title: A randomized multiinstitution comparison of the laparoscopic Nissen and Hill repairs.
abstract: BACKGROUND
  Laparoscopic Hill repair (LHR) and laparoscopic Nissen fundoplication (LNF) are established surgical antireflux procedures but have never been compared in a prospective trial. This trial was designed to compare the effectiveness of LHR against the gold-standard LNF.
  
  
  METHODS
  Patients with uncomplicated gastroesophageal reflux from two esophageal centers were randomly assigned and blinded from 2003 to 2007. Preoperative and postoperative evaluation included two quality of life metrics--Quality of Life in Reflux and Dyspepsia, and Dysphagia--as well as endoscopy, video esophogram, manometry, and pH testing.
  
  
  RESULTS
  Of 121 patients who consented to the trial, 102 underwent surgery; 46 LNF and 56 LHR were performed, with a mean follow-up of 12 months. Postoperatively, the DeMeester score normalized for both repairs, with no difference between them (LNF 6.8, LHR 11.1, p=0.26). Postoperative medication use was 4%, and the groups were equivalent. Lower esophageal sphincter pressure increased significantly for LNF (14.93 to 24.10, p=0.001) but not for LHR (19.91 to 20.25, p=0.87). Quality of life scores improved significantly for both repairs (LNF 3.77 to 6.65; LHR 3.84 to 6.54, p<0.001), and postoperative results were equivalent (p=0.99). Dysphagia scores preoperative/postoperative were LNF 33.88 to 38.33 and LHR 35.44 to 38.72, and were equivalent postoperatively (p=0.94). Two LNF and two LHR required reoperation for failed repair.
  
  
  CONCLUSIONS
  The LHR and the LNF both yield excellent and equivalent results for uncomplicated gastroesophageal reflux at 12 months. Their mechanisms of action may be different.
authors: Swedish Medical Center, Seattle, Washington 98104, USA. ralph.aye@swedish.org
authors: Ralph W
authors: RW
authors: Aye
authors: Lee L
authors: LL
authors: Swanstrom
authors: Seema
authors: S
authors: Kapur
authors: Gordon
authors: G
authors: Buduhan
authors: Christy M
authors: CM
authors: Dunst
authors: Ariel
authors: A
authors: Knight
authors: Judith A
authors: JA
authors: Malmgren
authors: Brian E
authors: BE
authors: Louie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D019160:Endosonography / Q000379:methods; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D056888:Patient Positioning; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult