A greater comprehension of the pathophysiology of gastroesophageal reflux disease has supported the use of selective procedures for various stages. Advanced disease is associated with shortening and loss of contraction amplitude of the esophageal body. The ideal procedure in this situation is a Collis gastroplasty, to add esophageal length and reduced tension on the organ, and a Belsey partial fundoplication to avoid dysphagia from poor esophageal propulsion.