Belsey Mark IV Fundoplication
Belsey Mark IV fundoplication in a 40-yo male ex-smoker's case (Images 1-6) :

TWO ROWS of surtures: Each Row consists of four (No 3/0 Prolene, PTFE-pledgetted) sutures:

—1st Row: Fundus (of stomach) - Oesophagus - Fundus by 270 degrees (Imag. 3-4).

—2nd Row: Similar + fixation of each suture under the diaphragm by sewing (Im. 5-6).

Finally, two No 1 Ticron sutures to the right crus of the hiatus, to reduce the oesophageal foramen.

IMAGES 7-8 : The final intraop result in another case (of a 37-yo non-smoker male).

1. A loop passed around the oesophagus (GREEN). YELLOW: left diaphragm


2. The Fundus (GREY/BLUE) is EVIDENTLY inside the left hemithorax = sliding Hiatal Hernia, prior to being repaired


3. First Row of 4 sutures (still untied). Diaphragm held by instrument


4. First Row of 4 sutures (PTFE-pledgetted), now tied.


5. Second Row of 4 sutures tied, with the hiatal hernia reduced (fixed below) the diaphragm


6. Complete Repair. YELLOW: the point where oesophagus is exiting the hemithorax towards the abdomen (no longer fundus in chest)


7. Final result in a different case, of a 37-yo non-smoker male.


8. The same as image 7, with Arrows to explain the anatomical structures shown