Standardized W-H fundoplication procedure for gastroesophageal reflux disease (2026)

Based on clinical experience and expert consensus from over a hundred medical centers across China, this technical specification systematically establishes a comprehensive operational framework for the standardized W-H fundoplication procedure in gastroesophageal reflux disease (GERD). To address common limitations of conventional techniques, such as postoperative dysphagia, bloating, and relatively high recurrence rates, this procedure incorporates a series of key innovations. These include precise hiatal repair with selective mesh reinforcement, restoration of the His angle, left-sided 180° fundoplication, reconstruction of the phreno-esophageal ligament, and novel three-dimensional fixation of the anti-reflux apparatus ("Wang fixation"). These techniques collectively enable physiological reconstruction of the anti-reflux barrier. The approach effectively balances anti-reflux efficacy with preservation of postoperative function while eliminating the need for routine division of the short gastric vessels. The technical specification comprehensively covers preoperative multidisciplinary evaluation, surgical indications, perioperative management, and a standardized surgical protocol (encompassing core components such as patient positioning/port placement, esophagus/hiatal dissection, hernia repair, mesh placement, fundoplication, posterior gastroesophageal junction fixation, and lesser omentum reconstruction), along with structured follow-up protocols. Its core philosophy places equal importance on both anatomical repair and functional recovery, integrating individualized surgical strategies with standardized procedures. This initiative aims to advance the standardization of GERD surgical management in China, providing clinicians with systematic and practical technical guidance and decision-making support.