Most pediatric surgeons prefer not to perform a fundoplication during the first few months of life if medical therapy is at all effective. However, when massive gastroesophageal reflux exists together with a very large hiatus hernia, surgery may be indicated if the infant fails to thrive. This video shows the Nissen fundoplication in an 11-day- old infant with massive gastroesophageal reflux and a thoracic stomach secondary to a huge hiatus hernia. The tape shows, in great detail, the crural repair, the fundoplication, and the posterior gastropexy.