPAROSCOPIC HILL REPAIR

Gastroesophageal reflux disease, with its attendant symptoms and compl ications of heartburn, esophagitis, dysphagia, and upper gastrointesti nal bleeding, is the most common disorder of the upper gastrointestina l tract. The open Hill repair, which has been utilized in more than 20 00 patients, is best defined as restoration of the anti-reflux barrier . The anti-reflux barrier includes the gastroesophageal valve, lower e sophageal sphincter, and diaphragm. The Hill repair has now been done laparoscopically in 17 patients (10 men and 7 women) who have been ent ered into a detailed protocol, including pre-operative evaluation, int ra-operative monitoring, and post-operative evaluation. Results have b een 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 m ortality or serious complications have occurred. Extensive post-operat ive testing in 13 patients, including complete symptom evaluation, sta ndard acid reflux testing, and 24-hour pH monitoring, has shown no rec urrence of reflux; lower esophageal sphincter pressure has been restor ed to a mean of 28 mm Hg, and gastroesophageal valve status to grade 1 . Because the laparoscopic procedure is similar to the open Hill repai r, expectations for good long-term results are very high.