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).
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