Antireflux procedures are among the most common operations performed in children today, most of which are done in the neurologically impaired (IMP). While some advocate a minimal access surgical technique (LAP), the superiority of this approach over the conventional open (OPEN) technique remains in question. We compared the operative time, hospital days, and complications of OPEN vs. LAP in IMP and neurologically normal (NL) children. The medical records of all children under 19 years old who underwent an antireflux procedure between 9/90-9/95 were reviewed. Chi squared analysis and the unpaired Student's t-test were used to evaluate the data. Two hundred and twelve fundoplications were reviewed. The procedure and data for the operative time, number of hospitalized days, and early and late complications (mean π SD) are presented below: shorter hospitalization and fewer late complications. In addition, NL children had fewer early complications when compared with the IMP group (5/69 vs. 56/143, p < 0.001). Laparoscopic antireflux procedures are a safe alternative to open procedures. Because of the shorter hospitalization and fewer late complications associated with the laparoscopic technique, this approach appears to be superior.