The Nissen-Hill Hybrid Repair: Experience with the First 500.

Publication Title

Annals of surgery

Authors

Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
George N Baison
Hassan Ahmed
Jeffery Watkins
Steven R DeMeester
Adam J Bograd, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.Follow
Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Brian Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow

Document Type

Article

Publication Date

7-15-2022

Keywords

washington; swedish; seattle; swedish thoracic

Abstract

INTRODUCTION: A new repair for gastroesophageal reflux and hiatal hernia, the Nissen-Hill hybrid repair (HYB), was developed to combine the relative strengths of its component repairs with the aim of improved durability. In several small series' it has been shown to be safe, effective and durable for paraesophageal hernia (PEH) , Barrett's esophagus (BE) and gastroesophageal reflux disease (GERD). This study represents our experience with the first 500 consecutive repairs for all indications .

METHODS: Retrospective study of prospectively collected data for the first 500 consecutive HYB repairs from March 2006 to December 2016 including all indications for surgery. Three quality of life metrics, manometry, radiographic imaging, and pH testing were administered before and at defined intervals after repair.

RESULTS: 500 patients with median follow up of 6.1 years. Indications for surgery were GERD in 231 (46.2%), PEH in 202 (40.4%), and re-operative repair in 67 (13.4%). The mean age was 59, with BMI of 30 and 63% female. A minimally invasive approach was used in 492 (98%). Thirty-day operative mortality was 1 (0.2%), with a 4% major complication rate and a median length of stay of 2 days. Preoperative to postoperative pH testing was available for 390 patients at a median follow-up of 7.3 months, with median DeMeester score improving from 45.9 to 2.7. At long-term follow-up (229 responses) all median quality of life scores improved: QOLRAD 4 to 6.9, GERD-HRQL 22 to 3 and Swallowing 37.5 to 45 and proton pump inhibitor use dropped from 460 (92%) to 50 (10%) Fourteen (2.8%) underwent re-operation for failure.

CONCLUSION: The combined Nissen-Hill hybrid repair is safe and effective in achieving excellent symptomatic and objective outcomes and low recurrence rates beyond 5 years.

Clinical Institute

Digestive Health

Specialty/Research Institute

Gastroenterology

Specialty/Research Institute

Surgery