In order to determine the in-hospital morbidity and mortality rates of antireflux surgery in a community hospital setting, a retrospective 10-year review of 355 antireflux procedures was conducted. A modified Nissen fundoplication, with an incomplete fundal wrap, was the most common operation performed. Concomitant procedures, usually biliary or gastric, were undertaken in 93 patients. Thirty-nine patients had previously undergone an operation involving hiatal dissection. Overall morbidity was 17%, and mortality was 1% (three deaths). Patients with previous hiatal surgery had higher morbidity (44%, p < 0.0001) and mortality rates (3%, p < 0.21). Wound infection occurred in 5% of patients and wound dehiscence in 1%. Splenic repair or splenectomy for iatrogenic injury was required in 2%. Postoperative gastroesophageal leaks occurred in six patients (2%). Patients with previous hiatal surgery had a higher incidence of gastroesophageal leaks (8%, p < 0.002). Three of six patients had contained leaks that resolved with antibiotics, cessation of oral intake, and nutritional support. Two of three patients with noncontained leaks died despite surgical intervention.