GASTRODIAPHRAGMATIC PLICATION, A MODIFICATION OF BELSEY MARK IV REPAIR FOR TREATMENT OF HIATAL HERNIA

Aim: Gastrodiaphragmatic plication, (G.D.P.) around the lower oesophageal segment (L.O.S.) has been designed on 
mechanical and functional basis. It is evaluated, with advantage, as a major modification of Belsey Mark IV repair for the 
treatment of hiatal hernia. It provides a wider area of fixation of the stomach under the diaphragm and good support of the (L.O.S.). 
Methods: Thirty five patients with hiatal hernia were operated upon during the period 1993-2001 with a median follow up of 5 years through left 7th rib thoracotomy. The lower 1/3 of oesophagus is mobilized in the mediastinum and elongated to the high pressure zone (H.P.Z) in the abdomen. Two levels of gastric fundic wraps of 270º around the L.O.S. The stitches are passed transversely sideways through the muscle wall to widen the area of fixation of stomach under the diaphragm. G.D.P. is accomplished by tying the adjacent sutures together on the diaphragm. 
Results: There is clinical cure to all patients with no refluxes and no recurrences. The LOP ascribes an average increase of 20 mm Hg. 
Conclusions: The G.D.P. over 270º of the oesophageal circumference increases LOS pressure as a competent antireflux 
technique. The free 90º acts as a safety segment for the passage of food without dysphagia. Vomiting and belching are quite possible. Widening of subdiaphragmatic gastric fixation prevents recurrence.