Preliminary results of thoracoscopic Belsey Mark IV antireflux procedure.

摘要: Laparoscopic Nissen fundoplication has replaced open approaches for refractory gastroesophageal reflux disease (GERD) in many major medical centers. Here we report our preliminary results of the Belsey Mark IV antireflux procedure performed by video-assisted thoracoscopy (VATS-Belsey). Fifteen patients underwent VATS-Belsey. The indications surgery included GERD to therapy (n=10), achalasia (n=2), diffuse esophageal spasms (n=1), epiphrenic diverticulum and paraesophageal hernia (n=1). median operative time was 235 min. There were three conversions minithoracotomy (8-10 cm) necessitated severe adhesions (n=2) repair a gastric perforation hospital stay 4 days. Postoperative complications persistent air leaks, requiring discharge with Heimlich valve one patient. no perioperative deaths. At follow-up 19 months, ten (66%) asymptomatic not taking any antacids. One patient who had taken proton pump inhibitors preoperatively required postoperative H2 blockers mild heartburn. In patients, recurrent symptoms (mean 6 months) led laparoscopic takedown fundoplication. achalasia, dysphagia after 1 year relief following VATS myotomy Belsey, esophagectomy. is technically feasible minimal morbidity. However, suggest that thoracotomy should remain standard operation poor motility when thoracic approach desired. We have modified partial fundoplications (Toupet or Dor) an abdominal possible.