Medical treatment of reflux oesophagitis requires life-long medication, does not relieve all patients of their symptoms and may not halt the progression of damage. Antireflux surgery is indicated in refluxing infants who fail to thrive, in disease uncontrolled by medical treatment or when laryngeal and pulmonary symptoms are associated with reflux. A full investigation to establish and quantitate the motility defect and severity of the reflux, nature of the refluxate and pattern of gastric emptying is necessary to plan a correct antireflux procedure which can assure a cure of up to 90% for 10 years.