Background: Gastroesophageal reflux disease (GERD) is frequently associated with impaired esophageal peristalsis, 
and many authorities consider this condition not suitable for Nissen fundoplication. 
Methods: To investigate the outcome of antireflux surgery in the presence of impaired esophageal peristalsis, 33 GERD 
patients with poor esophageal contractility underwent laparoscopic partial fundoplication. Upper gastrointestinal 
endoscopy, esophageal manometry, and 24-hour pH monitoring were performed preoperatively. 
Results: After antireflux surgery, 30 patients (93%) were free of heartburn, regurgitation and bloating and had no 
esophagitis on endoscopy. Twenty-eight patients (86%) were completely free of symptoms. The rate of dysphagia decreased from 44% preoperatively to 9% postoperatively (P < .001). The median DeMeester score on 24-hour esophageal pH monitoring decreased from 34.5 to 1.15 (P < .001). 
Conclusions: Esophageal motility is the main determining factor to determine the extent of wrap in fundoplication. 
Partial posterior fundoplication provides an effective antireflux barrier in patients with impaired esophageal body motility. 
Postoperative dysphagia is diminished, probably because of improved esophageal body function.