LAPAROSCOPIC HILL REPAIR IN PATIENTS WITH ABNORMAL MOTILITY

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.