Background
The classic 1961 paper by Skinner and Belsey resulted in the widespread adoption of a surgical technique they named Belsey Mark IV (BMIV), the development of which had begun 20 years earlier. Based upon advances in the understanding of the anatomy and physiology of the gastroesophageal junction achieved in the 1950s and perfected after multiple clinical trials, the procedure's results were finally published after it had been used on over 1000 patients, with a success rate of 85%. The operation had been a mainstay in the management of hiatal hernia/gastrointestinal reflux disease (GERD) for over 40 years. However, the introduction of laparoscopic techniques in the 1990s resulted in the operation falling into disfavor in recent years.
Our group has used BMIV as the primary treatment of hiatal hernia/GERD until laparoscopic techniques became widely available. However, in the past 6 years a small number of patients has been referred to us and operated via a thoracic approach. In this report we present a series of consecutive patients operated via the BMIV in an effort to not only provide a reminder of a useful technique, but also identify possible indications for its continuing use in an era where hiatal hernia surgery is predominated by laparoscopic techniques.