OBJECTIVE To investigate criteria for indication to surgery and results of laparoscopic fundoplication. BACKGROUND Gastroesophageal reflux is a common problem in well developed countries. Beside clinical symptoms of heartburn and regurgitation complications may occur like esophagitis, bleeding, ulceration, mucosal metaplasia and loss of motility. A connection of reflux disease, Barrett's esophagus and adenocarcinoma of motility. A connection of reflux disease, Barrett's esophagus and adenocarcinoma of the esophagogastric junction is discussed. In some patients medical treatment is complicated by relapse, persistent or progressive disease. For these patients laparoscopic antireflux surgery may be an effective alternative. METHODS 22 patients with chronic gastroesophageal reflux disease. METHODS Since 9-2-1922 patients with gastroesophageal reflux disease were prospectively evaluated and treated by laparoscopic Nissen fundoplication. RESULTS 11 patients had frequent recurrent disease, 9 persistent reflux and 2 a stricture while on medical treatment. All had pathologic reflux on 24 hour pH monitoring and defective sphincter on standard manometry. Beside an intraoperative pneumothorax there was no intraoperative complication. Postoperative 2 patients had a temporary and 1 mild persisted dysphagia. None had recurrent reflux. 10 patients were reevaluated one year after surgery. None had an esophagitis, abnormal reflux or an insufficient or hypercontinent sphincter. CONCLUSIONS Patients with recurrent or persistent reflux while on medical treatment with abnormal reflux on pH monitoring and defective sphincter on manometry can be treated by laparoscopic Nissen fundoplication with good results.