AIM: To demonstrate that age does not influence the choice of treatment for gastroesophageal reflux disease (GERD). We hypothesized that the outcome of total fun-doplication in patients > 65 years is similar to that of patients aged ≤ 65 years.METHODS: Four hundred and twenty consecu-tive patients underwent total laparoscopic fun-doplication for GERD. Three hundred and fifty-five patients were younger than 65 years (group Y), and 65 patients were 65 years or older (group E). The following elements were considered: pres-ence, duration, and severity of GERD symptoms; presence of a hiatal hernia; manometric evalu- ation, 24 h pH-monitoring data, duration of operation; incidence of complications; and length of hospital stay. RESULTS: Elderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in compari-son with younger patients. A mild intensity of heartburn often leads physicians to underestimate the severity of erosive esophagitis. The duration of the operation was similar between the two groups. The incidence of intra-operative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 92.9% young patients and 91.9% elderly patients. CONCLUSION: Laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly pa-tients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients. We hypothesized that the outcome of total fun-doplication in patients> 65 years was similar to that of patients aged ≤ 65 years. METHODS: Four hundred and twenty consecu-tive patients underwent total laparoscopic fun-doplication for GERD. Three hundred and fifty-five patients were younger than 65 years (group Y), and 65 patients were 65 years or older (group E). The following elements were Considered: pres-ence, duration, and severity of GERD symptoms; presence of a hiatal hernia; manometric evalua- tion, 24 h pH-monitoring data, duration of operation; incidence of complications; and length of hospital stay. more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in compari-son with younger patients. A mild intensity of heartburn often leads physicians to underestimate the severi The incidence of intra-operative and postoperative complications was low and the difference was not quite significant between the two groups. An excellent outcome was observed in 92.9% of young patients and 91.9% elderly patients. CONCLUSION: Laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly pa-tients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients.