World Journal of Surgery

, Volume 41, Issue 4, pp 1035–1039 | Cite as

Sleeve Gastrectomy Combined with the Simplified Hill Repair in the Treatment of Morbid Obesity and Gastro-esophageal Reflux Disease: Preliminary Results in 14 Patients

  • Daniel GeroEmail author
  • Lara Ribeiro-Parenti
  • Konstantinos Arapis
  • Jean-Pierre Marmuse
Original Scientific Report with Video



Our aim is to report our initial experience with a novel technique which addresses morbid obesity and gastro-esophageal reflux disease (GERD) simultaneously by combination of laparoscopic sleeve gastrectomy (LSG) and simplified laparoscopic Hill repair (sLHR).


Retrospective analysis of LSG+sLHR patients >5 months postoperatively includes demographics, GERD status, proton-pump inhibitor (PPI) use, body mass index (BMI), excess BMI loss (EBMIL), complications and GERD-Health Related Quality of Life (GERD-HRQL) questionnaire. LSG+sLHR surgical technique: posterior cruroplasty,  standard LSG, fixation of the esophagogastric junction to the median arcuate ligament.


Fourteen patients underwent LSG+sLHR [12 women and 2 men, mean (range) age 47 years (27–57), BMI 41 kg/m2 (35–65)]. Five patients had previous gastric banding (GB). All had symptomatic GERD confirmed by gastroscopy and/or upper-gastrointestinal contrast study, two with chronic cough, 10 took PPI daily. Twelve had hiatus hernia and two patulous cardia at surgical exploration. Associated interventions were three GB removals and one cholecystectomy. Postoperative complication was one surgical site infection. Follow-up of all patients at median 12.5 months (5–17) is as follows: symptomatic GERD 3/14 patients, chronic cough 0/14, daily PPI use in 1/14, mean EBMIL 68% (17–120), satisfaction 93%, mean GERD-HRQL score 3,28/50 (0–15), with 4 patients 0/50, occasional bloatedness in 2 patients and dysphagia not reported.


The novel technique which combines LSG with sLHR is feasible, safe and can be associated with GB removal. Preliminary results showed patient satisfaction, high remission rate of preexisting GERD, decrease in PPI use and unimpaired weight loss. Further evaluation is necessary in a controlled and staged manner to establish the technique’s real effectiveness.


Hiatus Hernia Laparoscopic Sleeve Gastrectomy Lower Esophageal Sphincter Symptomatic GERD Erosive Esophagitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are grateful to Mr Iván Eln for his precious contribution to the line art figure.

Compliance with ethical standards

Conflict of interest

Daniel Gero, Lara Ribeiro-Parenti, Konstantinos Arapis and Jean-Pierre Marmuse have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (AVI 185405 kb)


