Sixty-seven patients with symptoms of gastroesophageal reflux not responsive to medical therapy were treated by 180 degree anterior fundoplication. The operative mortality was 1.5% (one patient). The follow-up period ranged from 6 to 132 months and averaged 3 1/2 yr. The overall clinical results were satisfactory in 94% of the cases; one patient had mild retroesternal heartburn after operation, and three patients had recurrence of symptoms with persistent reflux in two of them. Among the improved patients, one experienced a transient gas-bloat syndrome. In 41 patients manometric evaluation of the gastroesophageal high pressure zone showed a significant increase in both the pressure and the length below the respiratory inversion point (p less than 0.001) but not in the total length. The standard acid reflux test carried out on 47 patients after surgery was found to be negative in all of them. We conclude that in patients with severe gastroesophageal reflux, 180 degree anterior fundoplication achieved good clinical results confirmed by objective methods.