Revisiting Short Gastric Division for Laparoscopic Nissen Fundoplication: A Literature Review

The debate continues over whether short gastric vessels (SGVs) should be divided during laparoscopic Nissen fundoplication (LNF) to alleviate the wrap tension. This study aimed to narratively compile evidence from laparoscopic-only studies (2005-2025) that compared the effects of dividing versus preserving the SGVs on dysphagia, gas-bloat syndrome, and reflux recurrence. We synthesized randomized trials, meta-analyses, and guidelines published between 2005 and 2025 comparing SGV division versus preservation. Across long-term randomized follow-up and multiple meta-analyses, routine SGV division did not reduce dysphagia or improve reflux outcomes. It was associated with more gas-bloat and slightly longer operative time. In contemporary LNF, using a standardized technique, routine SGV division is unnecessary, and selective division is reserved for cases with clear tension.