BELSEY MARK-IV ANTIREFLUX PROCEDURE FOR COMPLICATED GASTROESOPHAGEAL REFLUX DISEASE

Background. Over the past 20 years, medical management of gastroesopha geal reflux disease has met with increasing success, but a proportion of patients continue to have symptoms or complications requiring surgi cal treatment. The variety of operations available attests to the gene ral lack of satisfaction with any single procedure. Methods. A retrosp ective study was conducted of 276 patients who underwent the Belsey Ma rk IV antireflux procedure at our institution between 1979 and 1995. T he indication for operation was gastroesophageal reflux, disease refra ctory to medical therapy in 137 patients, gastroesophageal reflux dise ase with symptomatic stricture or Schatzki's ring in 36, achalasia or epiphrenic diverticulum in 74, paraesophageal hernia in 27, and esopha geal mass in 2. Fifteen patients (5.4%) had undergone prior antireflux operations. Results. There was one perioperative death (0.4%) resulti ng from an apparent myocardial infarction in an 87-year-old woman who underwent operation for paraesophageal hernia with volvulus. Two patie nts had contained leaks diagnosed by routine postoperative contrast st udies; both were managed successfully without operation. Two patients required early reoperation for recurrent symptoms: 1 underwent a repea ted Belsey Mark IV procedure and the other underwent an esophagogastre ctomy. An additional 7 patients experienced late recurrence of symptom s requiring surgical management. The overall complication rate was 10. 1%, with minor pulmonary complications (2.1%) and atrial arrhythmias ( 1.8%) occurring most commonly. Conclusions. The Belsey Mark IV procedu re is a safe and effective operation for the management of gastroesoph ageal reflux disease with complications, and it compares favorably wit h other antireflux procedures.