Hill procedure for recurrent XXXX post-Roux-en-Y gastric bypass.

@entity1 @entity28 @entity1282 @entity354
BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered to be an optimal surgical treatment option for @entity354 in the morbidly @entity28 @entity1 . Nevertheless, a subgroup of @entity1 suffer from recurrent or persistent @entity354 after their gastric bypass. Unfortunately, limited treatment options are available in these @entity1 . Fundoplication via mobilization of the remnant stomach and radiofrequency treatment of the lower esophageal sphincter have been described with some success. Our objective is to illustrate a safe and durable surgical option in the treatment of @entity1 with medically refractory @entity354 post-RYGB. METHODS: After placing five trocars in the usual position for a foregut laparoscopic surgery, a lysis of adhesions and standard dissection of the hiatus is performed. The anterior and posterior vagal nerves associated phrenoesophageal tissue bundles are identified. A primary crural repair with interrupted nonabsorbable sutures is performed. Four full-length nonabsorbable sutures are placed sequentially through the anterior and posterior phrenoesophageal bundle, posterior fundus and finally through the pre-aortic fascia. The repair is calibrated on a 44 French bougie. The sutures are tied from medial to lateral in the order of their placement under endoscopic guidance. RESULTS: No peri-procedural complications were encountered. Standard post-antireflux surgery clinical follow-up with the @entity1 completing a validated @entity354 clinical questionnaire at 1 and 6  months after the surgery demonstrated excellent @entity354 symptom control without any @entity1282 . A pH study and EGD performed at 6  months post-Hill procedure show the absence of pathological reflux with an intact Hill mechanism. CONCLUSION: The Hill procedure is a valid treatment for the post-bariatric surgical @entity1 with @entity354 in which the gastric fundus is absent or inaccessible thus eliminating standard fundoplication as a reasonable option. This also represents a safe and durable treatment of @entity354 in this uniquely challenging @entity1 population.
