Background Gastro-esophageal reflux disease (GERD) is one of the most frequent diseases of the upper gastro-enteric tract and incidence increases during lifetime [1]. In elderly patients [2] with a good LES basal tone and good peristalsis, evaluated with esophageal manometry, and even with a long exposure time fraction and a correlation between episodes of reflux and symptoms (SAP Symptom Association Probability), evaluated with 24h pHmetry [3], severe and refractory symptoms or intolerance to a conservative treatment, had a good response after a laparoscopic 270° fundoplication (Toupet technique); Toupet’s technique seems to offer good results such as Nissen-Rossetti fundoplication in terms of symptom control in a short-term evaluation [4-7].