Journal List > Korean J Pediatr Gastroenterol Nutr > v.9(1) > 1110229

Korean J Pediatr Gastroenterol Nutr. 2006 Mar;9(1):103-107. Korean.
Published online Mar 31, 2006.
Copyright © 2006 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
A Case of Belsey Mark IV Fundoplication after Failed Nissen Antireflux Surgery
Su Min Shon, Hyun Jung Shin, Moon Ho Park, Dong Yoon Keum,* Chang Kwon Park,* Won Joung Choi, Ae Suk Kim, and Jin Bok Hwang
Department of Pediatrics, Keimyung University School of Medicine, Korea.
*Department of Thoracic Surgery, Keimyung University School of Medicine, Korea.
Department of Pediatrics, Hyosung Children's Hospital, Daegu, Korea.
Department of Pediatrics, Dongguk University College of Medicine, Gyeongju, Korea.

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.

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