Thoracoscopic fundoplication and hiatoplasty were performed by a videoassisted technique in a patient with longstanding pathologic gastro-oesophageal reflux, reflux oesophagitis and hiatal hernia. Ten months later the patient was asymptomatic and had normal findings by oesophageal endoscopy and 24-hour pH-monitoring. Thoracoscopic fundoplication may be useful in patients with intra-abdominal adhesions due to previous abdominal surgery. Also obese patients with large hiatal hernias and perioesophageal adhesions may benefit from the thoracoscopic approach.