The left pillar is dissected going upwards, care being taken not to injure the vagus nerve. While the esophagus is retracted away from the left pillar, dissection is carried out under direct vision. A grasping forceps pulls the stomach in its middle to the right. By countertraction a second forceps exposes the gastrosplenic ligament. The short vessels are isolated with a coagulation hook.
Hemostatic control is performed by placing clips.
Luxating the wrap behind the esophagus A forceps grasps the fundus at the greater curvature and passes it to a second forceps inserted behind the esophagus. This latter forceps pulls the fundus until it reaches the right side of the esophagus. The wrap stays in place by itself, without need to maintain it. Performing the 360 fundoplication A 33 F Maloney dilator is introduced in the esophagus. By moving the wrap back and forth behind the esophagus one can make sure that no torsion of the luxated fundic wrap has occurred.