Transthoracic total fundoplication gastroplasty has been reported as having a low mortality and a 1.1% recurrence rate and to produce excellent results in 93.1% of patients, moderate results in 3.7% and poor results in only 2.8% of patients. In approximately 7.0% intercostal neuritis is a serious residual problem. The transabdominal total fundoplication gastroplasty uses the identical repair technique but avoids the chest-wall pain. Previous esophageal or gastric surgery and major esophageal shortening are contraindications to an abdominal approach. The authors report their results with 50 patients who underwent transabdominal total fundoplication gastroplasty and were followed up for 6 to 20 months. There was no mortality or major morbidity. Clinical follow-up was complete, 94% of patients were assessed by roentgenography and 72% by manometry. None had anatomic recurrence, 46 (92%) were asymptomatic and 4 (8%) had minor residual gastric symptoms of fullness or occasional epigastric pain. All were much improved and none had wound pain. Long-term follow-up of transabdominal total fundoplication gastroplasty is necessary; however, since the technique of repair is identical to the thoracic approach, the results should be similar.