Laparoscopic fundoplication is a very successful treatment modality for patients with gastroesophageal reflux disease with control of symptoms in about 80–90% of patients. However, about 10–20% of patients experience persistence or recurrence of their symptoms and eventually between 3% and 6% need a second antireflux operation. Most experts would agree that failure of a fundoplication to resolve symptoms is generally due to one of the following causes: (1) wrong indications for the operation; (2) wrong preoperative workup; and (3) failure to execute the proper technical steps. Patients that are still symptomatic postoperatively must be thoroughly evaluated to identify the cause of failure, and treatment must be individualized.