Antireflux surgery (ARS) is appropriate and effective management for patients who have gastroesophageal reflux disease (GERD) refractory to medical management, who are on lifelong acid suppression, or who are experiencing side effects of the medical management. Over the past 2 decades, the operations have evolved from predominantly open thoracic approaches to a predominantly laparoscopic abdominal approach with similar, if not better, outcomes. The success of ARS in managing GERD lies largely in an understanding of GERD and its diagnosis, proper patient selection, sound surgical technique, and postoperative management.