Background: Nowadays, in most surgical centers, Nissen fundoplication is the “gold standard" procedure for treatment of pathologic gastroesophageal reflux disease.
Objectives: Comparing between fixation of fundal wrap to esophageal musculature and to the phrenoesophageal membrane, in laparoscopic Nissen fundoplication, as regard its effect on post-operative dysphagia. 
Patients and Methods: From May 2013 to December 2015, laparoscopic Nissen fundoplication was done for 49 patients for treatment of gastroesophageal reflux disease and/or hiatal hernia at New Damietta University Hospital. These 49 patients were randomly divided into two groups; (A) 24 patients underwent fixation of the fundal wrap to the esophageal musculature, and (B) 25 patients underwent fixation of the fundal wrap to the remaining part of the phrenoesophageal membrane over the abdominal part of esophagus.
Results: Pre-operative dysphagia was present in 16 patients (66.7%) in group A {12 moderate and 4 mild}, and 15 patients (60%) in group B {11 moderate and 4 mild}. Post-operative dysphagia developed in 12 patients (50%) in group A {one severe and 11 moderate}, all of them got better gradually during the follow up period except one which needed dilation, and 5 patients (20%) in group B were moderate and gradually got better during the follow up period. Post-operatively, there was a recurrence of GERD in 5 patients (20.8%) of group A {3 patients with grade 1 improved spontaneously, one patient with grade 2 improved with PPI treatment, and one patient with grade 3 necessitated reoperation}. As regard group B, there was a recurrence of GERD in 3 patients (12%) {2 patients with grade 1 improved spontaneously, and one patient with grade 2 improved with PPI}. As regard recurrence of hiatal hernia, there was one (4.2%) recurrence in group A, and no one in group B. 
Conclusion: Success of surgical treatment of gastro-esophageal reflux disease and hiatal hernia will be achieved with good patient selection, correct choice of surgical procedure, and good quality performance of operation. Fixation of the fundal wrap to the phrenoesophageal membrane is preferable and good alternative to its fixation to muscle fibers of lower part of esophagus, as it decreased post laparoscopic Nissen fundoplication dysphagia and recurrence.