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

## TL;DR

This paper reviews whether cutting short gastric vessels during a specific stomach surgery improves outcomes and finds that it is generally unnecessary.

## Contribution

The study provides updated evidence from laparoscopic-only research on the impact of short gastric vessel division during Nissen fundoplication.

## Key findings

- Routine division of short gastric vessels does not reduce dysphagia or improve reflux outcomes.
- SGV division is associated with increased gas-bloat syndrome and longer operative time.
- Selective division is recommended only when tension is evident.

## Abstract

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.