A Combined Nissen Plus Hill Hybrid Repair for Paraesophageal Hernia Improves Clinical Outcomes and Reduces Long-Term Recurrences Compared with Laparoscopic Nissen Alone

Gal Levy, Ralph W. Aye, Alexander S. Farivar, Brian E. Louie

Research output: Contribution to journalArticle

5 Scopus citations


Introduction: We compared clinical and objective outcomes of combined Nissen-Hill hybrid (HYB) to Nissen fundoplication (LNF) for repair of paraesophageal hernia (PEH). Methods: This study is a single-institution retrospective chart review of prospectively collected data for consecutive patients undergoing PEH repair from 2006 to 2015 with at least 6 months of follow-up. Quality of life metrics (QOLRAD, HRQL, and dysphagia), manometry, radiographic imaging, and pH testing were administered pre- and postoperatively. Results: With 319 repairs (HYB = 141, LNF = 178), the groups were comparable in age and gender, but HYB had a higher BMI (30.95 vs 29.27, p < 0.05), larger hernia (6 vs 5 cm, p < 0.05), and more Barrett’s esophagus (42 vs 29, p < 0.05). At a median follow-up of 22 months, DeMeester scores were equivalent but PPI use was higher in the LNF group. All three quality of life scores were better for HYB: GERD-HRQL 3.75 vs 7.49, p = 0.01; QOLRAD 6.59 vs 6.23, p = 0.04; and swallowing 40.71 vs 36.47, p = 0.01. At a median follow-up of 60 months (HYB = 39, LNF = 31), anatomic recurrences and reoperations were lower for HYB: 5 vs 45 % (p < 0.05), 2.6 vs 9.7 % (p = 0.2). Conclusion: Combining Nissen and Hill for PEH repair appears to result in better quality of life and fewer recurrences compared to LNF.

Original languageEnglish (US)
Pages (from-to)121-125
Number of pages5
JournalJournal of Gastrointestinal Surgery
Issue number1
StatePublished - Jan 1 2017
Externally publishedYes



  • Antireflux surgery
  • Fundoplication
  • Laparoscopic
  • Paraesophageal hernia

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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