Hill Classification Predicts Postoperative Pneumonia After Minimally Invasive Distal Gastrectomy for Gastric Cancer.

Postoperative pneumonia still occurs and is a poor prognostic factor despite advances in minimally invasive gastrectomy. Aspiration is considered a principal mechanism of postoperative pneumonia after gastrectomy. Because the reconstruction method after gastrectomy influences bile reflux, postoperative reflux may contribute to aspiration and thereby increase the risk of pneumonia. Hill classification is an endoscopic grading system used to evaluate the function of the gastroesophageal flap valve and has been reported to reflect the severity of gastroesophageal reflux.