  1. 1.
    Patti MG (2015) An evidence-based approach to the treatment of gastroesophageal reflux disease. JAMA Surg 2:1–6Google Scholar
  2. 2.
    Santoro S, Lacombe A, Aquino CG, Malzoni CE (2014) Sleeve gastrectomy with anti-reflux procedures. Einstein (Sao Paulo) 12(3):287–294CrossRefGoogle Scholar
  3. 3.
    Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ (2006) Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 130(3):639–649CrossRefPubMedGoogle Scholar
  4. 4.
    Oor JE, Roks DJ, Ünlü Ç, Hazebroek EJ (2016) Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg 211(1):250–267CrossRefPubMedGoogle Scholar
  5. 5.
    Rosenthal RJ, Diaz AA, International Sleeve Gastrectomy Expert Panel et al (2012) International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 8(1):8–19CrossRefPubMedGoogle Scholar
  6. 6.
    Mahawar KK, Carr WR, Jennings N, Balupuri S, Small PK (2015) Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review. Obes Surg 25(1):159–166CrossRefPubMedGoogle Scholar
  7. 7.
    Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20(2):130–134CrossRefPubMedGoogle Scholar
  8. 8.
    Pallati PK, Shaligram A, Shostrom VK, Oleynikov D, McBride CL, Goede MR (2014) Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the bariatric outcomes longitudinal database. Surg Obes Relat Dis 10(3):502–507CrossRefPubMedGoogle Scholar
  9. 9.
    Rebecchi F, Allaix ME, Giaccone C, Ugliono E, Scozzari G, Morino M (2014) Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg 260(5):909–914CrossRefPubMedGoogle Scholar
  10. 10.
    Daes J, Jimenez ME, Said N, Dennis R (2014) Improvement of gastroesophageal reflux symptoms after standardized laparoscopic sleeve gastrectomy. Obes Surg 24(4):536–540CrossRefPubMedGoogle Scholar
  11. 11.
    Baumann T, Grueneberger J, Pache G, Kuesters S, Marjanovic G, Kulemann B, Holzner P, Karcz-Socha I, Suesslin D, Hopt UT, Langer M, Karcz WK (2011) Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endoscopy 25(7):2323–2329CrossRefGoogle Scholar
  12. 12.
    Tai CM, Huang CK, Lee YC, Chang CY, Lee CT, Lin JT (2013) Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc 27(4):1260–1266CrossRefPubMedGoogle Scholar
  13. 13.
    Samakar K, McKenzie TJ, Tavakkoli A, Vernon AH, Robinson MK, Shikora SA (2016) The effect of laparoscopic sleeve gastrectomy with concomitant hiatal hernia repair on gastroesophageal reflux disease in the morbidly obese. Obes Surg 26(1):61–66CrossRefPubMedGoogle Scholar
  14. 14.
    Worrell SG, Greene CL, DeMeester TR (2014) The state of surgical treatment of gastroesophageal reflux disease after five decades. J Am Coll Surg 219(4):819–830CrossRefPubMedGoogle Scholar
  15. 15.
    Aye RW, Swanstrom LL, Kapur S, Buduhan G, Dunst CM, Knight A, Malmgren JA, Louie BE (2012) A randomized multiinstitution comparison of the laparoscopic nissen and Hill repairs. Ann Thorac Surg 94(3):951–957CrossRefPubMedGoogle Scholar
  16. 16.
    Le Page PA, Martin D (2015) Laparoscopic partial sleeve gastrectomy with fundoplication for gastroesophageal reflux and delayed gastric emptying. World J Surg 39(6):1460–1464CrossRefPubMedGoogle Scholar
  17. 17.
    Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252(2):319–324CrossRefPubMedGoogle Scholar
  18. 18.
    Aye RW, Rehse D, Blitz M, Kraemer SJ, Hill LD (2011) The Hill antireflux repair at 5 institutions over 25 years. Am J Surg 201(5):599–604CrossRefPubMedGoogle Scholar
  19. 19.
    Pescarus R, Sharata AM, Dunst CM, Shlomovitz E, Swanström LL, Reavis KM (2015) Hill procedure for recurrent GERD post-Roux-en-Y gastric bypass. Surg Endosc. doi: 10.1007/s00464-015-4442-0 Google Scholar
  20. 20.
    Sánchez-Pernaute A, Talavera P, Pérez-Aguirre E, Domínguez-Serrano I, Rubio MÁ, Torres A (2016) Technique of hill’s gastropexy combined with sleeve gastrectomy for patients with morbid obesity and gastroesophageal reflux disease or hiatal hernia. Obes Surg. doi: 10.1007/s11695-016-2076-5 Google Scholar
  21. 21.
    Obeidat F, Shanti H (2015) Early weight loss as a predictor of 2-year weight loss and resolution of comorbidities after sleeve gastrectomy. Obes Surg. doi: 10.1007/s11695-015-1903-4 PubMedGoogle Scholar
  22. 22.
    Arman GA, Himpens J, Dhaenens J, Ballet T, Vilallonga R, Leman G (2016) Long-term (11 + years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. doi: 10.1016/j.soard.2016.01.013

Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  1. 1.Department of General and Digestive SurgeryUniversity Hospital Bichat – Claude-BernardParisFrance

Personalised recommendations