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epostoperative complication. Late evaluation at 5 years after surgery has shown excellent or good results in 85 % and fair or poor results in 15 % of the patients. KEY WORDS: Laparoscopic, Nissen fundoplication, reflux esophagitis Nissen fundoplication is the “gold standard ” pro-cedure in most surgical centers to treat pathologic gastroesophageal reflux.1 The laparoscopic approach has shown excellent results in patients with noncom-plicated reflux esophagitis and has replaced completely the open approach.1,2 According to the literature from dedicated centers in North America and Europe, the standard Nissen fundoplication in-cludes the following steps: • Division of short gastric vessels from a left ap-proach allowing the mobilization of the gastric fundus. However, with this approach, the poste-rior short gastric vessels are not divided, making this mobilization incomplete. • Opening of the lesser omentum usually dividing the hepatic branch of the left (anterior) vagal nerve, which represents a risk of late gallstone disease.3 • Isolation of the abdominal esophagus through a careful dissection between the right crus and the posterior wall of the esophagus. With these steps, a floppy wrap can be obtained; nevertheless, one or both vagal trunks may be in-cluded in the plication, as well as the gross fatty tissue. The purpose of the present report is to show how we perform a laparoscopic Nissen fundoplication by a different surgical approach, to see clearly all struc-tures of the esophagogastric junction, to keep fatty tissue away from the plication, to construct a symmet-rical plication, and to preserve intact both vagal trunks outside the wrap. METHODS We approach the esophagogastric junction via what we call “the right posterior approach. ” We start the operation by dissecting the lesser curve (right approach) 2–3 cm distal to the esophagogastric junc-tion, just where the anterior and posterior layers of the lesser omentum insert into the lesser curvature.“How I Do It