Belsey Mark fundoplication

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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

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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