Background: GERD is a very common disorder and can be managed effectively in a large number of patients with combination of life style modifications and appropriate medical therapy. Managing refractory GERD, which can be seen in up to 40% of the patients receiving PPI once daily, can be challenging. The best initial approach is optimization of PPI therapy. A careful history and use of investigative tools can help identify the contributing factors for PPI failure. Management of patients with GERD who are not responding to medical treatment represents a clinical dilemma. Laparoscopic anti-reflux surgery, especially Nissen fundoplication, is validated for management of PPI-responsive patients. However, the role of LNF for management of poor responders to PPI is controversial. Some authors advocate LNF as a proper treatment for patients with refractory GERD. Other reports considered response to medical treatment as a predictor of surgical success. GERD is a syndrome resulting from breakdown of anti-reflux barrier at the lower end of esophagus. This breakdown of anti-reflux barrier results in reflux of gastric contents into the esophagus. Mechanisms for the anti-reflux barrier breakdown are thought to be due to TLESRs and hiatus hernia. Patient with GERD poorly responding to medical treatment should not be precluded from anti-reflux surgery. However, thorough assessment and judicious evaluation is mandatory to confirm the diagnosis of GERD. A substantial proportion of PPI failures show good response to LNF but significantly than clinical response in PPI responders. Increased likelihood of poor outcome after surgery should be discussed with the patient. The aim of this work is to evaluate laparoscopic Nissen fundoplication for patients with gastro esophageal reflux disease non responding to medical treatment. Methods: This study was conducted on 40 patients presented with symptoms of GERD and admitted to Benha University hospital between 2019 and 2021. Results: The results showed that GERD patients who respond well to medication benefit excellently after laparoscopic Nissen procedure, while those who do not respond well to modern medical treatment such as gastric acid secretion inhibitors should not be excluded from anti-reflux surgery, especially if a comprehensive evaluation is done by a method This is necessary to confirm the diagnosis of GERD, and this is clearly shown in the good response to the laparoscopic Nissin operation in these patients compared to patients who continue on medication only without the laparoscopic Nissin operation. But the surgeon must explain to the patient the extent of the long-term benefit from the procedure. Finally, the study proved that the Nissen operation for gastro-oesophageal reflux is a good way to treat patients' weakness or lack of response to medications, and some sources consider it the appropriate treatment for these cases. The results showed that there was no difference between the laparoscopic Nesin operation or the surgical incision, with the necessity of conducting a test to measure the pressure of the lower esophageal muscle to exclude diseases accompanied by symptoms similar to cases of gastroesophageal reflux disease. Finally, the study proved that surgical operations for gastroesophageal reflux disease are a good way to treat these cases, and some sources consider it the only treatment for these cases. Conclusion: Laparoscopic Nissen fundoplication is a safe and effective procedure for gastro-esophageal reflux disease. With experience, the duration of operation falls and the hospital stay is shorter. Short- term symptomatic and pH results are consistently improved by surgery. It was found that GERD can be treated, with good results, by laparoscopic Nissen fundoplication when medical treatment fails. The procedure can be performed effectively and safely locally.