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

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • 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
    • 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
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • 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
    • Video Based Assessments (VBA)
    • 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-Coming Soon!
    • 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
  • Store
    • “Unofficial” Logo Products
  • Log In

Hill Repair After Gastric Bypass: A Case Series

Simon C Chow, MD1, Emily Speer, MD2, Amber Shada, MD2, Valerie J Halpin, MD1, Lee L Swanstrom, MD2, Kevin M Reavis2. 1Legacy Good Samaritan Medical Center, 2Providence Portland Medical Center

Introduction: The symptoms of gastroesophaeal reflux disease (GERD) are frequently improved following roux-en-Y gastric bypass, however 10 to 30% of patients have persistent or new GERD post bypass. Traditional fundoplication is not an option due to surgical disconnection of the fundus from the esophagogastric junction. Endoluminal solutions are restricted to radiofrequency treatments and efficacy of this treatment is often compromised by anatomic issues including hiatal hernia. The laparoscopic Hill repair is an anti-reflux procedure with proven durability for long-term relief of gastroesophageal reflux disease which utilizes anatomy within a few centimeters of the esophagogastric junction. We present clinical outcomes of patients with refractory GERD post-gastric bypass who underwent Hill repair.

Methods: A retrospective review of prospectively collected data was performed. Data collection was approved by the institutional IRB. Data including age, gender, pre- and post-gastric bypass weight and body mass index (BMI), excess weight loss (EWL), details of the surgeries, time between gastric bypass and Hill repair, gastric acid suppression medication use, and preoperative esophageal physiology tests including esophagogastroduodenoscopy (EGD), manometry, upper gastrointestinal radiologic studies, and BRAVO or impedance pH results was analyzed. A GERD symptom questionnaire with Likert scale was administered to the patients preoperatively and 1 month postoperatively. Morbidity and mortality data at 30 days was also collected.

Results: There were 3 patients who had undergone Hill repair after gastric bypass for refractory GERD. All patients were treated with maximum dose proton pump inhibitors and had refractory symptoms (heartburn, volume regurgitation). Mean BMI prior to gastric bypass was 43.2. The mean time between gastric bypass and Hill repair was 3.7 years, during which they had a mean EWL of 59.1%. At the time of Hill repair they had a mean age of 54.4 years and mean BMI of 32.2. Pre-operative manometry revealed: baseline lower esophageal sphincter (LES) pressure 19.8, residual LES pressure 4.3 (mmHg), integrated relaxation pressure (IRP) 8.4 [mean values]. Two of the patients underwent impedance pH testing and the mean distal catheter results were: 18.5 acidic episodes, 17 non-acidic episodes and a composite DeMeester score of 43.5. The 3rd patient underwent Bravo pH testing and had 146 reflux episodes with an overall DeMeester score of 39.2. All three patients had small (2-3cm) hiatal hernias which were concomitantly repaired at the time of Hill repair. Two patients also underwent truncal vagotomy, 1 patient had a revision of the gastrojejunostomy anastomosis with partial gastrectomy for pouch dilatation, and 1 patient had esophageal balloon dilation for gastrojejunostomy stricture. Length of stay was between 1-4 days. Preoperatively, all patients had severe continuous heartburn and reflux episodes throughout the day and night on symptom assessment form. One patient complained of occasional (1-2 times/week) chest pain and dysphagia to solid foods. Postoperatively at 1 month, there was complete symptom resolution reported in all patients. There were no 30-day complications.

Conclusion: The Hill repair is a safe and effective treatment for refractory GERD in post bypass patients who have documented disease.

367

Share this:

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

Related

« Return to SAGES 2015 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

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