Hill Repair VS Fundoplication

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bnand
New Member


Date Joined Mar 2005
Total Posts : 5
   Posted 4/7/2005 2:03 AM (GMT -6)   
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.

dbab
Veteran Member


Date Joined Jan 2004
Total Posts : 4151
   Posted 4/7/2005 7:17 AM (GMT -6)   
If you do go with the surgery, please keep us updated. I'm not much on surgery (although I may change my mind after living with this for another 10 years) however my mother is really miserable and it may be something that she may consider. I will have her ask her doctor about it.

Thanks,
dbab
"Slow down and everything you are chasing will come around and catch you."
- John De Paola


Blasterboy
New Member


Date Joined Apr 2005
Total Posts : 7
   Posted 4/7/2005 8:46 AM (GMT -6)   
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 J
Regular Member


Date Joined Apr 2005
Total Posts : 57
   Posted 4/7/2005 9:35 AM (GMT -6)   
Can somebody explain to me what the two of these surgeries are supposed to do? I've asked my doctor if there is anything to help my hiatel hernia and she says that I could have a rubber band type ring inserted to keep my esophogous closed better?!?!? (I think) but that it's not permanent. Is this one of the procedures that you all are talking about. I've never really received much help with my acid reflux, but now that I'm off prilosec and need to use natural remedies, I think I need to look into some other options. I'm 31 and just can't see living the rest of my life not being able to excercise, bend over, or lift things!

Thanks so much for all of your input!

Shelley

bnand
New Member


Date Joined Mar 2005
Total Posts : 5
   Posted 4/9/2005 12:46 PM (GMT -6)   
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 mrgeecue@msn.com.

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

Lady39
New Member


Date Joined May 2005
Total Posts : 17
   Posted 5/6/2005 4:23 PM (GMT -6)   
Ben, what surgeon did you speak to about the Hill Repair? I'm also interested in that proceedure but am finding it diffucult to find much info. Jen

greatnorwegian
New Member


Date Joined Apr 2006
Total Posts : 1
   Posted 4/11/2006 12:35 AM (GMT -6)   
 
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
 

prego35
New Member


Date Joined Apr 2006
Total Posts : 2
   Posted 4/28/2006 5:11 PM (GMT -6)   
Hello,

Has the person who had the Hill procedure back here? how is he doing? I am interested in hearing his progress and recommendations.

Thanks
prego

transplant2007
New Member


Date Joined Aug 2008
Total Posts : 3
   Posted 8/18/2008 11:31 AM (GMT -6)   
idea  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. 

transplant2007
New Member


Date Joined Aug 2008
Total Posts : 3
   Posted 8/20/2008 11:43 AM (GMT -6)   
what?

stkitt
Elite Member


Date Joined Apr 2007
Total Posts : 32602
   Posted 8/20/2008 11:50 AM (GMT -6)   

Transplant,

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

Kitt


 

Kitt, Moderator: Anxiety/Panic & Depression
& GERD  Forums
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Seattle_Stardust
New Member


Date Joined Dec 2008
Total Posts : 1
   Posted 12/2/2008 1:14 AM (GMT -6)   
bnand said...
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 mrgeecue@msn.com.


Hi Bnand,
I know you haven't posted since 05 but I'm wondering if you ever did get the Hill done.  I am scheduled for a consult with a surgeon at the end of the month for the Hill procedure.
I'd love to know your status.  Your story about the throat symtoms is VERY much like mine and I am only 36 year old.
 
Seattle_Stardust

MinnesotaMark
Regular Member


Date Joined Dec 2009
Total Posts : 53
   Posted 12/2/2009 12:38 PM (GMT -6)   
Any updates? Interested in hearing from someone who had this surgery! MM

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/2/2009 5:59 PM (GMT -6)   
I'm having the Hill done in three weeks on the 22nd.
I've got an excellent doctor who is very experienced in the Hill. He could of been the surgeon of the person who first posted, but he is an expert in doing the Lap method. He can do it in 30 minutes. :)

Joy

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5013
   Posted 12/3/2009 4:56 PM (GMT -6)   
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.
Alcie
 
 


couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/3/2009 8:33 PM (GMT -6)   
I wanted the EsophyX procedure, but my doctor said my HH was too big and would pull my stomach up into my chest if he did it. He said he doesn't do the Nissen any more because too many people have problems with it.
Some people look at me and say why surgery? All you do is cough. But imagine coughing everytime you get stressed, hungry, or eat. It's very frustrating.


Joy

stkitt
Elite Member


Date Joined Apr 2007
Total Posts : 32602
   Posted 12/3/2009 9:23 PM (GMT -6)   
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
Veteran Member


Date Joined Oct 2009
Total Posts : 5013
   Posted 12/3/2009 9:41 PM (GMT -6)   
Seattle and Minnesota
There's a good explanation with pictures of the different laproscopic surgeries at
http://www.nature.com/gimo/contents/pt1/full/gimo56.html
Maybe Kitt will note this address and put it in the threads at the top of the forum.

Post Edited By Moderator (stkitt) : 12/3/2009 7:52:17 PM (GMT-7)


stkitt
Elite Member


Date Joined Apr 2007
Total Posts : 32602
   Posted 12/3/2009 10:08 PM (GMT -6)   
 
Good link and I added it to my own resource above which is a locked down sticky now.
 
