Laparoscopic reconstruction of gastroesophageal anatomy for the treatment of reflux disease.

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.