BACKGROUND: Gastroesophageal reflux is frequently associated with abno
rmal motility in the body of the esophagus, Concern for dysphagia has
led surgeons to perform less competent procedures in this group, or to
avoid surgery altogether, The current study was undertaken to evaluat
e our experience with the laparoscopic Hill repair in patients with re
flux-associated abnormal motility. METHODS: A retrospective review of
338 laparoscopic Hill repairs was performed; 253 patients had adequate
information for analysis, and 8 patients were excluded because of hyp
ertensive motility. The remaining 245 patients were divided into group
I (175) with normal esophageal body peristalsis, group IIA (37) with
moderate dysmotility, and group IIB (33) with severe dysmotility, All
patients underwent standard laparoscopic Hill repair, Follow-up includ
ed postoperative manometry and 24-hour pH studies and interview by an
independent physician. Dilation for dysphagia was performed when neces
sary, Statistical analysis was performed using the F test. RESULTS: Me
an follow-up was 11.0 months (range 1 to 41), Early dysphagia (<3 mont
hs) occcurred in 4.0% of group I patients and 12.9% of group II patien
ts, Late dysphagia (>3 months) occurred in 1.1% of group I patients an
d 1.4% of group II patients, Postoperative motility returned to normal
in 43% of group IIB patients studied, Twenty-four hour pH evaluation
showed fractional pH <4 an average of 4.8% in group I (median 2.1%) an
d 6.4% in group II (median 4.0%; P = 0.57), Patient rating of results
was good to excellent in 91.0% with no statistical difference between
the two groups. No patient required reoperation for dysphagia. CONCLUS
ION: The laparoscopic Hill repair can be safely performed in patients
with reflux-associated dysmotility, with excellent results. Even sever
ely disordered motility will return to normal in a high percentage of
cases. Manometric control of the repair and secure distal fixation of
the gastroesophageal junction are advantages. Abnormal motility may be
an indication for, rather than a contraindication to, laparoscopic Hi
ll repair. (C) 1997 by Excerpta Medica, Inc.