Between 1975 and 1986, 96 adult patients were operated upon for gastro-esophageal reflux using the abdominal approach to Nissen's operation, eight of these patients having undergone previous surgery to treat reflux. Diagnosis in 44 patients was stage III esophagitis, and in 16, symptomatic peptic stenosis. Mortality was 0.9% (1 case) and morbidity 14%. Morbidity was not increased in previously operated patients. Based on these results and a literature review, different technical factors are discussed that could reduce morbidity of Nissen's operation.