Although the concept of laparoscopic anti-reflux surgery (LARS) for the treatment of gastroesophageal reflux disease (GERD) has been introduced into China for more than 20 years, the current status of laparoscopic anti-reflux surgery for GERD in China is not optimistic, except for a few large medical institutions that are equipped to set up GERD centers. Because LARS is a type of functional reconstructive surgery and because of the pathogenesis of multiple complex factors in GERD, the efficacy of LARS is far from comparable to that of other organ resections. In addition, some patients have symptoms such as gastrointestinal distention, diarrhea, nausea and dysphagia after LARS, which have meaningful impact on postoperative quality of life; meanwhile, the surgery itself does not delay the development of Barrett’s esophagus and adenocarcinoma, so many scholars have a negative attitude toward laparoscopic anti-reflux surgery for GERD. However, from the large number of available case reports, the recent surgical outcomes of patients who have undergone more rigorous screening are more satisfactory, especially the improvement of heartburn, acid reflux and throat irritation and respiratory syndrome is more significant. The Chinese Society of Gastrointestinal Endoscopy proposed guidelines for the diagnosis and treatment of reflux esophagitis in China in 2003, which concluded that those who are effectively treated with regular medical therapy but do not want to take medication for life, those who are ineffective or those with complications can carefully choose surgical anti-reflux surgery or laparoscopic fundoplication. Based on the recommendations of national and international authors and some of our experience in practice, we believe that anti-reflux surgery can indeed solve some of the clinical problems of GERD and that the correctness of previous diagnosis and treatment should be revisited before deciding on surgical treatment so that the patient is fully informed about the purpose and regression of the procedure. Patients should also be clearly informed that they cannot fully expect that surgery will no longer require medical medication or that all symptoms of GERD will disappear, and that both physicians and patients should understand that surgical treatment should not be considered as the final treatment for this disease, but rather as a reasonable measure of treatment choice. According to our clinical experience, for patients with GERD who have: 1) typical GERD clinical symptoms such as heartburn, acid reflux and regurgitation; 2) esophageal manometry suggesting low LES pressure; 3) 24-hour dynamic acid measurement of the esophagus suggesting abnormal acid reflux; 4) imaging data suggesting esophageal hiatal hernia. The above four points are absolute indications for LARS, and the surgical results are good with high patient satisfaction rate; with 1, 2 and 3 above, but not 4 points, laparoscopic anti-reflux surgery is also recommended, and the patient’s GERD-related symptoms will improve significantly after surgery; with only 4 points, and the patient himself does not have typical GERD symptoms, and does not have 2 and 3 points, laparoscopic anti-reflux surgery can be considered, but The purpose of surgery is only to treat hiatal hernia, not GERD, and the patient may have symptoms such as epigastric pain, epigastric discomfort, and feeling of fullness before surgery, which are less likely to be relieved after surgery; with points 1 and 3 and normal LES pressure, LARS can be considered but not strongly recommended because GERD symptoms can be controlled after surgery, but the incidence of specific complications after anti-reflux surgery is high and prone to Chronic dysphagia; with points 1 and 2, LARS is not recommended if esophageal acid measurements do not indicate abnormal acid reflux, because on the one hand, the diagnosis of GERD is insufficient, and on the other hand, patients may indeed have GERD, but their reflux is gas reflux, non-acid reflux or weak acid reflux, and the efficacy of anti-reflux surgery in these patients is not yet certain.