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Hill Modified, a Novel Approach: Technique Description and Experience in Patients with Laparoscopic Sleeve Gastrectomy

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Abstract

Background

Gastroesophageal reflux disease (GERD) is a common disease among patients with obesity, with an associated prevalence of 39 to 61% between the population who attends a bariatric surgery evaluation. Laparoscopic sleeve gastrectomy (LSG) has become a popular and valid option for obesity treatment, even though the literature is ambivalent regarding the increase or decrease in GERD after this surgery. Thus, it is necessary to propose new surgical techniques as a solution to GERD in patients with a concomitant LSG or with a history of it. Therefore, we present a modified technique based on Hill’s gastropexy described originally in 1967.

Objective

Describe and propose a surgical procedure for GERD management based on the Hill technique that can be applied in all patients who undergo an LSG or with a history of it.

Methods

Retrospective observational study with a prospective database in which we described, Hill modified technique in a group of 16 patients with GERD who underwent this procedure concomitantly with an LSG or who presented with GERD after LSG with a 3-year follow-up. The surgical technique is based on an intra-abdominal esophageal length of a minimum of 3 cm and posterior fixation of the gastroesophageal junction to the crus.

Results

Postoperative controls have shown satisfactory results in the control and management of GERD symptoms in this group of patients, with very few to no complications associated with the procedure and without reintervention or medication out of the standard protocol.

Conclusion

Hill modified technique can be used and presented as an option for GERD control in patients with LSG.

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Authors and Affiliations

  1. Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, 110111, Colombia

    Ricardo Nassar, Lina M. Rodríguez, Alberto E. Ricaurte & Juan D. Hernandez

  2. School of Medicine, Universidad de los Andes, Bogotá D.C., 111711, Colombia

    Ricardo Nassar, Felipe Giron, Andres M. Garcia, Lina M. Rodríguez, Roberto J. Rueda-Esteban, Alejandro Pizano & Juan D. Hernandez

  3. School of Medicine, Universidad del Rosario, Bogotá D.C., Colombia

    Ricardo Nassar, Felipe Giron & Alberto E. Ricaurte

  4. Bogotá D.C., Colombia

    Felipe Giron

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  1. Ricardo Nassar
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  2. Felipe Giron
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Correspondence to Felipe Giron.

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Ethical Statements

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The authors declare no competing interests.

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Key Points

• GE junction fixation as a antireflux mechanism

• No need of PPIs after postoperative management (PPIs free period mean 29.57 months)

• GERD symptoms control in all patients 3-year follow-up period

• Hill modified technique is a feasible option for GERD management in patients with LSG

Dr Ricardo Nassar is first author, principal researcher and chief and chairman.

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Nassar, R., Giron, F., Garcia, A.M. et al. Hill Modified, a Novel Approach: Technique Description and Experience in Patients with Laparoscopic Sleeve Gastrectomy. OBES SURG 31, 3646–3652 (2021). https://doi.org/10.1007/s11695-021-05465-z

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