Objectives: There is considerable discussion regarding “success” rates for laparoscopic anti-reflux surgery (LARS). We hypothesized that, in part, this was a reflection of the outcome variables used. We, therefore, categorized several such variables and assessed outcomes for each in a large cohort of patients Methods: Four hundred patients (208 females; median age 52y/o) who underwent LARS at the University of Washington from 1993 to 2008 were given a comprehensive questionnaire to assess various aspects of their outcomes from LARS.Results: The median follow-up was 107 (6-175) months.Symptom Improvement: Heartburn (N=376) in 326 (87%), regurgitation (N=365) in 331 (91%), and chest pain (N=265) in 207 (79%), measured by patient's perception.Medication use: 236 (59%) patients remain completely off medications for GERD, 164 are using anti-reflux medications (41%). Of these, 73 patients are taking less medication than before LARS. The most common reasons for continuing GERD medication after LARS were: heartburn (n=100) 60%, regurgitation (n=13) 8%, Barrett’s Esophagus (n=13) 8%. pH Monitoring: The average pre-op DeMeester score was 56.8±5.1 (n=321), which decreased to 16.5±10.9 in patients who underwent post-op testing (n=174). One Hundred thirty-two (76%) had normalization of this score. Side-effects: The following side-effects developed or worsened: dysphagia in 72 (18%) patients; bloating in 96 (24%) patients; diarrhea in 61 (15%) patients. The severity (0-10 scale) of these was: dysphagia 5.1±2.6, bloating 6.5±2.2, diarrhea 6.5±2.9.Patient perception of Success: Currently, 279 (70%) patients rate their operation as a complete success and 111 (22%) as partially successful. Those with partial or no success cited recurrent reflux (n=70), a side-effect (n=37), or both (n=14) as the reason. Reoperations: Fifteen (3.7%) patients required reoperations, 9 for recurrent reflux and 6 for side-effects.Progression of Barrett’s: Of the 58 patients with Barrett’s before LARS, 2 developed HGD/cancer (or 1 per 258 patient years).Durability: The percentage of patients with successful control of GERD symptoms: 88% at 1 year, 83% at 2 years, 77% at 5 years, and 74% after 10 years.Conclusion: LARS is an effective and durable treatment option for GERD. Success or failure cannot be defined in a single domain. A comprehensive analysis of outcomes requires categorization that includes symptom response, side-effects, patient’s perception and objective measurement of acid exposure, mucosal integrity, and the need for additional medical or surgical treatment. Only then can patients and physicians better understand the role of LARS and make informed decisions.