Difference between revisions of "Belsey Mark fundoplication"
From WikiAnesthesia
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| anesthesia_type = GA | | anesthesia_type = GA | ||
| airway = DLT | | airway = DLT | ||
| lines_access = | | lines_access = 1-2 large bore PIV | ||
| monitors = Standard ASA | | monitors = Standard ASA | ||
EKG | |||
| considerations_preoperative = Consider RSI for reflux | | considerations_preoperative = Consider RSI for reflux | ||
| considerations_intraoperative = | | considerations_intraoperative = One lung ventilation for L thoracotomy | ||
| considerations_postoperative = Consider thoracic epidural | | considerations_postoperative = Consider thoracic epidural | ||
}} | }} | ||
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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. --> === | ||
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=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
* One lung ventilation (e.g. DLT or bronchial blocker) | |||
* Fiberoptic scope | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
Consider thoracic epidural or serratus block for postop pain management | |||
== Intraoperative management == | == Intraoperative management == | ||
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=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ||
Typically floor/IMC is adequate | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
Thoracic epidural PCEA or serratus block | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
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! | !Belsey Mark | ||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
| | | | ||
|- | |- | ||
|Indications | |Indications | ||
| | | | ||
|- | |- | ||
|Position | |Position | ||
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|- | |- | ||
|Surgical time | |Surgical time | ||
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|- | |- | ||
|EBL | |EBL | ||
| | |200-300 mL | ||
|- | |- | ||
|Postoperative disposition | |Postoperative disposition | ||
| | | | ||
|- | |- | ||
|Pain management | |Pain management | ||
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|- | |- | ||
|Potential complications | |Potential complications | ||
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Latest revision as of 12:59, 15 September 2022
Belsey Mark fundoplication
| Anesthesia type |
GA |
|---|---|
| Airway |
DLT |
| Lines and access |
1-2 large bore PIV |
| Monitors |
Standard ASA EKG |
| Primary anesthetic considerations | |
| Preoperative |
Consider RSI for reflux |
| Intraoperative |
One lung ventilation 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
- One lung ventilation (e.g. DLT or bronchial blocker)
- Fiberoptic scope
Patient preparation and premedication
Regional and neuraxial techniques
Consider thoracic epidural or serratus block for postop pain management
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
Typically floor/IMC is adequate
Pain management
Thoracic epidural PCEA or serratus block
Potential complications
Procedure variants
| Belsey Mark | |
|---|---|
| Unique considerations | |
| Indications | |
| Position | |
| Surgical time | |
| EBL | 200-300 mL |
| Postoperative disposition | |
| Pain management | |
| Potential complications |
References
Top contributors: Tony Wang