Tri-comparison of Laparoscopic Nissen, Hill, and Nissen-Hill Hybrid Repairs for Uncomplicated Gastroesophageal Reflux Disease.

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Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract


Adult; Esophageal pH Monitoring; Female; Fundoplication; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Laparoscopy; Male; Manometry; Middle Aged; Proton Pump Inhibitors; Quality of Life; Randomized Controlled Trials as Topic; Recurrence; Reoperation; Retrospective Studies; Treatment Outcome


BACKGROUND: A randomized controlled trial (RCT) showed that laparoscopic Nissen fundoplication (LNF) and Hill (LHR) repairs are equivalent in treating uncomplicated GERD. We combined both repairs to create a laparoscopic Nissen-Hill Hybrid repair (HYB). The purpose of this study is to compare clinical and objective outcomes of a matched group of HYB to the two cohorts of the RCT.

METHODS: A retrospective analysis of prospectively collected data from the RCT and a prospectively collected data base was performed. Data were collected preoperatively, postoperatively short-term (ST) at 6 weeks and mid-term (MT) at 6-12 months. Evaluation was standardized according to the RCT and included three quality of life metrics (QOLRAD, GERD-HRQL, Dysphagia), endoscopy, manometry, pH testing, and barium swallow.

RESULTS: There were 51 HYB, 46 LNF, and 56 LHR patients. Age, BMI, follow-up, and gender were comparable. QOLRAD, HRQL, PPI use, DeMeester scores, and pH% timeLNF, four LHR, and two HYB patients. Reoperations were performed in three LHR, two LNF, and zero HYB patients.

CONCLUSION: Tri-comparison shows that HYB is a promising alternative to LHR and LNF. Side effects were not increased and there were fewer reoperations for failure.

Clinical Institute

Digestive Health