THE BELSEY MARK-IV ANTIREFLUX PROCEDURE - INDICATIONS AND LONG-TERM RESULTS

From 1977 to 1990, a Belsey Mark IV antireflux procedure was performed in 177 patients. The primary indication was gastrooesophageal reflux (GOR) resistant to medical treatment in all but 5 patients presenting themselves with a complicated para-oesophageal hernia. Ninety-eight patients (53.5 %) had some form of additional pathology or complication: grade III oesophagitis: 26, grade IV: 6, Barrett's oesophagus: 38, reintervention: 14, concomitant duodenal ulcer requiring highly selective vagotomy: 14, bleeding: 23, small benign tumours: 2. There was one postoperative and one late mortality. At one year an objective evaluation was made in all patients operated on since this interval (N = 147), consisting in endoscopy: 121, Barium-swallow: 113, 24 hour oesophageal pH-monitoring: 81, manometry: 69. A recurrence was documented in 11 patients (7.4 %). The mean follow-up of these 147 patients is 4.4 years with a range from 1 to 13 years. Over the entire follow-up period 17 patients (11.5 %) had symptoms suggestive of recurrent reflux. Subjective and objective recurrence rate was 13 %. Undesired gastrointestinal side effect were seen in 13 patients (8.8 %), whereas postthoracotomy pain was equally noticed in 13 patients (8.8 %). The final score combining recurrence rate and side effects showed excellent to very good results in 77.5 % of the patients, good results in 7.5 % and bad results in 15 %. Conclusion: Candidates for surgical treatment of GOR often present themselves with a variety of reflux related complications or additional pathology. Long term follow-up shows good reflux control in 87 % of the patients. Standardisation of criteria for indications and for evaluation of objective and subjective results as well as grouping of patients with the same pathology are required.