[A modified Hill's procedure in the surgical treatment of hiatal hernia]

After an introduction on the problems regarding indications and surgical management of gastro-oesophageal reflux disease, the Authors describe the technique they use, which is a modification of Hill's posterior gastropexy, involving the placement of suture through the median arcuate ligament, without exposing the celiac axis. The preliminary results of a prospective randomized clinical trial, conducted at the Surgical Clinic Department of Catholic University, Rome, are described. The trial evaluated early and late results of Hill's modified technique versus a control group, in which a Dor technique has been used. Intraoperative oesophageal manometry has been performed in both groups, to set the cardioplasty more properly. Ninety-one patients out of 132 have been studied; 65 had a good response to medical therapy and 26 have been operated upon. In 9 cases (6 Dor and 3 Hill) intraoperative manometry was performed. All patients have been studied pre-operatively with upper g.i. series, endoscopy with biopsies, oesophageal manometry and 24-h pH monitoring; this protocol has been repeated after 3 to 6 months postoperatively, to evaluate the results more accurately. The preliminary data, although statistically non significant because of the small study group, seem to favour the Hill modified technique, both for complication and reflux control. Further data are needed to confirm them.