Figure 7

Median arcuate ligament repair or Hill procedure. The initial dissectionshould clearly define the median arcuate ligament and the celiac axis. Crural approximation and hiatus closure is performed first after mobilization of the distal esophagus. Interrupted sutures anchor the gastroesophageal junction posteriorly to its primary attachment, the prearotic fascia (posterior gastropexy). The gastropexy reduces the esophageal circumference and bunches tissue into its lumen. The procedure has to be done under manometric control