Anti-reflux surgery is an alternative treatment for chronic GERD with recurrent symptoms. In some carefully selected patients (e.g., those who are young, have typical GERD symptoms, an abnormal pH, and respond well to PPIs), antireflux surgical treatment is as efficacious as PPIs, and therefore antireflux surgery should be used as an alternative to pharmacologic therapy in this group of patients. However, patients should be made aware of the risks of antireflux surgery, such as postoperative dysphagia, decreased ability to belch, and the possibility of increased bloating and flatulence. There is considerable debate as to whether the effectiveness and efficacy of antireflux surgery for the treatment of GERD is equal to or better than long-term drug therapy. Proper patient selection and preoperative evaluation are very important.Belsey, Nissen, and Hill fundoplication are the 3 most widely used antireflux procedures in clinical practice. The goal of the procedure is to create an abdominal esophagus and to create a “flap” at the gastroesophageal junction by encircling the lower esophagus with the fundus muscle in order to increase the pressure on the lower esophageal sphincter. For patients with normal esophageal body motility, Nissen fundoplication is often effective; for those with esophageal body motility disorders, surgery is less effective and is associated with postoperative dysphagia, so surgery is contraindicated or only an incomplete procedure (i.e., Toupet fundoplication) is preferred. Anti-reflux surgery is effective in relieving symptoms and healing esophageal mucosal injury up to 85%, but there is still a 10% recurrence rate in long-term follow-up. A common complication of antireflux surgery is dysphagia. The introduction of endoscopic antireflux surgery provides clinicians with a new surgical treatment method. The main endoscopic treatments are: radiofrequency surgery performed in the region of the lower esophageal sphincter; endoscopic suture technique (to reduce reflux); and injection technique in the region of the lower esophageal sphincter. Surgical treatment is a new method to prevent GERD with satisfactory short-term efficacy, but its long-term efficacy has yet to be proven. The indications for surgical treatment of GERD are as follows: 1. Those who are ineffective in internal medicine treatment. 2. Those who cannot tolerate long-term medication. 3. Those who cause comorbidities, such as gastrointestinal bleeding, recurrent mucosal erosions causing esophageal stricture, and who do not get good results after endoscopic dilatation. 4. Those who develop recurrent pneumonia or even asthma. 5. Patients with Barrett’s esophagus, who have developed severe hyperplasia or develop cancer, surgery should be considered.