Belsey Gastroplasty

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Figure 13-9 Esophagogram demonstrating a "slipped Nissen" fundoplication in an obese woman with esophageal shortening due to reflux esophagitis. She had undergone an antireflux operation 9 months earlier. After initial control of reflux symptoms, regurgitation, pyrosis, and obstructive symptoms began. The stomach has "telescoped" through the fundoplication, the horizontal folds of which (arrow) can still be seen below the diaphragm. There is a recurrent hiatal hernia, and intermittent obstruction occurs when food is lodged at the point of gastric constriction by the fundoplication.

Figure 13-10 Combined Thal fundic patch operation and Nissen fundoplication for esophageal reflux stricture. Top panel: A, Longitudinal incision of the stricture. B, Opened stricture. C, Transverse closure of the incision, which widens the area of stenosis but shortens the esophagus. Middle, A split-thickness skin graft has been sutured to the gastric fundus to provide epithelial continuity within the esophagus. Bottom panel: A, The fundic path is sutured into the esophageal defect. B, A fundoplication is completed for reflux control. (From Thomas, H.F., Clarke, J.M., Rayl, J.E., et ah: Results of the combined fundic patch-fundoplication operation in the treatment of reflux esophagitis with stricture. Surg. Gynecol. Obstet, 135:241, 1972, by permission of Surgery, Gynecology and Obstetrics.)

Collis GastroplastyCollis Belsey

Figure 13-11 Construction of the Collis gastroplasty tube using the GIA surgical stapler. A, Sixth left interspace incision used. B, The No. 54 or 56 French dilator inserted through the stricture is displaced against the lesser curvature of the stomach. The dotted line indicates the site of application of the stapler. The main illustration shows the advancement of the knife assembly. C, The new functional distal esophagus is a 5-cmtube of healthy stomach. (From Orringer, M.B., and Sloan, H.: An improved technique for the combined Collis-Belsey approach to dilatable esophageal strictures. J. Thorac. Cardiovasc. Surg., 68:298, 1974, with permission.)

Naked Woman

Figure 13-12 Belsey reconstruction of the esophagogastric junction after construction of the Collis gastroplasty tube. Main illustration, Oversewing the staple suture line. A, Placement of the first row of three mattress sutures between the new distal "esophagus" and the gastric fundus. The posterior crural sutures have been placed but are left untied at this point. B, Placement of the second row of mattress sutures through the diaphragm, gastric fundus, and distal esophagus 2 cm proximal to the first row. C, The completed repair reduced beneath the diaphragm shows a 4-cm intraabdominal distal esophageal segment (the gastroplasty tube) partially compressed by the Belsey fundoplication. The posterior crural sutures have been tied. (From Orringer, M.B., and Sloan, H.: An improved technique for the combined Collis-Belsey approach to dilatable esophageal stricture. J. Thorac. Cardiovasc. Surg., 68:298, 1974, with permission.)

Belsey Stomach

Figure 13-13 Decreased amount of gastric fundus available for Belsey repair after Collis procedure. A, Cross section through the gastric fundus in the plane indicated shows the area of stomach (s) available for the standard Belsey Mark IV repair with a 240-degree gastric wrap as shown in B. C, Construction of the Collis gastroplasty tube (e) results in a smaller area of stomach (s') available for the Belsey repair. D, Only a limited 180-degree fundo plication is possible after the Collis procedure, and the elongated, narrowed gastric fundus is angulated beneath the diaphragm (dotted line) as the second row of sutures of the Belsey repair are tied. (From Orringer, M.B., and Sloan, H.: Complications and failings of the combined Collis-Belsey operation. J. Thorac. Cardiovasc. Surg., 74:726, 1977, with permission.)

Figure 13-13 Decreased amount of gastric fundus available for Belsey repair after Collis procedure. A, Cross section through the gastric fundus in the plane indicated shows the area of stomach (s) available for the standard Belsey Mark IV repair with a 240-degree gastric wrap as shown in B. C, Construction of the Collis gastroplasty tube (e) results in a smaller area of stomach (s') available for the Belsey repair. D, Only a limited 180-degree fundo plication is possible after the Collis procedure, and the elongated, narrowed gastric fundus is angulated beneath the diaphragm (dotted line) as the second row of sutures of the Belsey repair are tied. (From Orringer, M.B., and Sloan, H.: Complications and failings of the combined Collis-Belsey operation. J. Thorac. Cardiovasc. Surg., 74:726, 1977, with permission.)

Operation Belsey

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Virtual Gastric Banding

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