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.