Hill anti reflux procedure for gastro esophageal reflux disease after sleeve gastrectomy – a single center experience

Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure but is frequently complicated with postoperative gastroesophageal reflux disease (GERD). While Roux-en-y gastric bypass (LRYGB) is the standard revision surgery for GERD after LSG, some patients continue to require antireflux medication. The Hill antireflux repair (LHR) offers a potential alternative by restoring the gastroesophageal junction anatomy and augmenting the lower esophageal sphincter (LES) pressure without fundoplication. A retrospective single-center study was conducted between 2019 and 2022, including 10 patients who underwent LHR for GERD symptoms following LSG. The purpose of this study was to evaluate the medium and long-term outcomes of LHR in this patient population. Ten patients underwent LHR. Mean preoperative GERDQ-score was 12, improving to 6 at one year and 8 at three years. The use of proton pump inhibitors decreased from 100% preoperative to 30% at three years postoperative. Median LES pressure increased significantly from 8mmHg preoperatively to 23mmHg after applying Hill-sutures. There were no short-term complications. Two patients required revisional surgery due to recurrent hiatal hernia and dysphagia. LHR appears as feasible surgical option for patients with GERD after LSG. Larger, prospective studies with objective postoperative assessments are needed to validate long-term outcomes and to define its therapeutic role.