Surgical Correction of Refractory Reflux Esophagitis Using the Standard Unmodified Belsey Mark IV Technique

Abstract

The treatment of symptomatic hiatus hernia unresponsive to medical treatment has been refined in the last decade. The work of Hill and colleagues in investigating the pathophysiology of this problem, and the anatomical techniques developed by Dr. Nissen and Mr. Belsey, have reduced the recurrence rate in the surgical management of symptomatic hiatus hernia to the point where it is at least as low as that for surgically treated duodenal ulcer. The most commonly employed methods of surgical repair for symptomatic hiatus hernia are those advocated by Drs. Nissen and Hill and Mr. Belsey, which are superior to the many unmonitored methods employed in the past. Recently, the use of modifications of these techniques has been reported in the literature with short follow-up studies. The current communication relates one surgeon's experience treating 85 consecutive patients with refractory reflux esophagitis using the standard unmodified Belsey Mark IV repair as originally described by Mr. Ronald Belsey of Bristol, England. Details of this repair are presented.