MODIFIED HILL OPERATION VS NISSEN FUNDOPLICATION IN THE SURGICAL-TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

Background/Aims: The authors compared the results of the Nissen fundop lication technique with the results of the Hill procedure, by using a 10-year history of patients with gastro-esophageal reflux disease. Mat erials and Methods: Seventy two consecutive patients entered the study , 32 of whom underwent a 360 degrees fundoplication according to Nisse n and 40 with a modified Hilt operation. In the Nissen Group, intraope rative manometry (IOM) was carried out in all patients; in the Hilt Gr oup, the patients were randomized in two sub-groups (A and B), before operation; in 20 of them (group A), the procedure was randomly associa ted to IOM. Results: The overall complications were Low in both groups (15.6% in the Nissen Group and 5% in the Hill Group, p=0.1), and ther e was no mortality rate. The clinical results were excellent or good i n 28 patients (87.6%) of the Nissen Group and in. 36 patients (90%) of the Hill Group (p=0.5); in. particular, an excellent outcome was obse rved in 16 patients (80%) with IOM (sub-group A), while 12 patients (6 0%) without it (subgroup B) showed similar results. The manometric stu dies carried out six months after surgical treatment showed a decrease of the lower esophageal sphincter pressures in all patients if compar ed to the pressure recorded intra-operatively. In, comparison, to the pre-operative values, both the lower esophageal sphincter length and i ts intra-abdominal portion were markedly increased in, the Nissen Grou p and in, the sub-group A of the Hill patients. Conclusions: These res ults support the conclusions that modified posterior gastropexy and 36 0 degrees fundoplication are effective, well tolerated, and can. be pr operly used in the treatment of Gastro-esophageal reflux disease (GERD ), since both techniques showed good clinical results. A favorable cli nical outcome depends mostly on adequate lower esophageal sphincter le ngth (LESL) and LESIA extension, which could be more efficiently achie ved by the use of intraoperative manometry (IOM).