• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Does the Nissen-Hill hybrid repair reduce recurrence rates for uncomplicated GERD

Andreas M Schneider, MD, Ralph Aye, MD, Alex Farivar, MD, Eric Vallieres, MD, FRCSC, Candice Wilshire, MD, Brian Louie, MD. Swedish Medical Center

Introduction: In a prospective randomized controlled multi-institution trial (RCT) comparing the Nissen (LNF) and Hill (LHR) repairs we were able to show that the two repairs were equivalent in the surgical treatment of uncomplicated gastroesophageal reflux disease (GERD). However recurrence patterns differed, reflecting the inherent weakness in each repair. We therefore combined critical features of each repair to create a laparoscopic Nissen-Hill Hybrid operation (HYB). Its safety and feasibility have been studied in a separate trial. This study aims to evaluate clinical and objective outcomes of the HYB in comparison to the two established repairs.

Methods: 51 consecutive patients with uncomplicated GERD (hiatal hernia (HH) <5cm, normal esophageal motility, <2cm Barrett’s metaplasia) underwent HYB in a prospective trial between 6/2011 and 12/2013. Preoperative and postoperative evaluation was standardized in accordance with the RCT and included 3 quality of life metrics (QOLRAD, GERD-HRQL, Dysphagia) which were administered preoperatively and postoperatively short-term (ST) at 6 weeks and mid-term (MT) at 6-12 months. Endoscopy, manometry, pH testing and barium swallow were obtained preoperatively and at 6-12 months. Results were then compared retrospectively with the two cohorts from our prior RCT, which included 46 LNF and 56 LHR patients.

Results: Demographic features such as age, BMI, ASA, length of stay, follow up, as well as the pre-operative clinical HH size, lower esophageal residual pressures (rLESP), esophageal motility, pH, and DeMeester (DM) score were comparable between the 3 groups.

51 patients underwent HYB repair; 44 patients were available for MT analysis. Mean follow up for HYB, LNF and LHR was 21.1, 15.3 and 18.3 months. The mortality rate was 0%. Major complications included: intraoperative gastrotomy (HYB=1,LNF=2, LHR=1), bleeding >200cc (HYB=0, LNF=1, LHR=2) and dilatation for dysphagia (HYB=3, LNF=1, LHR=4). Postoperative QOL metrics QOLRAD and GERD-HRQL were significantly improved and equivalent between groups. MT dysphagia score was significantly better for HYB (39.1) compared to LNF (34.0) but not the LHR (36.5) group (p= 0.055).

Objective outcomes: pH and DeMeester scores were significantly improved and equivalent between groups. LESP was significantly higher in LNF (26.2) compared to the LHR (19.7) but remained comparable to the HYB (26.4); rLESP, however, was statistically higher in the HYB group (16.7) LNF (8.2) and LHR (10.0) (p = 0.014). Resumption of PPI’s was comparable between HYB (13.6), LNF (5.26%) and LHR (9.62%) (Yates p value = 0.65).

There were two reoperations each in the LNF and LHR groups for failure and recurrent reflux. In the HYB group radiographic studies showed 2 herniations >2cm on UGI, with one patient having resumed PPI’s despite negative pH testing and the other with mild symptoms not requiring intervention. There were no re-operations in the HYB group

Conclusion: Our investigation shows that at mid-term follow up, the HYB repair results in equivalent clinical and objective outcomes compared to the LNF and LHR for uncomplicated GERD, though the recurrence rate may be lower. Dysphagia was significantly better than LNF, though rLESP was higher. Long-term follow up is necessary.

179

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons