Laparoscopic reconstruction of gastroesophageal anatomy for the treatment of reflux disease

Abstract

This paper presents the technique and results of an operation that restores normal anatomical and physiological antireflux mechanisms for the treatment of gastroesophageal reflux disease (GERD). The Hill procedure was modified beginning in 1973, evolving into an operation that has been standard in our practice since 1987. Major changes included total fixation of the abdominal esophagus and elimination of phrenoesophageal bundle plication. We began performing the procedure laparoscopically in 1991 and simultaneously began a study to look at our results. This is the first report of the first 44 patients operated on from October 1991 through March 1994. There was one operative complication. Mean follow-up was 14 months. One patient was lost to follow-up and one patient died. There were no long-term side effects. A Visick grading scale was designed to categorize results. Forty graded satisfactory (95%) and two unsatisfactory.

360° laparoscopic fundoplication with tension-free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease

“…The hiatus closely surrounds the esophagus; posteriorly, a fatty or areolar tissue fills the space between the esophagus and the hiatus (mesoesophagus). The cruses on the sides and behind the esophagus have few or no tendinous fibers [13,18]. The hiatal border is stronger anteriorly on account of the endothoracic and endoabdominal fascia and the central tendon of the diaphragm.…”

GERD surgery in non-neurologic patients: Modified Laparoscopic Hill-Snow Repair is a valid alternative to Nissen fundoplication. Results of a 20 years of follow-up

“…4 According to the modification introduced by Snow (1987), the Hill-Snow procedure, the distal abdominal oesophagus is fixed by suturing the posteromedial wall of the cardia to the body of the crural decussation and tendon (the caudal part of the crus) with two-three stitches (Figure 1b). 5 For both techniques, the GEV is re-established by suturing the fundus of the stomach to the entire length of the abdominal esophagus and to the diaphragm with running or single 2/0 or 3/0 sutures.…”

“…The modification introduced by Snow (1987) consists of distal abdominal oesophagus fixation by suturing the posteromedial wall of the cardia to the body of the crural decussation and tendon (the caudal part of the crus) with two-three stitches. 5 It has been performed laparoscopically since 1991.…”