Hill Repair—Why It Is Still Relevant and Should Be Taught

Abstract

The Hill repair for gastroesophageal reflux disease, though effective, durable, and in some regards a superior repair, has unfortunately seen less widespread adoption in the laparoscopic era relative to Nissen and Toupet fundoplications. Some purported objections to the Hill repair include conceptual and technical barriers, need for intraoperative manometry, and lack of clear-cut advantages. However, it has proven to be remarkably durable at 20 years and beyond relative to other repairs, with a low side-effect profile; there are also unique applications of the Hill repair and Hill sutures which broaden one’s armamentarium for managing the spectrum of patients with reflux disease. Lastly, understanding its anatomic components strengthens the surgeon’s knowledge of the anatomy and function of the gastroesophageal junction and antireflux repairs.