From 1972 to 1985, 37 consecutive patients underwent primary Belsey repair and 40 consecutive patients underwent primary Nissen fundoplication because of reflux disease. The operative procedures were performed by a single surgeon in each group. For the purpose of comparison, both groups were divided into two subsets: (1) patients with proved reflux, and (2) patients with different indications. The first subset consisted of 30 patients in the Belsey series and 32 in the Nissen series. The remaining patients were included in the second subset. One death occurred in the Belsey series; morbidity consisted of minor pulmonary complications in the Belsey series (10.8%) and spleen injuries requiring splenectomy (5%) in the Nissen series. In patients with proved reflux good-to-excellent results were achieved in 89.3% of subjects of the Belsey series and 86.6% of patients of the Nissen group. The failures rates were 7.1% and 10%, respectively. Inability to vomit and/or belch was reported in 7.1% of patients with proved reflux of the Belsey group and 10% of patients with proved reflux of the Nissen group. In patients with different indications there were no failures after either operation. Finally 82.2% of subjects in the Belsey group and 73.3% of patients in the Nissen group declared that they were satisfied with the operative results. In conclusion the Belsey and the Nissen procedures are equally able to achieve long-term control of reflux disease in comparable groups of patients. Failures and gastrointestinal symptoms are equally frequent after either procedure and do not affect the overall patient acceptance of antireflux surgery.