From 1977 to 1990, a Belsey Mark IV antireflux procedure was performed in 177 patients. The primary indication was gastro-oesophageal reflux (GOR) resistant to medical treatment in all but 5 patients presenting themselves with a complicated para-oesophageal hernia. Ninety-eight patients (53.5%) had some form of additional pathology or complication: grade III oesophagitis: 26, grade IV: 6, Barrett's oesophagus: 38, reintervention: 14, concomitant duodenal ulcer requiring highly selective vagotomy: 14, bleeding: 23, small benign tumours: 2. There was one postoperative and one late mortality. At one year an objective evaluation was made in all patients operated on since this interval (N = 147), consisting in endoscopy: 121, Barium-swallow: 113, 24 hour oesophageal pH-monitoring: 81, manometry: 69. A recurrence was documented in 11 patients (7.4%). The mean follow-up of these 147 patients is 4.4 years with a range from 1 to 13 years. Over the entire follow-up period 17 patients (11.5%) had symptoms suggestive of recurrent reflux. Subjective and objective recurrence rate was 13%. Undesired gastrointestinal side effect were seen in 13 patients (8.8%), whereas post-thoracotomy pain was equally noticed in 13 patients (8.8%). The final score combining recurrence rate and side effects showed excellent to very good results in 77.5% of the patients, good results in 7.5% and bad results in 15%. CONCLUSIONS Candidates for surgical treatment of GOR often present themselves with a variety of reflux related complications or additional pathology. Long term follow-up shows good reflux control in 87% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)