OBJECTIVE Gastroesophageal reflux disease (GERD) is commonly associated with morbid obesity (MO). Antireflux surgery has a higher failure rate in MO and addresses only one of the comorbidities present. This paper reviews the results of laparoscopic Roux-en-Y gastric bypass (LRYGBP) performed for recalcitrant GERD in MO. METHODS Patients with recalcitrant GERD and a body mass index (BMI)>35 undergoing LRYGBP were included. LRYGB included crural repair, creation of a small gastric pouch (30 mL), and intestinal bypass (150 to 180 cm). All patients were followed in clinic and by telephone. RESULTS From February 1999 to April 2001, 57 patients (51 F, 6 M) with a mean age of 43 (range, 22 to 67) and a median BMI of 43 underwent LRYGBP. Hiatal hernia or esophagitis, or both, were present in 48, Barrett's in 2. LRYGBP was possible in 52 patients; 5 required open conversion. The median hospital stay was 3 days. Complications included 1 leak, 1 pulmonary emboli, 2 reoperations for internal roux limb hernia, and 7 gastrojejunal strictures. At a mean follow-up of 18 months (range, 3 to 30), all patients report improvement or no symptoms of GERD and a mean weight loss of 40 kg (range, 16 to 70). Quality of life scores (SF-36) were above national norms for physical and mental components (median 55, norms=50). GERD-health related quality of life median score was <1 (scale, 0 to 45, 0=asymptomatic, 45=worse). CONCLUSIONS LRYGBP was effective for recalcitrant GERD in MO. LRYGBP also led to weight loss and improvement in other comorbidites. Surgeons with minimally invasive expertise should consider LRYGBP for treatment of GERD in the morbidly obese.