The operation consists in the creation of a posterior 180° hemi-valve. In our view, it may be indicated in cases where the presence of an alteration in oesophageal peristalsis counter-indicates total plasty. The operation does not require the short gastric arteries to be sectioned. The gastric fundus, transposed behind the oesophagus, is fixed with single stitches to the right anterolateral edge of the oesophagus, to the right crus of the diaphragm and to the left anterolateral edge of the oesophagus.

A malleable hook inserted by the operator with his right hand has loaded the oesophagus. The forceps in his left hand passes posteriorly and grips the most cranial part of the anterior wall of the gastric fundus to take it behind the oesophagus.

The part of the gastric fundal wall to be used for the hemi-valve has been withdrawn as far as the right side of the oesophagus. The hook is about to be withdrawn.

The lower part of the valve is grasped by the assistants forceps, leaving both of the operators hands free for the suture.

The needle has loaded the most distal part of the posterior wall of the hemi-valve and amply transfixes the lower end of the right crus of the diaphragm.

The needle and thread have been withdrawn into the trocar and brought outside for the extracorporeal knot.

The most cranial stitch of the suture consolidates the oesophageal wall 3-4 cm above the cardias with the end of the gastric hemi-valve and, in fact, begins the second suture between the right edge of the oesophagus and the anterior side of the gastric valve.

The most cranial stitch of the suture has been passed between the oesophagus and the gastric valve. As with all extra-corporeal knots, a forceps inserted into the loop prevents damage being caused to the structures involved by the stitch during traction.

According to the Vayre technique, the stitch does not only include the oesophagus and the stomach wall. It also transfixes the apex of the right crus of the diaphragm, fixing the valve-oesophageal wall complex.

The suture between the anterior wall of the stomach and the left edge of the oesophagus is begun. It is usually more convenient to begin with the stitch most proximal to the diaphragm.

The last stitch in the plasty, on the right side, completes the gastro-oesophageal fixation and reconstructs the cardiac incisure.

Once the operation is completed, one notes the gastro-oesophageal suture lines which, together with the posterior diaphragmatic gastropexy, help to keep a good stretch of the oesophagus in the abdomen.