The pars flaccida technique. A tunnel is made in the posterior gastric fatty tissue at the level of the gastroesophageal junction and just inferior to the crural confluence. This technique decreases the incidence of posterior gastric herniation.
The myotomy being carried distally, using hook electrocautery. Care must be taken to elevate the muscle fibers away from the mucosa before the electrocautery is applied. The myotomy extends about 5 to 6 cm proximal to the gastroesophageal junction and abo
The fundoplication is sutured in place with a single U-stitch of 2–0 Prolene pledgeted on the outside. A 60-French mercury-weighted bougie is passed through the gastroesophageal junction prior to fixation of the wrap to assure a floppy fundoplication. Ins
A. Three to six interrupted 0-gauge silk sutures are used to close the crura. B. Exposure of the crura and posterior aspect of the esophagus is facilitated by traction on a Penrose drain encircling the gastroesophageal junction.