Abstract
BackgroundThe Belsey Mark IV operation has been used for the management of hiatal hernia for over 40 years, but with the introduction of laparoscopic techniques its role has become questionable. To determine the current role of this procedure we present a contemporary series of patients.MethodsWe reviewed fifteen consecutive patients, mean age of 63 years, who underwent a Belsey Mark IV fundoplication for gastroesophageal reflux in the presence of a hiatal hernia in our Department from January 2005 to March 2011. Indications for the thoracic approach included paraesophageal hernias, recurrent hiatal hernias and previous upper abdominal surgery.ResultsThere was no operative mortality. Immediate postoperative morbidity included 1 case of bleeding, 1 case of pneumonia and 1 case of atrial fibrillation. The mean length of stay was 5.9 days. After a mean follow-up time of 49 months, all patients reported total or partial alleviation of their symptoms. No hernia recurrence was detected during barium swallow examination.ConclusionsThe Belsey approach is a procedure that can be useful as an alternative in selected cases when there are co-morbidities complicating the transabdominal (laparoscopic) approach.
Highlights
The Belsey Mark IV operation has been used for the management of hiatal hernia for over 40 years, but with the introduction of laparoscopic techniques its role has become questionable
In this report we present a series of consecutive patients operated via the Belsey Mark IV (BMIV) in an effort to provide a reminder of a useful technique, and identify possible indications for its continuing use in an era where hiatal hernia surgery is predominated by laparoscopic techniques
The guidelines for the surgical treatment of gastroesophageal reflux disease issued by the Society of American Gastrointestinal and Endoscopic Surgeons in November 2010 do not mention the transthoracic approach as an option for the treatment of either primary or recurrent gastrointestinal reflux disease (GERD) [3]. Even though these guidelines do not address the management of paraesophageal hernia it is still interesting how an operation widely performed with excellent results for more than four decades [4] fell into disfavour so quickly after the transition to laparoscopic techniques
Summary
The Belsey Mark IV operation has been used for the management of hiatal hernia for over 40 years, but with the introduction of laparoscopic techniques its role has become questionable. The classic 1961 paper by Skinner and Belsey resulted in the widespread adoption of a surgical technique they named Belsey Mark IV (BMIV), the development of which had begun 20 years earlier. The operation had been a mainstay in the management of hiatal hernia/gastrointestinal reflux disease (GERD) for over 40 years. The introduction of laparoscopic techniques in the 1990s resulted in the operation falling into disfavor in recent years. In this report we present a series of consecutive patients operated via the BMIV in an effort to provide a reminder of a useful technique, and identify possible indications for its continuing use in an era where hiatal hernia surgery is predominated by laparoscopic techniques
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