Vesicoureteral reflux (VUR) is a well recognised risk factor for pyelonephritis, reflux nephropathy, hypertension and, chronic kidney disease. Open surgical management of VUR with an anti-reflux procedure is undertaken when endoscopic correction with a submucosal injection of bulking agent has been unsuccessful or is not suitable or practicable. Although laparoscopic and robotic-assisted approaches to ureteral re-implantation are gaining popularity, yet the open techniques currently remains the most commonly employed technique with high success rate of >95% of cases and relatively low complication rate. In this chapter different open procedures are described, both intravesical (Cohen, Politano-Leadbetter, Glenn-Anderson) and extravesical (Lich-Gregoir) techniques. Additional procedures may be required in selected cases as ureteral tailoring and psoas hitch. Special consideration should be considered in duplex kidneys with a functioning refluxing lower moiety where ureteroureterostomy seems to be an alternative reliable option. Similarly, nephroureterectomy may be employed in the non-functioning kidney. Different factors may affect the outcome of open ureteral re-implantation especially the grade of VUR or the presence of pre-operative bladder and bowel dysfunction. On the otherhand, the type of the surgical procedure or prior endoscopic injection of bulking agent did not seem to affect the outcome of subsequent surgery.