From 1976 to 1993, among 582 patients with reflux esophagitis seen at our Institution, 164 (28%) presented with an esophageal stricture, and 68 of these (41%) underwent surgical treatment. The male to female ratio was 1.6:1, and the median age 51 (range 15-78). Thirteen of the 68 patients (19%) had an associated Barrett's esophagus. Esophageal manometry revealed scleroderma in nine individuals (13%). In 11 patients (16%) observed before 1985 the stricture was not dilatable. Surgical therapy consisted of fundoplication (n = 39), Collis gastroplasty plus fundoplication (n = 10), total duodenal diversion (n = 4), and esophageal resection (n = 15). The mortality rate was 4.4%: two patients died of necrosis of the colon transplant and one of acute pancreatitis. The median follow-up was 27 months (6-129). Esophageal sparing procedures significantly reduced the need of further endoscopic dilatation (p < 0.001). Standard fundoplication was successful in 30 of 39 patients (77%). Regression of Barrett's epithelium was not recorded after any of the conservative surgical procedures.