 The neo-esophagus is approximately 3 cm long. The mechanical suture line is covered with a sero- muscular running suture. A hiatoplasty is routinely performed; in the event of a type II-IV HH, the sutures applied to the diaphragmatic crura are reinforced with polytetrafluoroethylene-pledgeted sutures two for each stitch, placed laterally at the edges of the crura and over the peritoneum. A floppy Nissen fundoplication one 1.5-cm U stitch reinforced with pledgets is performed. The superior edges of the fundoplication are placed above the clips, which mark the native E-G junction, to fully wrap the neo-esophagus. Two vertical U stitches intended to grab the inner, circular, muscular layer are applied laterally between the fundus and the esophagus to prevent slippage. 