Hill Repair VS Fundoplication

In this forum people are mentioning Nissen Fundoplication as a means of surgical relief but if you are considering surgery for GERD, you may want to get info on the Hill Repair as well. Nissen is a basic tightening of the Lower esophageal sphincter (LES) by wrapping the upper part of the stomach (fundus) around it. This commonly works well but leaves the patient unable to vomit. The Hill repair is a newer more complex procedure that is a restructuring of the LES so that it works as nature intended. The Hill repair allows the patient to retain their ability to vomit. So why does Nissen remain the surgery of choice if the Hill repair seems to be the better method? I asked my doctor this and he candidly said, because surgeons in general are not very good at what they do, in his opinion. So they are going to choose the easier procedure to help their patient because they may not have the skill to do a Hill repair. Of course, this doctor is a general surgeon who has performed almost 200 Hill repairs since 1994. So far he has had two people with recurring symptoms-both were extremely obese. There was a study done on 20 year results of a Hill repair that indicates over 90 percent of the patients were still satisfied with the way they feel. It can be done laporoscopically but my doctor does them open as there is a lot to keep track of and his theory is, you only want to do this once. He told me expect to have a three day hospital stay and slow integration of normal food. I think I'm getting close to having a Hill repair since I'm young and don't want to spend the next 60 years of my life battling with GERD. If I do, I will be sure to post my progress to the forum. I just want people to know that there are surgical options and it's a matter of doing what's best for you. I wish you all well.

I'm having a Fundoplication surgery in a couple of weeks and my research points to the long held opinion and findings that there is a 90% success rate for it.  Same as the Hill treatment and if it's not as complex, it sounds more user friendly to me....  Really through if the surgeon that I came across recommended that that was his master type surgery then I'd have a "Hills" but my surgeon performs a Partial anterior Fundoplication "very well" in his opinion and the partial wrap does usually allow patients to vomit and burp within a short a few weeks of surgery.  I would be much more nervous of a full wrap Nissan, as then there is a high chance of not being able to vomit and burp....

Shelley,

The rubber band treatment is not related to the Hill repair or Fundoplication procedure as far as I know. I think I read a little about it though but I don't know about its success rate. If it's the one I'm thinking of, there is an occasional problem with the ring band moving to places it shouldn't be. In brief terms, the Hill Repair does three things. It corrects the hiatel hernia, creates a flap valve at the junction of the esophagus and stomach, and tightens the valve itself. If you want, I can send you the detailed article my doctor gave me about the Hill repair. You can email your mailing address to me at [email protected].

I am in a similar situation as I am 32 and like you, I don't want to battle with this forever either. I figure as scary as the thought of surgery is, if it helps me to live a better life, it would be worth it. I didn't really have to make many lifestyle adjustments to begin with to comply with the typical remedies for GERD. Even before my symptoms presented, I didn't drink coffee, drank very little soda-maybe once per week, didn't smoke, didn't use alcohol or drugs, exercised regularly and was thin. Over the last three years I have tried many remedies and medications for months at a time and at best they offered temporary relief. So I have to accept that the mechanical part of my acid defense is defective-I've given it all the help I can. So what makes the most sense to me is to fix the defect-meaning have the surgery. I agree with everyone in that surgery should be a last resort and I am not trying to sell you on surgery. But I do believe that you have to reach a point where you say "enough" and attack the problem as aggressively as it has been attacking you. In my opinion, the younger I am when I do it, the better off I'll be.

Ben

 

Ben, Shelley -

I'm 30 yrs of age. Many of your symptoms are familiar. 6 yrs ago after college I began having reflux. My father had the Nissen surgury when he was in his 40's. I've been diagnosed with chronic gastritis and had had every test & med you can think of. My symptoms are a bit uncommon for normal gerd suffers. Next week, I'm finally getting the Nissen Fundoplication procedure praying it will solve my problems.

My main ailments which have been severe enough for hospitalization include:

Frequent:

- upper abdominal pain which I've thought to be diaphramic tears or hiatal hernia due to weight lifting, alchohol, indigestion & stress. I get this pain after drinking alchohol, carbonated bevs, meals with beans & heavy tomatoe sauce and primary during exercise brought on by tighting of the abs and bearning down while lifting. Rarely do I reflux food or stomach juices back into my mouth and rarely does it feel like this is happening. My pain stays centered under my sternum and upper abdominal region. I can have difficulty breathing during strenious cardio or weight lifting, especially when wearing tight clothing. This is very new to me being a track athlete in college and always wearing tight clothing to workout in or race in. Never experiencing ANY of these issues.