Thanks
 
Kitt

sillylilly
Regular Member


Date Joined Oct 2006
Total Posts : 317
   Posted 12/5/2009 4:41 PM (GMT -6)   
Hi Couchtater and everyone,

I don't post very often anymore since I had the Hill repair done over one year ago. Couchtater, who is the doctor doing your surgery? Mine was DR. Aye at Swedish in Seattle.

I agree with Alcie that the surgery you have should match your individual needs. I had regular heartburn with a small 2cm HH. 80mg of Nexium a day plus 300mg of Zantac and the meds still weren't stopping my heartburn. I could have either procedure in my case but I chose the Hill by Dr. Aye. It has worked great for me. Contrary to popular belief, it's still not a good idea to vomit with the Hill either. It can disrupt the repair if you wretch too much. I keep a script of promethizine handy if I get the flu which I haven't yet. I also was able to do a baby burp the day after surgery. I do not burp very much and they are always very tiny. I did have extra gas in the beginning but now is normal.

The surgery did the trick for me. I had a bravo and upper GI after six month and no reflux. I am still doing well and highly recommend the Hill. Dr. Aye and Dr. Wright in Seattle are the two best known doctors who do the Hill. I flew from Florida where I live to Seattle to have this procedure done there because of my confidence in Dr. Aye and the procedure.

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/5/2009 7:44 PM (GMT -6)   
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

sillylilly
Regular Member


Date Joined Oct 2006
Total Posts : 317
   Posted 12/6/2009 3:43 PM (GMT -6)   
Joy,

Well, you did better than I did in finding a surgeon who does the Hill procedure. I searched every state and could not find anyone who did it outside of Seattle and Portland in the northwest. Do you know where he got his training because the Hill is not taught in any medical school. It was developed in Seattle by Dr. Hill back in the 60's and very few doctors do it because it is technically more difficult than the Nissen.

I'm a little concerned that your doctor says he can do the Hill in 30 minutes. Dr. Aye is one of the original people who worked with Dr. Hill and learned the procedure from him and I had it done lap and was on the table for 4 hours. Even the Nissen takes about 45 min to one hour to do with the lap method.

I wish the best for you and Gerd free soon.

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/7/2009 9:29 PM (GMT -6)   
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

chaz999
New Member


Date Joined Feb 2010
Total Posts : 5
   Posted 2/10/2010 5:53 PM (GMT -6)   
The Hill repair was developed by a surgeon at Virginia Mason in Seattle. I had my hiatal hernia diagnosed there in my early 20s and was initially treated with Zantac. At age 30, my GERD symptoms grew much worse, and I decided to have the Hill repair. This was about 1990... Dr. Hill was still technically on staff there, although actually mostly retired. My surgeon was John Ryan, a sort-of protege of Dr. Hill, who had worked closely with him on hundreds of procedures. They did an open procedure -- I got conned into having my gall bladder removed at the same time (pre-surgical ultrasound revealed some stones, although they were asymptomatic.) The cool thing was that I got a nice centered vertical "fillet" scar, from navel to nipples.
 
I was told there would be no long-term limitations on my activities. I do not enjoy strenuous sports.
 
The procedure was very successful for a couple of years. I was completely medication free. Then symptoms started returning. Zantac controlled at first, but then Prilosec was new and worked much better. The symptoms can usually be controlled well, assuming a low-fat diet, small meals, and no alochol or smoking.
 
about 7 years ago, I was having significant GERD problems. A barium swallow revealed that "your hiatal hernia is back". My GI doc was a little vague about exactly what had happened. Also, an endoscopy revealed some esophogeal tissue changes that suggested Barett's esophogus, which is a change in the tissues caused by frequent acid exposure -- a condition often seen in patients who eventually develop esophogeal cancer. Follow up endoscopies showed no further indications of Barett's.
 
I have been told by other VM docs that other surgeons have not had nearly the same success with the Hill repair as Dr. Hill. He was a particularly gifted surgeon. The surgeons who were trained directly by him have somewhat better results than those further removed. This is most likely why the procedure is mainly available in the Pacific Northwest.
 
I'd never heard before that this procedure makes it harder to vomit. I do know that I vomit only rarely, but never made the connection. Sometimes I wish I could heave more easily. On those rare occasions when I get a nasty full stomach that won't flush through (rare now that I don't use antacids) I've wished I could do the bulimia thing or even get a bottle of Ipecac.
 
Curiously, my standard poodle had a Gastropexy surgery a few years ago... Active barrel-chested breeds often get a condition where their stomach's get twisted which can become quickly life-threatening.
 
--c
 

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 2/10/2010 7:07 PM (GMT -6)   
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
sleep apnea, hypothyroidism, GERD, glaucoma, OA in lower back, environmental, food, and drug allergiesasthma, high cholesterol, pre-diabetic
Medications:Nexium 1X a day, K-Dur, Lasix 2x a day, Zyrtec, Vytorin, Lumigan, Advair, Albuterol, synthoid
 
12-22-09   270 degree wrap - no more GERD!
 
 Doctor, doctor, have mercy on me.
Sometimes your cure is worse than my disease.
 -Ray Stevens

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