Hill antireflux operation.

There are multiple published reports of the efficacy of the Hill procedure in controlling problems with primary reflux, recurrent hiatal hernias, and failed previous operations, and in patients with reflux complicated by peptic esophageal stricture. There also are more recent reports demonstrating its applicability in laparoscopic antireflux operations. Currently, the longest follow-up study for patients undergoing antireflux surgery originated at the Virginia Mason Medical Center and was published in 1988. This review followed 167 patients for a minimum of 15 to 20 years (mean 17.8 years) following their Hill operations. This study demonstrated the durability of the Hill antireflux operation in that more than 85% of patients were still completely satisfied with their postoperative results 15 to 20 years following the operation. In 1993 the author and colleagues carried out a quality-of-life analysis 1 year following standard open antireflux surgery in 60 patients operated on between April 1991 and November 1992. Forty-nine of these patients underwent primary operations, whereas 11 (18%) were undergoing repeat operations. A prospective modified Visick-type classification as proposed by Dr. Pope was used and all patients were asked to prospectively rate their quality of life on a standard scale (from 0 = worst to 10 = best) preoperatively and then 1 year following operation. It was found that symptom scores on the modified Visick scale improved dramatically (Table 1) and that patients' individual perceptions of their quality of life were equally dramatically improved (see Table 1). We have found the Hill procedure to be highly effective, safe therapy for primary, recurrent, and complicated antireflux problems. The repair is durable in the long-term, and it can be applied laparoscopically. We have made some minor changes in surgical technique to make the procedure easier to understand and apply by all surgeons interested in treating patients with antireflux disease.