Korean J Pediatr Gastroenterol Nutr.  2006 Mar;9(1):103-107.

A Case of Belsey Mark IV Fundoplication after Failed Nissen Antireflux Surgery

• Shon SM
• Shin HJ
• Park MH
• Keum DY
• Park CK
• Choi WJ
• Kim AS
• Hwang JB

Abstract

Antireflux surgery has been indicated in gastroesophageal reflux disease (GERD) that does not respond to medical treatments. Although the most commonly performed operation is Nissen fundoplication, Belsey Mark IV fundoplication is indicated for more complicated cases, such as, in cases of a failed Nissen operation or a long lasting hiatal hernia. Here, we report a case of Belsey Mark IV fundoplication for a failed Nissen fundoplication. The infant developed frequent times of aspiration pneumonia after initial Nissen for a hiatal hernia with GERD during the newborn period. At 15 months of age, a 2nd Nissen operation was attempted, but fundoplication was not available because of excessive mesenteric adherence to the liver and cardia. Therefore, Belsey Mark IV fundoplication was performed via trans-thoracic approach, which can provide full esophageal mobilization and better visualization of the herniated fundus and the surrounding tissues. Subsequently, she has shown an improved general condition without GERD.

Keyword

Nissen fundoplication; Belsey Mark IV fundoplication; Hiatal hernia; Gastroesophageal reflux disease

MeSH Terms

Cardia
Fundoplication*
Gastroesophageal Reflux
Hernia, Hiatal
Humans
Infant
Infant, Newborn
Liver
Pneumonia, Aspiration