71895 - The Hill Anti Reflux Procedure -a Possible new solution to GERD post Bariatric Surgery?

Introduction

Gastroesophageal reflux disease (GERD) is one of the main concerns after bariatric surgery with an occurrence of about 30% after Sleeve Gastrectomy. While Gastric Bypass surgery (GBP) often relieves symptoms, upto 8% still suffer from significant GERD. Effective treatment options for patients with large hiatal hernia and severe obesity as well as those with refractory GERD after GBP are scarce.

The aim of this study was to evaluate the feasibility of the Hill reflux procedure as an adjunct to gastric bypass.

Method

The study is a phase 2a-trial aimed to include 8 consecutive patients with refractory GERD after gastric bypass surgery or large hiatal hernia, GERD and severe obesity.

Preoperative and 1 year follow-up evaluation includes upper-GI endoscopy, 24h-pH measure, manometry, radiology and subjective symtoms estimated with GerdQ. All operations are performed laparoscopically by one surgeon according to the Hill-technique (fig1). Each procedure is filmed and postoperatively evaluated by a team of international experts.

Result

Preliminary report involves data for the first three cases, including one patient with severe GERD with intrathoracic pouch herniation after GBP and two patients with primary gastric bypass and large hiatal hernia.

There were no conversions or intraoperative complications, but one Grade-2 postoperative complication.

During 1-4 months follow-up GerdQ has been normalized in all three cases.

Discussion

Early, data suggest feasibility of the procedure in a group of patients with today few effective treatment options.