The Hill’s Classification is useful to predict the development of postoperative gastroesophageal reflux disease and erosive esophagitis after laparoscopic sleeve gastrectomy

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is one of the commonest bariatric procedures. However, it is associated with postoperative gastroesophageal reflux disease (GERD) and erosive esophagitis (EE). This study aims to assess the impact of various preoperative clinical and endoscopic characteristics on the development of postoperative GERD and EE. Methods: A single institution retrospective cohort study involving all patients who underwent LSG. A univariate and multivariate analysis was performed to identify preoperative parameters that were significantly associated with the development of postoperative GERD and EE, at up to 1-year follow-up. Results:At up to 1-year follow-up, out of 127 patients, only preoperative endoscopic presence of a hiatal hernia noted on axial length (p=0.024), and the Hill’s classification of the gastroesophageal junction (p<0.001), were significantly associated with the development of postoperative GERD. Similarly, at 1-year follow-up endoscopy, the presence of a hiatal hernia (p=0.041) and the Hill’s classification (p=0.001) were associated with postoperative EE. On the multivariate analysis, compared to patients with a Hill’s I flap valve, Hill’s II patients were more likely to develop postoperative GERD (OR 7.13, 95% CI: 1.69-29.98, p=0.007), and Hill’s III patients were more likely to develop postoperative GERD (OR 20.84, 95% CI: 3.98-109.13, p<0.001) and EE (OR 34.49, 95% CI: 1.08-1105.36, p=0.045). All patients with Hill’s IV developed postoperative GERD and EE in this study. Conclusion: Postoperative GERD and EE remains an important limitation following LSG. Proper preoperative assessment using the Hill’s classification can help to accurately predict patients at risk of postoperative GERD and EE.

Hill’s Classification of Gastro-Oesophageal Flap Valve Weakness - A Valuable Tool for Endoscopic Grading of Gastro-Oesophageal Reflux Disease

“…All patients with grade 4 seem to definitely have GERD and EE post sleeve gastrectomy. Since postoperative GERD and EE remain important limitation towards the choice of sleeve gastrectomy as a bariatric surgery, Hill's classification can provide adequate information about the probability of occurrence of the complications and also help in choosing other types of bariatric procedures if a high grade is found on endoscopy [9].…”