Recently, PPI and laparoscopic Nissen operation were introduced to clinical field for the treatment of reflux esophagitis. The indication of surgical treatment for reflux esophagitis is as follows: (1) patients resistant to medical treatments, (2) free reflux patient, (3) patients with short esophagus or stenosis, (4) patients with respiratory complications. As for surgical treatment, there are many operative methods were reported. Recently, laparoscopic Nissen operation is the most popular procedure, and Toupet method, Dor method, and Tokai University method are employed for elderly patients or patients with sever esophagitis. Collis or Deitel operation is indicated for short esophagus patients. We should select appropriate operative method for individual patients considering about their pathophysiological condition.