Belsey Mark fundoplication

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

Operating room setup

• One lung ventilation (e.g. DLT or bronchial blocker)
• Fiberoptic scope

Regional and neuraxial techniques

Consider thoracic epidural or serratus block for postop pain management

Intraoperative management

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

Postoperative management

Disposition

Typically floor/IMC is adequate

Pain management

Thoracic epidural PCEA or serratus block

Procedure variants

	Belsey Mark
Unique considerations
Indications
Position
Surgical time
EBL	200-300 mL
Postoperative disposition
Pain management
Potential complications