To address the durability and long-term side effects of the Nissen fundoplication as surgical therapy for gastroesophageal reflux disease, we evaluated 100 patients postoperatively. With careful attention to technical detail as described, the incidence of temporary postoperative dysphagia was 39% and permanent dysphagia was 3%. Effective relief of reflux symptoms over more than 10 years was achieved in 91% of the patients with minimal side effects.