For general anesthesia intubation, the patient is placed in a supine position with both lower extremities abducted, head high and feet low at 30o, and the operator stands between the patient’s legs. A pneumoperitoneum is established with a pneumoperitoneal pressure of 12-15 mm Hg. Generally, two 1.0-cm and three 0.5-cm holes are poked in the upper abdomen to place the appropriate size trocar needle. The first 1.0-cm hole is located at the junction of the umbilicus and the middle and lower 1/3 of the glabella, where a 30o endoscope is placed; the second 1.0-cm hole is located 2 cm below the costal margin of the left midclavicular line, which is the main operating hole, where the ultrasonic knife and other primary operating instruments are placed; the first 0.5-cm hole is located below the costal margin of the left anterior axillary line, where non-invasive grasping forceps and other assistant instruments are placed; the second 0.5-cm hole is located below the costal margin of the right midclavicular line, which is the secondary operating hole for the main The third 0.5 cm hole is located under the glabella, and a babcock forceps is placed to grasp the fascia above the esophageal hiatus to open the liver and expose the hiatus. In cases with esophageal hiatal hernia, the contents of the hernia were first reset, and the omental tissue between the fundus of the stomach and the spleen and the short gastric vessels were detached segment by segment with an ultrasonic knife; the gastric diaphragm and the esophageal diaphragmatic ligament were cut free to expose the left diaphragmatic foot, the omental tissue on the side of the gastric lesser curvature was detached with an ultrasonic knife, and the right diaphragmatic foot and the peritoneum in front of the esophagus were detached; the length of the esophagus was detached ≥5 cm to create a posterior esophageal gap. The esophageal fissure was narrowed with 2-0 silk sutures interrupted on both sides of the diaphragmatic foot; if the fissure diameter was greater than 5 cm, patch repair could be used as appropriate. The fundus is pulled posteriorly through the esophagus to the anterior esophagus and sutured to the gastric wall on the left side of the esophagus (2-3 interrupted stitches with 2-0 silk, approximately 1.5-2.0 cm wide, with at least two stitches in the esophageal musculature) to form a loose 360° fold (Nissen fundoplication) that wraps tension-free around the entire circumference of the lower esophagus. In the case of Toupet fundoplication, the gastric tissue on each side of the esophagus is sutured and fixed to the lateral wall of the esophagus, forming a 180° to 270° partial fundoplication. schematic diagram of Nissen fundoplication: schematic diagram of Toupet fundoplication: schematic diagram of Toupet fundoplication: schematic diagram of Toupet fundoplication