Gastroplasty, as proposed by Collis, combined with fundoplication of varying degree, has been increasingly used during recent years for management of hiatal hernia complicated by shortened oesophagus and oesophageal stricture. A modification of this procedure using 180 degree fundoplication and the transthoracic-transdiaphragmatic approach is described. Thirty consecutive patients have been subjected to the procedure since 1973. The clinical results and results of X-ray examinations and laboratory investigations of gastro-oesophageal reflux in 29 patients examined postoperatively are analysed. The concept of combining artificial lengthening of the oesophagus with fundoplication is considered to be a promising approach for solving the problems associated with the management of hiatal hernia complicated by shortened oesophagus.