INTRODUCTION Creation of a floppy and symmetrical fundoplication is desired during antireflux procedures. Intraoperative Esophago gastroduodenoscopy (EGD) can be helpful in determining these factors at time of surgery. The aim of this study is to determine if intraoperative EGD improved outcomes in patients undergoing laparoscopic antireflux procedures. METHOD Fifty consecutive patients undergoing laparoscopic Nissen fundoplication from 2002-2004 were entered into a prospective database. Preoperative and postoperative data point included symptom scores; pH, manometry and esophageal length were recorded and statistically analyzed. Mean follow up was 9 month. RESULTS Of the 50 patients studied the 1^st 25 did not have intraoperative EGD while the 2^nd 25 had and EGD. Out of the 25 patients who did not receive intraoperative endoscopy 11(44%) had to undergo additional postoperative evaluations of the esophagus and stomach for occurrence of symptoms. These symptoms included development of nausea, dyspepsia, and dysphasia, with 3 (27.2%) out of 11 patients required esophageal dilatation. Of the 25 who underwent intraoperative endoscopy, all had their fundoplication adjusted based on EGD visualization. None of the 25 patients who received intraoperative endoscopic evaluation required additional postoperative studies and no dysphagia was reported. CONCLUSION Intraoperative EGD is a valuable tool to evaluate the geometry and position of the fundoplication at the time of surgery. The creation of a symmetrical and floppy Nissen fundoplication can be greatly facilitated by intraoperative endoscopy and may lead to improved clinical outcomes.