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

Nassar, Ricardo; Girón, Felipe; Garcia, Andres M; Rodríguez, Lina; Ricaurte, Alberto; Rueda‐Esteban, Roberto Javier; Pizano, Alejandro; Hernández, Juan David

doi:10.1007/s11695-021-05465-z

Cited by 6 publications

(6 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A modified Hill’s gastropexy was also proposed as a possible surgical technique to control GERD after LSG [ 19 ] but the literature scarce for the outcomes of these procedures. Sánchez-Pernaute et al, presented good 6 months results in one patient [ 19 ] and Nassar et al observed satisfactory GERD control in a 3-year retrospective study including 16 patients [ 51 ]. Nevertheless, stitching cardia to the preaortic fascia may narrow the GEJ and cause postoperative dysphagia [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Hutopilă

Ciocoiu²,

Paunescu³

et al. 2023

Surg Endosc

View full text Add to dashboard Cite

Background Laparoscopic Sleeve Gastrectomy (LSG) is the most attractive bariatric procedure, but the postoperative intrathoracic gastric migration (ITM) and “de novo” GERD are major concerns. The main objective of our study was to evaluate the efficiency of the concomitant HHR with or without partial reconstruction of phreno-esophageal ligament (R-PEL) to prevent ITM after LSG. The secondary objectives focused on procedure’s metabolic and GERD-related outcomes. Patients and method Consecutive patients who underwent primary LSG and concomitant HHR were included in a single-center prospective study. According to the HHR surgical technique, two groups were analyzed and compared: Group A included patients receiving crura approximation only and Group B patients with R-PEL. The patients’ evolution of co-morbidities, GERD symptoms, radiologic, and endoscopic details were prospectively analyzed. Results Two hundred seventy-three patients undergoing concurrent HHR and LSG were included in the study (Group A and B, 146 and 127 patients) The mean age and BMI were 42.6 ± 11.3 and 43.4 ± 6.8 kg/m 2 . The 12-month postoperative ITM was radiologically found in more than half of the patients in Group A, while in group B, the GEJ’s position appeared normal in 91.3% of the patients, meaning that R-PEL reduced 7 times the rate of ITM. The percentage of no-improvement and “de novo” severe esophagitis (Los Angeles C) was 4 times higher in group A 3.4% vs. 0.8% with statistical significance, and correlated to ITM. The GERD symptoms were less frequent in Group B vs Group A, 21.3% vs 37%, with statistical significance. No Barrett’s esophagus and no complication were recorded in any of the patients. Conclusion Concurrent LSG and HHR by crura approximation only has a very high rate of ITM in the first postoperative year (over 50%). R-PEL is an innovative technique which proved to be very efficient in preventing the ITM after HHR.

show abstract

Section: Discussionmentioning

confidence: 99%

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Hutopilă

Ciocoiu²,

Paunescu³

et al. 2023

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…In our population, all patients underwent laparoscopic sleeve gastrectomy. Additional Hill modi ed technique was performed as Nassar et al described, [21] in patients with intraoperative nding of hiatal hernia (11.7% of patients). Adhesional syndrome was documented in all cases, perforation and stula were documented in 11% of patients in accordance with Lim et al, who described perforation as a common intraoperative nding in revisional procedures due to a 1-2% risk in those patients [22].…”

