Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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A Case of Belsey Mark IV Fundoplication after Failed Nissen Antireflux Surgery

실패한 Nissen 술을 Belsey Mark IV 위바닥주름술로 교정한 1예

  • Shon, Su Min (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Shin, Hyun Jung (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Park, Moon Ho (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Keum, Dong Yoon (Department of Thoracic Surgery, Keimyung University School of Medicine) ;
  • Park, Chang Kwon (Department of Thoracic Surgery, Keimyung University School of Medicine) ;
  • Choi, Won Joung (Department of Pediatrics, Hyosung Children's Hospital) ;
  • Kim, Ae Suk (Department of Pediatrics, Dongguk University College of Medicine) ;
  • Hwang, Jin-Bok (Department of Pediatrics, Keimyung University School of Medicine)
  • 손수민 (계명대학교 의과대학 소아과학교실) ;
  • 신현정 (계명대학교 의과대학 소아과학교실) ;
  • 박문호 (계명대학교 의과대학 소아과학교실) ;
  • 금동윤 (계명대학교 의과대학 흉부외과학교실) ;
  • 박창권 (계명대학교 의과대학 흉부외과학교실) ;
  • 최원정 (효성아동병원 소아과) ;
  • 김애숙 (동국대학교 의과대학 소아과학교실) ;
  • 황진복 (계명대학교 의과대학 소아과학교실)
  • Received : 2006.01.31
  • Accepted : 2006.02.23
  • Published : 2006.03.01
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Abstract

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 $2^{nd}$ 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.

Belsey Mark IV 위바닥주름술은 이전의 역류 방지 수술이 실패하여 재수술을 해야 하는 경우 혹은 식도 열공 탈장이 오래 되어 유착이 있는 경우에 적응증이 된다. 본 증례는 식도 열공 탈장과 GERD로 진단되어 Nissen 위바닥 주름술을 시행하였으나 실패하였고 재수술을 시도하였지만 수술 부위의 유착이 심하여 수술적 접근이 불가능하였다. 저자들은 흉강을 통하여 Belsey Mark IV 위바닥주름술을 실시하였고, 수술 후 증상과 영양상태의 호전을 보인 1예를 문헌 고찰과 함께 보고하는 바이다.

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