Gastroesophageal reflux disease (GERD) is a common disorder of the foregut. Over the past twenty-five years the developement of instrumentation and techniques to study GERD have revealed it to be a complex disorder. Increasingly effective pharmacotherapeutics have been developed over the same time frame. As such the great majority of patients are adequately treated by a medical regimen. Patients who are medically refractory or those requiring long term medications are potential candidates for anti-reflux surgery. Over the past decade decreasing numbers of anti-reflux surgical procedures have been performed. The two main reasons are improved pharmacology i.e. Prilosec and the complication rate associated with antireflux surgery. The laparoscopic performance of anti-reflux surgery offers dramatic benefits to the patient. As in the performance of laparoscopic cholecystectomies the decreased postoperative morbidity and rapid return to normal activities ensures overall cost savings. We present our experience with laparoscopic anti-reflux surgery to include the work up, technique, results, and a new laparoscopic anti-reflux procedure.