The Belsey Mark V procedure.

A potential weak link in the Belsey Mark IV partial fundoplication operation is the placement of the plicating mattress sutures in the esophageal muscle. During or after repair, if these sutures are tied too tightly, if the esophagus is pulled taut beneath the diaphragm, or if the diaphragm moves forcibly, the sutures can pull out. This causes partial or complete disruption of the repair. The use of Teflon felt pledgets with the mattress sutures is described (Mark V procedure). This modification seems to give better purchase of the sutures in the muscle of the esophagus and may help to lower the incidence of recurrence.