Figure 4

Belsey Mark IV operation. Through a left sixth interspace posterolateral thoracotomy, the lower part of the esophagus and the hiatus are exposed. The esophagus is completely mobilized to the level of the lung root ant the cardia. The upper part of the stomach is mobilized and brought through the hiatus into the left chest. The sutures in the crus poeteriorly have been placed and tied to close the hiatus. The construction of a 240° partial fundoplication is started by placing the first row of three mattress sutures between the fundus of the stomach and esophagus, 2 cm above the gastroesophageal junction.