It is sometimes difficult or inappropriate to adopt the standard surgical steps of adult laparoscopic procedures in pediatric patients because of the inevitably smaller anatomical structures and confined intra-abdominal working space. During laparoscopic Nissen fundoplication difficulties are usually encountered, especially when dissecting the diaphragmatic crura, creating the retroesophageal window, and repairing the crura. Thus, we devised a technique to accomplish these steps in pediatric patients. Both crural dissection and repair are approached from the left side of the esophagus and the port configuration for the laparoscope and other instruments is altered, providing better surgical exposure and easier handing of the instruments, even in very small patients. We describe this technique in detail and our results.