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The Hill’s Classification Is Useful to Predict the Development of Postoperative Gastroesophageal Reflux Disease and Erosive Esophagitis After Laparoscopic Sleeve Gastrectomy

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is one of the commonest bariatric procedures. However, it is associated with postoperative gastroesophageal reflux disease (GERD) and erosive esophagitis (EE). This study aims to assess the impact of various preoperative clinical and endoscopic characteristics on the development of postoperative GERD and EE.

Methods

This study is a single-institution retrospective cohort study involving all patients who underwent LSG. A univariate and multivariate analysis was performed to identify preoperative parameters that were significantly associated with the development of postoperative GERD and EE, at up to 1-year follow-up.

Results

At up to 1-year follow-up, out of 127 patients, only preoperative endoscopic presence of a hiatal hernia noted on axial length (p=0.024) and the Hill’s classification of the gastroesophageal junction (p<0.001) were significantly associated with the development of postoperative GERD. Similarly, at 1-year follow-up endoscopy, the presence of a hiatal hernia (p=0.041) and the Hill’s classification (p=0.001) were associated with postoperative EE. On the multivariate analysis, compared to patients with a Hill’s I flap valve, Hill’s II patients were more likely to develop postoperative GERD (OR 7.13, 95% CI: 1.69–29.98, p=0.007), and Hill’s III patients were more likely to develop postoperative GERD (OR 20.84, 95% CI: 3.98–109.13, p<0.001) and EE (OR 34.49, 95% CI: 1.08–1105.36, p=0.045). All patients with Hill’s IV developed postoperative GERD and EE in this study.

Conclusion

Postoperative GERD and EE remain an important limitation following LSG. Proper preoperative assessment using the Hill’s classification can help to accurately predict patients at risk of postoperative GERD and EE.

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Authors and Affiliations

  1. Upper Gastrointestinal and Bariatric Surgery Service, Department of Surgery, Sengkang General Hospital, Medical Centre, Level 9, 110, Sengkang E Way, 544886, Singapore

    Koy Min Chue, Cheryl Min En Chua, Bin Chet Toh, Lester Wei Lin Ong, Wai Keong Wong, Chin Hong Lim, Jeremy Tian Hui Tan & Baldwin Po Man Yeung

  2. Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore

    Daniel Wen Xiang Goh

  3. Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Bukit Merah, Singapore

    Wai Keong Wong, Chin Hong Lim & Jeremy Tian Hui Tan

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  1. Koy Min Chue
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Chue, K.M., Goh, D.W.X., Chua, C.M.E. et al. The Hill’s Classification Is Useful to Predict the Development of Postoperative Gastroesophageal Reflux Disease and Erosive Esophagitis After Laparoscopic Sleeve Gastrectomy. J Gastrointest Surg 26, 1162–1170 (2022). https://doi.org/10.1007/s11605-022-05324-x

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