Postoperative paraoesophageal hiatus hernia occurred in 17 of 253 patients who underwent laparoscopic fundoplication at five different hospitals. Ten patients have undergone subsequent surgical revision, eight by an open technique and two by laparoscopy. This complication may have important implications for the technique of laparoscopic fundoplication, as it is possible that routine posterior repair of the diaphragmatic hiatus may greatly reduce the risk. Early postoperative contrast radiology may also achieve earlier diagnosis, enabling correction to be undertaken by laparoscopy.