Alternatives to Nissen Fundoplication: The Hill Repair and the Nissen-Hill Hybrid
Since its introduction in 1967, the Hill repair has proven to be an effective and durable surgical intervention for the management of gastroesophageal reflux disease. In addition to the standard tenets of antireflux surgery, it incorporates three key anatomic concepts: the intra-abdominal posterior fixation of the gastroesophageal junction (GEJ), the pivotal role of the lower esophageal sphincter collar sling musculature in the proper reconstruction of the GEJ, and the importance of the gastroesophageal valve for the competence of the antireflux barrier. It has undergone two major modifications since its inception including conversion from an open to a laparoscopic procedure, and incorporation into a new operation to include a Nissen fundoplication wrap as part of the Nissen-Hill hybrid procedure. The original Hill procedure, as well as its variants, demonstrated excellent long-term outcomes in the surgical management of uncomplicated and complicated gastroesophageal reflux disease as well as paraesophageal hernias. We will discuss the history, principles, techniques, and results of the Hill Repair and Nissen-Hill hybrid antireflux operations.
KeywordsAntireflux surgery Gastroesophageal reflux disease Hill repair Nissen-Hill hybrid Manometry Lower esophageal sphincter Gastroesophageal valve Gastroesophageal junction
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