Laparoscopic antireflux surgery is a widely used and effective option in the properly selected patient with gastroesophageal reflux disease. Poor symptomatic outcomes occur even in the best of hands, the most common being recurrent or persistent heartburn (or atypical symptoms) and dysphagia. When heartburn predominates, anatomic and physiologic evaluation is needed to determine whether acid reflux is controlled and if the postoperative neoanatomy is appropriate. Dysphagia in the immediate postoperative setting mandates reassurance, as conservative measures alone often suffice. With persistent dysphagia, anatomic and physiologic evaluation again is indicated in search of a mechanical, motility, or reflux-related symptom basis. Reoperation carries substantial morbidity and reduced success rates when compared with the initial procedure, mandating careful patient selection and referral to a center with thorough surgical experience in these procedures.