Background: Failure of anti-reflux surgery means persistence of the previous symptoms of gastro-oesophageal reflux disease (GERD) or appearance of new symptoms of over correction after surgery. This needs a careful evaluation & management. The aim of this study is the diagnosis of the causes of failed anti-reflux surgery and to select patients who are in need for re-do surgery. Patients and methods: Over a 31-month period (April 2009 to October 2011), 31 patients (mean age 39.44 ± 7.5) presented with symptoms of failed anti-reflux surgery starting shortly after the primary surgery. 18 patients (58.1%) were complaining of symptoms of recurrence and 13 patients (41.9%) were complaining of symptoms of overcorrection. Conservative management was tried first and the integrity of the previous fundoplication was evaluated by upper endoscopy, barium oesophago-gastrogram, manometric studies and 24-hours ambulatory pH monitoring. Results: 11 patients (35.4%) were managed conservatively, 4 patients (12.9%) required oesophageal dilatation and 16 patients (51.6%) were in need for revision of the primary surgery. Improvement was noted in all patients with redo surgery, only 3 patients developed postoperative dysphagia that was managed conservatively. Conclusion: The rate of redo surgery may be further reduced by a meticulous surgical technique; redo surgery should be offered for only selected patients with failed anti-reflux surgery and should be done by an experienced surgeon to ensure the best results.