Adding to the pain and hard to differentiate when exercise is soarness in my chest wall and ribcage from a weight lifting accident 2.5 yrs ago. I was bench pressing and the bar slipped off my hands down ono my chest - 225lbs of weight. Luckily I hadnt broke anything but I have had chronic chest wall pain and inflammation in the chest wall and near the connecting points of the abs and ribs. Pain I feel during exercise, be it strenuois cardio or weight lifting is often very difficult to determine the source of the pain.

GERD symptoms, like mine appear to be cyclic. I'll stay away from weights, keep a strict gerd-friendly diet and cut out alchohol for a period of time. I assume my abs, diaphram, esophogas, etc heal during this time as the pain will subside. Eventually the exercise will pick back up or the diet will relax a bit and symtpoms will come back. Sometimes not right away.

The most difficult aspect of the last 4 yrs have been inconclusive findings from ph/motility tests, x-rays, ct scans, bravo study, gastric emptying test, barium swallow tests, ekg's, stress tests, blow tests, you name it - I've done it! My gastroenterologists or other specialists have never been convinced of what was truly causing my symptoms as nothing was screaming "heres the source!".

I will post again after my surgery next week. I was lucky to find the drs who had relationships with my fathers surgeon to approve the "go ahead" to perform the procedure on me. I can hardly blame their reluctance given my history. Whats the worse that can happen? This can help things or they stay the same.  

I've never heard of the Hill procedure before. My main concern is my ability to be active, lift weights, do stenuois cardio, etc without the risk of hurting myself or making matters worse after surgery. Does anyone knoe if you'll be limited in physical activity post surgery life?

sincerely,

GN

 

 Is the Hill correction similar to the toupee fundoplication, which is a 3/4 wrap?  My son's surgeon recommended this over the nissen because it allows you to vomit, burp, etc.  but reduces GERD. 

Transplant,

A "bump" just meant I moved your topic to the top as you had a question on your last post.

Kitt

Any updates? Interested in hearing from someone who had this surgery! MM

There are more than two types of surgery.  I had the partial wrap, mentioned by Blasterboy.  This is knows as a Toupet fundoplication.

The type of operation should not be based on preference, but on what the patient NEEDS.  In my case, I had poor esophageal motility, a wide open LES, and a paraesophageal hiatal hernia (the type that is not sliding, but stuck in the chest). 

1.  I NEEDED an operation because this type of hernia does not get better on its own and causes severe symptoms.

2. I NEEDED a partial wrap because I would not be able to swallow past a full wrap with my weak esophageal movement.

3. My surgeon has done 4000, yes thousand, of these surgeries.  Based on pre-op testing AND what he saw during surgery, HE ELECTED to do the partial wrap.  I went in expecting a full Nissen, but woke up with the partial and was fine with it.

I wouldn't have dreamed of demanding a different surgery from what such an experienced surgeon, with a 98% or better success rate and patient satisfaction, decided.  I am pretty happy with the results.  6 weeks after surgery I can burp a little.  That doesn't matter because all of us still get extra gas, which gets a little better at this stage of the recovery.  I'm not saying it's been fun and games.  I'm old, have several comorbidities, including polio, which affect my recovery.  I have posted a lot previously.

I didn't consider the type of closure with the magnets because 1) I had a hernia that needed repair (some don't need repair) and 2) I will have to have more MRIs in the future for my spine problems and you can't have them with ferromagnetic metal in you.  Noone considered the other types of LES repair done through the esophagus because of the hernia.

So read everything and discuss with your physician what might be best for you.  If you don't agree, get a second opinion.

MinnesotaMark and Seattle_Stardust

Hello and welcome to HealingWell and we are glad you found us. Yes you did post on a thread that is very old when looking at the date of the original post.

We have a great search feature if you ever want to look back at old post but things are changing fast in the way procedures are perforums for GERD so please do read through the current threads and do feel comfortable in post your own threads.

We do love to meet the new members, so share you stories with us.

MM I am also from the Land of 10,000 Lakes. :)
Again welcome

Kitt

Alcie

Good link and I added it to my own resource above which is a locked down sticky now.

Thanks

Kitt

My doctor is Dr. Bagnato in Albany, GA.
It's a five hour drive for me, but I feel he will answer my needs best.
I was wondering how it felt a year later for someone who had the Hill.

Joy

He says he does his own method of the Hill and does it all the time. He's originally from New York. So I guess that's where he was trained.

Joy

They say the Nissen doesn't last long for some people. I guess the same can be said about the Hill. I hope mine last a long time.

Joy