Modified Hill operation vs. Nissen fundoplication in the surgical treatment of gastro-esophageal reflux disease.
OBJECTIVE
The authors compared the results of the Nissen fundoplication technique with the results of the Hill procedure, by using a 10-year history of patients with gastro-esophageal reflux disease.


METHODS
Seventy two consecutive patients entered the study, 32 of whom underwent a 360 degrees fundoplication according to Nissen and 40 with a modified Hill operation. In the Nissen Group, intraoperative manometry (IOM) was carried out in all patients; in the Hill Group, the patients were randomized in two sub-groups (A and B), before operation; in 20 of them (group A), the procedure was randomly associated to IOM.


RESULTS
The overall complications were low in both groups (15.6% in the Nissen Group and 5% in the Hill Group, p = 0.1), and there was no mortality rate. The clinical results were excellent or good in 28 patients (87.6%) of the Nissen Group and in 36 patients (90%) of the Hill Group (p = 0.5); in particular, an excellent outcome was observed in 16 patients (80%) with IOM (sub-group A), while 12 patients (60%) without it (sub-group B) showed similar results. The manometric studies carried out six months after surgical treatment showed a decrease of the lower esophageal sphincter pressures in all patients if compared to the pressure recorded intra-operatively. In comparison to the pre-operative values, both the lower esophageal sphincter length and its intra-abdominal portion were markedly increased in the Nissen Group and in the sub-group A of the Hill patients.


CONCLUSIONS
These results support the conclusions that modified posterior gastropexy and 360 degrees fundoplication are effective, well tolerated, and can be properly used in the treatment of Gastro-esophageal reflux disease (GERD), since both techniques showed good clinical results. A favorable clinical outcome depends mostly on adequate lower esophageal sphincter length (LESL) and LESIA extension, which could be more efficiently achieved by the use of intraoperative manometry (IOM).
Civello
I M
IM
Department of Surgery, Catholic University, Rome, Italy.
Brisinda
G
G
Sganga
G
G
De Fazio
S
S
Maria
G
G
Crucitti
F
F
D000328:Adult; D000368:Aged; D004943:Esophagogastric Junction / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000145:classification / Q000379:methods*; D005748:Gastric Fundus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011312:Pressure; D012189:Retrospective Studies; D016896:Treatment Outcome