Difference between revisions of "Belsey Mark fundoplication"
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=== Indications<!-- List and/or describe the indications for this surgical procedure. --> === | === Indications<!-- List and/or describe the indications for this surgical procedure. --> === | ||
Paraesophageal hernias that are not good candidates for a Nissen fundoplication such as: | |||
* hostile abdomen from many prior abdominal procedures | |||
* concern for pericardial adhesions in a longstanding paraesophageal hernia | |||
=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> === | === Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> === | ||
Revision as of 12:55, 15 September 2022
Belsey Mark fundoplication
| Anesthesia type |
GA |
|---|---|
| Airway |
DLT |
| Lines and access |
Large bore PIV, arterial line |
| Monitors |
Standard ASA, arterial monitor |
| Primary anesthetic considerations | |
| Preoperative |
Consider RSI for reflux |
| Intraoperative |
DLT for L thoracotomy |
| Postoperative |
Consider thoracic epidural |
| Article quality | |
| Editor rating | |
| User likes | 0 |
The Belsey Mark IV fundoplication was a technique developed by Dr. Ronald Belsey whereby the distal esophagus is moved below the diaphragm, and an incomplete (240 degree) fundal wrap is performed. This restores the gastoesophageal junction (GEJ).
Overview
Indications
Paraesophageal hernias that are not good candidates for a Nissen fundoplication such as:
- hostile abdomen from many prior abdominal procedures
- concern for pericardial adhesions in a longstanding paraesophageal hernia
Surgical procedure
The incision is typically left thoracotomy along 6th rib
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
One lung ventilation is needed for surgical exposure of esophagus, using either double lumen tube (DLT) or bronchial blocker.
Positioning
R lateral decubitus
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Tony Wang