The reflux of stomach fluids into the esophagus, which may result in gastroesophageal reflex disease (GERD), is often caused by a deformity of the gastroesophageal junction (GEJ), a hiatal hernia, or both. A procedure to repair the hiatal hernia and create a properly function GEJ was developed by Dr. Lucius Hill, and is known as the Hill repair. During a Hill repair, the hiatal hernia is fixed by bringing the stomach back through the opening in the diaphragm and lessening the opening in the diaphragm at the esophagus. To improve the function of the valve in the GEJ, the esophageal membranes of the GEJ are anchored to the connective tissue surrounding the heart using sutures. The bend at the opening of the stomach, known as the angle of his, is reshaped to make the angle more acute and is secured to the diaphragm.
GERD is often caused or complicated by a hiatal hernia, a condition where a quantity of the stomach pushes through the small opening, known as the hiatus, in the diaphragm through which the esophagus passes. When present, the first step in the Hill repair is to eliminate the hiatal hernia. The stomach is brought back through the hiatus, and then the hiatus is made smaller to prevent or decrease the opportunity for another hiatal hernia.
Hill repair aims to prevent GERD by improving the function of the GEJ's valve system, which is primarily made up of the angle of his and the lower esophageal sphincter (LES), the ring of muscles at the base of the esophagus. During a Hill repair, the function of these structures is strengthened by anchoring the GEJ to the connective tissue of the heart and reshaping the angle of his using sutures attached to the diaphragm. The shape of the GEJ structures is changed by tightening and loosening the sutures used for anchoring, and a manometer is used to measure the pressure around the LES. Surgeons know when the optimal shape is achieved by looking at the pressure reading of the LES.
A Hill repair procedure is not typically advised unless treatment of GERD with antacids and acid blockers has failed. Surgery carries with it inherent risks, and is not a viable treatment for all patients. Before surgery, doctors will carefully review the GEJ valve using a manometer to test the valve pressure, as well as an endoscope to watch the valve function, to determine if the procedure will be successful.
