Ricardo Nassar, MD2, Juan D Linares2, Felipe Giron, MD2, Erika Torres, MD2, Natan Zundel1, Juan D Hernandez, MD2. 1Florida International University School of Medicine, 2Hospital Universitario Fundacion Santa Fe de Bogota
Introduction: Hiatal hernia is a common condition with a prevalence of 20% in general population, although symptoms are present in only 10% of the patients. It becomes problematic when is accompanied by gastroesophageal reflux disease (GERD). The most definitive management is still surgical, with restoration of the sphincter mechanism. Among obesity patients there is an increased risk of developing this illness because of the heightened intraabdominal pressure. On the other hand, once these patients lose weight, the hiatus may be widened with the disappearance of fat. The rapid growth of bariatric surgery has brought also the appearance of GERD in patients undergoing different operations, although the attention is centered in laparoscopic sleeve gastrectomy (LSG), since a high-pressure gastric conduit is created. Several techniques have been proposed to correct hiatal hernia and GERD, considering the altered anatomy. We present a technique based in Hill´s posterior gastropexy, described originally in 1967 for GERD with a whole stomach, but now part of the technique has been adapted to patients with LSG.
Objective: Describe and propose a surgical approach based on a part of the Hill technique, that can be used in patients with hiatal hernia and GERD after LSG.
Methods: Short case series in which a “Hill modified technique” is described for patients with past history of LSG as treatment to correct hiatal hernia and GERD. Surgical technique includes: 1. Posterior closure of the hiatus; 2. Achieving an intra abdominal esophageal length of minimum 3 cm and 3. Posterior fixation of the gastro esophageal junction to the preaortic fascia.
Results: In a period of three years, four patients underwent a hiatal hernia reduction followed by hiatal closure and posterior gastropexy. There wer not immediate complications and postoperative controls have shown satisfactory results, with no early or late complications associated to the procedure nor GERD-related symptoms. There was no need for antirreflux medication out of the standard protocol.
Conclusion: “Hill modified technique” seems to be a valid approach for the management of Hiatal hernia and GERD in patients with LSG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80834
Program Number: P363
Presentation Session: Poster (Non CME)
Presentation Type: Poster