Yeseul Park, BS, Ralph W Aye, MD, Alex S Farivar, MD, Jeffrey Watkins, MD, Brian E Louie, MD. Swedish Medical Center
Background: The open Hill repair for gastroesophageal reflux disease and hiatal hernia is remarkably durable, with a median 10 year reoperation rate of only 3% and satisfaction of 93%. No long-term data exist for the laparoscopic Hill repair (LHR).
Methods and Procedures: Patients who underwent primary LHR at Swedish Medical Center for reflux and/or hiatal hernia at least 5 years earlier (1992-2010) were identified from an IRB-approved data base. There were 554 patients who met inclusion criteria, including 457 undergoing repair for reflux and 97 for paraesophageal hernia. Two questionanaires were administered via mail to evaluate long-term quality of life using the 5-point validated GERD-HRQL scale (range 0-50, lower=better), a Swallowing score (range 0-45, higher=better) and a 5-point global satifaction score. Outcomes were defined by GERD-HRQL score, Swallowing score, resumption of proton pump inhibitor (PPI) therapy, need for reoperation, and global satisfaction with overall results.
Results: One hundred seven patient completed and returned the survey (62 lost to follow up, 102 deceased, 315 non-responders), of which 51.4% were male. The average age at the time of surgery was 49.7 years. Median follow up was 18.6 years. The average GERD-HRQL score (8.5) and the average Swallowing score (37.5) both indicated excellent symptomatic outcomes. Twenty-four percent of patients are using daily PPI's. Seven patients (6.5%) required re-operation for failure during the follow up period, 5 in the reflux group and 2 in the paraesophageal hernia group, and 1 underwent surgery for perforation resulting from esophageal dilation. Overall, 83% reported good to excellent results and 76% would recommend the operation to someone in their family with a simlar condition.
Conclusion: LHR shows excellent long-term durability and quality of life similar to the open Hill repair, with 83% good to excellent results at a median follow up of 19 years, and a reoperation rate of under 7%. It is surmised that Hill suture fixation of the gastroesophageal junction to the preaortic fascia may confer unique structural integrity compared to other repairs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80690
Program Number: P360
Presentation Session: Poster (Non CME)
Presentation Type: Poster