BACKGROUND. Transabdominal gastroplasty is used to lengthen the esophagus during hiatal hernia repair and establishes an acid-secreting neoesophagus above the fundoplication resulting potentially in less effective control of reflux symptoms and impaired quality of life (QOL). Little is known about its effect on QOL. AIM. To determine the effect of transabdominal gastroplasty on overall and reflux-related QOL. HYPOTHESIS. Transabdominal gastroplasty impairs QOL as compared to matched controls. METHODS. Retrospective matched cohort study comparing 116 consecutive patients who had transabdominal gastroplasty and fundoplication for a short esophagus to 116 matched control patients who had transabdominal fundoplication alone between January 1997 and June 2005. Overall and reflux-related QOL were evaluated with Short Form-36 (SF-36) and Quality Of Life in Reflux and Dyspepsia (QOLRAD) instruments. Overall survey response rates were 72% in the gastroplasty group and 70% in the control group. Altogether 58 matched pairs returned both the gastroplasty and control surveys. Long-term follow-up and QOL were compared for the 58 matched pairs. RESULTS. The groups did not differ by age, sex, operative approach, hospital stay, or complications (p>0.05). Gastroplasty patients had larger hiatal hernias (6 vs. 3 cm) and higher body mass index (BMI) (29 vs. 28 kg/m2), and were more likely to have had a previous fundoplication (14% vs. 4%) (p<0.05). There were no perioperative deaths in either group. Major morbidity occurred in 18% of both groups. Survey respondents were older than non-respondents (p<0.05). Complications did not impact response rates (p>0.05). Median follow-up in the gastroplasty group was 18 months (range, 2 to 72) and 26 months (range, 3 to 79) (p=0.02) in controls. No difference was observed in the 58 matched pairs regarding the 8 domain and 2 composite scores of the SF-36 and the 5 domain scores of the QOLRAD (p>0.05). The overall frequency of patient satisfaction, perceived health status, and self reported symptoms of reflux, dysphagia, bloating, diarrhea, and belching also did not differ between the groups (p>0.05 for all). Control patients, however, were more likely to require additional hospitalizations/interventions (p<0.05). CONCLUSION. Transabdominal gastroplasty and fundoplication for shortened esophagus results in similar long term QOL compared to patients undergoing fundoplication alone.