Tri-comparison of Laparoscopic Nissen, Hill, and Nissen-Hill Hybrid Repairs for Uncomplicated Gastroesophageal Reflux Disease.
BACKGROUND
A randomized controlled trial (RCT) showed that laparoscopic Nissen fundoplication (LNF) and Hill (LHR) repairs are equivalent in treating uncomplicated GERD. We combined both repairs to create a laparoscopic Nissen-Hill Hybrid repair (HYB). The purpose of this study is to compare clinical and objective outcomes of a matched group of HYB to the two cohorts of the RCT.


METHODS
A retrospective analysis of prospectively collected data from the RCT and a prospectively collected data base was performed. Data were collected preoperatively, postoperatively short-term (ST) at 6 weeks and mid-term (MT) at 6-12 months. Evaluation was standardized according to the RCT and included three quality of life metrics (QOLRAD, GERD-HRQL, Dysphagia), endoscopy, manometry, pH testing, and barium swallow.


RESULTS
There were 51 HYB, 46 LNF, and 56 LHR patients. Age, BMI, follow-up, and gender were comparable. QOLRAD, HRQL, PPI use, DeMeester scores, and pH% time <4 significantly improved in all groups and were equivalent. Anatomic recurrence was seen in five LNF, four LHR, and two HYB patients. Reoperations were performed in three LHR, two LNF, and zero HYB patients.


CONCLUSION
Tri-comparison shows that HYB is a promising alternative to LHR and LNF. Side effects were not increased and there were fewer reoperations for failure.
['Schneider|Andreas M|AM|', 'Aye|Ralph W|RW|', 'Wilshire|Candice L|CL|', 'Farivar|Alexander S|AS|', 'Louie|Brian E|BE|']
D000328:Adult D050782:Esophageal pH Monitoring D005260:Female D018662:Fundoplication D005764:Gastroesophageal Reflux D006801:Humans D006863:Hydrogen-Ion Concentration D010535:Laparoscopy D008297:Male D008365:Manometry D008875:Middle Aged D054328:Proton Pump Inhibitors D011788:Quality of Life D016032:Randomized Controlled Trials as Topic D012008:Recurrence D012086:Reoperation D012189:Retrospective Studies D016896:Treatment Outcome
Gastroesophageal reflux Fundoplication Quality of life Recurrence Reoperation