Laparoscopic Toupet fundoplication

One midline skin incision markedly superior to the umbilicus. After having introduced the Verres needle and checked its correct position, establish the pneumoperitoneum.

Introduce the laparoscope with attached camera through a 5 mm/10 mm trocar. Perform a diagnostic laparoscopy. Introduce 4 epigastric trocars under direct visual control.

Lift up the left hepatic lobe with the exploratory probe and tense the stomach with the Babcock clamp. Incise the flaccid portion of the lesser omentum with the harmonic scalpel.

Now expose the right crus of the diaphragm. Via the anterior commissure then proceed anteriorly to the left crus and expose it as well. This opens up the mediastinum anteriorly.

At the level of the splenic hilum transect the gastrosplenic ligament and short gastric vessels along the greater curvature up to the superior pole of the spleen and further on to the left crus of the diaphragm, until the gastric fundus has been freed completely.