Section: Discussionmentioning

confidence: 99%

Gastric Plication Failure: A retrospective analysis

Nassar

Girón

Rodríguez

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Obesity has evolved into a worldwide disease affecting millions of patients. This condition is related to a wide variety of health problems such as diabetes, hypertension, aterosclerotic disease, among others. There is a wide range of methods for managing obesity, varying from medical to surgical interventions. Even though bariatric surgery is not a one size fits all solution, since its advenment it has become an excellent option for those living with obesity. Although its low cost is very appealing, the high need of re-intervention and complications (70% according to literature) have led to controversy surrounding the use of gastric plication. The aim of this study is to describe the characteristics, experience and outcomes of patients with history of gastric fundoplication that required reintervention between 2014 and 2020 in our institution. Methods We conducted a retrospective observational study with a prospective database. We included patients that developed complications from a previous gastric plication. Revision to laparoscopic sleeve gastrectomy was made. Data regarding baseline and evolution were obtained and analyzed. Revision cause, perioperative outcomes, intraoperative characteristics, complications and weight loss were variables included in the surgical analysis. Post-operative follow-up was done up to 5 years. Results Seventeen patients required revisional surgery. Mean age of the patients was 39.71 years, 52.9% were men and 47.1% were women. In the first consultation the main concerns were weight regain (88.2%), and abdominal pain (82.3%). 47% of the patients reported dyspepsia and 47.1% had symptoms related to nausea and emesis. Mean body mass index in the group was 31.2 kg/m² before reintervention, 27.6 kg/m² 6 months after surgery and 24.1 kg/m² 5 year after surgery. All the patients had abdominal adhesions as intraoperative findings, 41.17% had severe inflammation and 1 patient (5.8%) had a gastroesophageal fistula. Conclusions In our series, gastric plication failure was mainly associated with abdominal pain and weight regain. Revisional surgery proved to be a safe and effective alternative for management of complications after this procedure.

show abstract

“…Technical modifications introduced to ameliorate GERD symptoms after SG are currently being investigated. [3][4][5][6] SG, a preferred bariatric procedure globally, has the advantages of preserving the normal continuity of the gastrointestinal tract with no anastomoses, and fewer metabolic disruptions. 6 However, in randomized controlled trials (RCTs), SG is associated with a higher rate of GERD symptoms and GERD-related complications in the years following surgery compared to RYGB.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] SG, a preferred bariatric procedure globally, has the advantages of preserving the normal continuity of the gastrointestinal tract with no anastomoses, and fewer metabolic disruptions. 6 However, in randomized controlled trials (RCTs), SG is associated with a higher rate of GERD symptoms and GERD-related complications in the years following surgery compared to RYGB. [7][8][9][10] For instance, in the SM-BOSS trial, the rates of GERD worsening and de novo GERD were both 32% at 5 years after SG, compared to 6% and 11% after RYGB.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long‐term impact of gastropexy on use of acid‐reducing medication, second operations for gastroesophageal reflux and subjective reflux symptoms after sleeve gastrectomy

et al. 2023

View full text Add to dashboard Cite

SummaryWe investigated whether adding gastropexy to sleeve gastrectomy (SG) reduced gastroesophageal reflux disease (GERD) in patients operated for severe obesity, assessed mainly by use of anti‐reflux medication (ARM) and second operations due to GERD worsening. In a prospective non‐randomized study, patients undergoing SG at two Norwegian hospitals were included from 2011 to 2015 and followed for 7 years. GERD was defined by regular use of ARM, and epigastric pain and heartburn were measured by the Rome II questionnaire. Gastropexy was done by suturing the gastrocolic ligament to the staple line. Patients undergoing SG only, mainly before gastropexia was introduced in 2013, were compared to those with additional gastropexy from 2013 onwards. Of 376 included patients (75% females, mean age 42.6 years and BMI 42.9 kg/m2), 350 (93%) and 232 (62%) were available for evaluation after 1 and 7 years, respectively. Baseline characteristics in the no‐gastropexy (n = 235) and gastropexy groups (n = 141) were similar. In patients without ARM use before surgery, the use increased and in those that used ARM at baseline, the proportion decreased, with no difference in the no‐gastropexy and gastropexy groups. With a combined endpoint of ARM use and/or second operation for GERD, there was no difference during follow‐up between the two groups. With time, adding gastropexy did not reduce symptoms of GERD significantly. In this population, adding gastropexy to SG did not reduce use of ARM and/or second operation for uncontrolled GERD, epigastric pain or heartburn during the first 7 postoperative years.

show abstract

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

Cited by 6 publications

References 35 publications

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Gastric Plication Failure: A retrospective analysis

Long‐term impact of gastropexy on use of acid‐reducing medication, second operations for gastroesophageal reflux and subjective reflux symptoms after sleeve gastrectomy

Contact Info

Product

Resources

About