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Eur J Cardiothorac Surg 2003;24:625-630
© 2003 Elsevier Science NL

The place of Belsey Mark IV fundoplication in the era of laparoscopic surgery

^a Department of Surgery, Section of General Thoracic Surgery, University of Catania, Catania, Italy
^b *Department of Surgery, University of Parma, Parma, Italy

Received 19 January 2003; received in revised form 4 June 2003; accepted 12 June 2003.

^* Corresponding author. Ospedale Tomaselli, Via Passo Gravina 187, 95124, Catania, Italy. Fax: +39-095-221599
e-mail: mmiglior{at}unict.it

Objectives: Laparoscopic fundoplication to correct or avoid gastroesophageal reflux decreased Belsey Mark IV fundoplication (BMIV) dramatically worldwide. The purpose of this paper was to determine the role of BMIV and its current indications. Methods: We reviewed all patients who underwent fundoplication between April 1997 and December 2001. All patients underwent a complete work-up included barium meal, endoscopy, 24-h pH-metry and manometry preoperatively. Results: Sixty-two consecutive fundoplications were performed. There were 23 males and 39 females. Forty-six patients were treated by laparoscopic approach (37 patients with total and nine patients with partial fundoplication). BMIV was preferred in 16 patients with the following indications: reoperations for failed oesophageal surgery (5), hiatal hernia fixed in the chest (4), epiphrenic oesophageal diverticula (3), diffuse oesophageal spam (2), hiatal hernia associated with bullous emphysema (1), leiomyoma of the oesophago–gastric junction (1). Excellent to good results were reported in 14 patients and poor in two. Follow-up was completed in all patients. Conclusions: BMIV remains a valid fundoplication although the current indications are now limited. The technique is to be considered an additional, but necessary, weapon for thoracic surgeons with interest in oesophageal disease.

Key Words: Failed antireflux surgery • Fundoplication • Laparoscopy