title: A Combined Nissen Plus Hill Hybrid Repair for Paraesophageal Hernia Improves Clinical Outcomes and Reduces Long-Term Recurrences Compared with Laparoscopic Nissen Alone.
abstract: We compared clinical and objective outcomes of combined Nissen-Hill hybrid (HYB) to Nissen fundoplication (LNF) for repair of paraesophageal hernia (PEH).
  
  
  
  This study is a single-institution retrospective chart review of prospectively collected data for consecutive patients undergoing PEH repair from 2006 to 2015 with at least 6 months of follow-up. Quality of life metrics (QOLRAD, HRQL, and dysphagia), manometry, radiographic imaging, and pH testing were administered pre- and postoperatively.
  
  
  
  With 319 repairs (HYB = 141, LNF = 178), the groups were comparable in age and gender, but HYB had a higher BMI (30.95 vs 29.27, p < 0.05), larger hernia (6 vs 5 cm, p < 0.05), and more Barrett's esophagus (42 vs 29, p < 0.05). At a median follow-up of 22 months, DeMeester scores were equivalent but PPI use was higher in the LNF group. All three quality of life scores were better for HYB: GERD-HRQL 3.75 vs 7.49, p = 0.01; QOLRAD 6.59 vs 6.23, p = 0.04; and swallowing 40.71 vs 36.47, p = 0.01. At a median follow-up of 60 months (HYB = 39, LNF = 31), anatomic recurrences and reoperations were lower for HYB: 5 vs 45 % (p < 0.05), 2.6 vs 9.7 % (p = 0.2).
  
  
  
  Combining Nissen and Hill for PEH repair appears to result in better quality of life and fewer recurrences compared to LNF.
authors: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WA, USA.
authors: Gal
authors: G
authors: Levy
authors: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WA, USA. Ralph.aye@swedish.org.|Swedish Thoracic and Esophageal Surgery, 1101 Madison Suite 900, Seattle, WA, 98104, USA. Ralph.aye@swedish.org.
authors: Ralph W
authors: RW
authors: Aye
authors: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WA, USA.
authors: Alexander S
authors: AS
authors: Farivar
authors: Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WA, USA.
authors: Brian E
authors: BE
authors: Louie
mesh_terms: D001471:Barrett Esophagus / Q000601:surgery; D003680:Deglutition Disorders / Q000517:prevention & control; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Antireflux surgery; Fundoplication; Laparoscopic; Paraesophageal hernia