Hiatus hernia with GERD is a relatively common problem among children and infants. Failure to respond to medications for six months is a clear indication for surgery. The present study was conducted in Cairo University Specialized Pediatric Hospital on 20 patients presenting with hiatus hernia associated with GER as evidenced by clinical examination and barium radiography as well as upper GI endoscopy.. The main presenting symptoms were: Repeated vomiting in 16 patients (80%), Dysphagia in 4 patients (20%), Haematemesis in 8 patients (40%), and Failure to thrive in 4 patients (20%).All patients underwent laparoscopic Nissen fundoplication.One case was converted to open procedure (5%), the average operative time was 150 30 min, the average hospital stay was 3-7 days.The main postoperative problems were dysphagia in 1 patient (5%), vomiting in 4 patients (20%) and haematemesis in 2 patients (10%). The use of laparoscopic Nissen fundoplication for hiatus hernia in infant and children is a safe, feasible and may be one of the most important developments in the field of laparoscopic surgery in children.