Laparoscopic antireflux surgery is a safe and effective alternative surgical approach for the treatment of gastroesophageal reflux disease (GERD). However, the same rigorous evaluation required for open fundoplication is mandated for patients undergoing laparoscopic antireflux surgery. For successful laparoscopic antireflux surgery, both the mastery of laparoscopic techniques and the application of the principles of antireflux surgery are required. Operative mortality and morbidity compare favorably with those of open antireflux procedures, and there is a marked reduction of certain complications. Meticulous laparoscopic technique during the mobilization of the gastric cardia and esophagus will limit mortality and intraoperative and postoperative complications. Although laparoscopic antireflux surgery shortens postoperative recovery and speeds return to work, it may be the double-edged sword causing early failures. Short and intermediate term results compare similarly with open antireflux surgery. Laparoscopic antireflux surgery is an important and significant advancement in the evolution of GERD therapy, its definitive role in the surgeon's armamentarium is dependent on evaluation of long-term data.