Division of Thoracic Surgery, Swedish Cancer Institute and Medical Center, 1101 Madison, Suite #900, Seattle, WA, 98104, USA.
Surg Endosc. 2018 Oct;32(10):4111-4115. doi: 10.1007/s00464-018-6150-z. Epub 2018 Mar 30.
The open Hill repair for gastroesophageal reflux disease and hiatal hernia is remarkably durable, with a median 10-year reoperation rate of only 3% and satisfaction of 93%. No long-term data exist for the laparoscopic Hill repair (LHR).
Patients who underwent primary LHR at Swedish Medical Center for reflux and/or hiatal hernia at least 5 years earlier (1992-2010) were identified from an IRB-approved database. There were 727 patients who met inclusion criteria, including 648 undergoing repair for reflux and 79 for paraesophageal hernia. Two questionnaires were administered via mail to evaluate long-term quality of life using validated GERD-HRQL, Swallowing score, and global satisfaction score. Outcomes were defined by GERD-HRQL score, Swallowing score, resumption of proton pump inhibitor (PPI) therapy, need for reoperation, and global satisfaction with overall results.
Two hundred forty-two patients completed and returned the survey (226 lost to follow-up, 90 deceased, 3 denied undergoing LHR, 166 non-responders), of which 52% were male. The average age at the time of surgery was 49.5 years. Median follow-up was 18.5 years (range 6.2-24.7). The average GERD-HRQL score (7.1) and the average Swallowing score (39.9) both indicated excellent symptomatic outcomes. 30% of patients are using daily PPIs. 24 patients (9.9%) required reoperation for failure during the follow-up period, 21 in the reflux group and 3 in the paraesophageal hernia group. Overall, 85% reported good to excellent results, and 76% would recommend the operation.
LHR shows excellent long-term durability and quality of life similar to the open Hill repair, with 85% good to excellent results at a median follow-up of 19 years and a reoperation rate under 10%. It is surmised that Hill suture fixation of the gastroesophageal junction to the preaortic fascia may confer unique structural integrity compared to other repairs.
开放式 Hill 修复术治疗胃食管反流病和食管裂孔疝的效果非常持久，中位 10 年再手术率仅为 3%，患者满意度为 93%。腹腔镜 Hill 修复术（LHR）尚无长期数据。
从瑞典医疗中心经 IRB 批准的数据库中确定了至少在 5 年前（1992-2010 年）接受原发性 LHR 治疗反流和/或食管裂孔疝的患者。符合纳入标准的患者共有 727 例，其中 648 例接受修复治疗反流，79 例接受食管旁疝修复治疗。通过邮件向患者发放了两份问卷，使用经过验证的 GERD-HRQL、吞咽评分和总体满意度评分评估长期生活质量。根据 GERD-HRQL 评分、吞咽评分、质子泵抑制剂（PPI）治疗恢复情况、再手术需要以及对整体结果的总体满意度来定义结局。
共有 242 例患者完成并返回了调查（226 例失访，90 例死亡，3 例否认接受过 LHR，166 例未回复），其中 52%为男性。手术时的平均年龄为 49.5 岁。中位随访时间为 18.5 年（范围 6.2-24.7 年）。平均 GERD-HRQL 评分为 7.1，平均吞咽评分为 39.9，均表明症状得到了极好的缓解。30%的患者正在使用每日 PPI。在随访期间，24 例（9.9%）患者因手术失败需要再次手术，其中反流组 21 例，食管旁疝组 3 例。总体而言，85%的患者报告结果良好或优秀，76%的患者会推荐该手术。
LHR 具有极好的长期持久性和生活质量，与开放式 Hill 修复术相似，中位随访 19 年再手术率低于 10%，85%的患者报告结果良好或优秀。推测 Hill 缝线将胃食管连接固定于主动脉前筋膜可能赋予了该术式独特的结构完整性，这与其他修复术式不同。
