The open Hill repair is established as a highly effective and durable antireflux procedure. At the present time, we have multi-institutional experience with over 140 laparoscopic Hill repairs. Detailed follow-up on the first 40 patients at our institution is described. All patients had well-documented reflux or esophagitis preoperatively, 7 patients had evidence of peptic stricture or Schatzki's ring, 11 had large hiatal hernia, and 10 weighed more than 200 lb. There were no serious complications and no reoperations. There was 1 death during the follow-up period that was not attributable to the repair. Hospital stay averaged 2.8 days with return to normal activity in 7 to 14 days. Postoperative manometry has been obtained in 24 of the 39 patients available for follow-up (62%) and 24-hour pH studies in 23 of the 39 (59%). Thirty-nine patients were evaluable at a mean follow-up of 10 months and a median follow-up of 8 months (range: 4 to 20 months), with 36 (92%) subjectively rating results as good or excellent. Only one of the three remaining patients has objective evidence of reflux, yielding 97% clinical control of reflux. Mean lower esophageal sphincter pressure (LESP) was raised from 10.7 mm Hg, preoperatively, to 25 mm Hg, postoperatively. Postoperatively, 33 of the 39 patients (85%) are now free of medications referable to the esophagus or upper gastrointestinal tract. This early follow-up experience with the laparoscopic Hill repair leads us to conclude that it is safe, widely applicable, and highly effective as an antireflux operation. Its special features give it certain advantages over the laparoscopic Nissen repair, and we recommend it as the procedure of choice.