A rationale for, and the results of, antireflux surgery in 58 children are reported. Suitability of the patient with primary reflux for this type of surgical correction is emphasized. Conversely, it is pointed out that the child with neurogenic reflux is usually unsuitable for this type of management. Allusion is made to a probable relationship between juvenile reflux and chronic pyelonephritis in young women. Primary importance is placed on differentiation of the obstructed from the unobstructed causation of reflux. Relief of the obstructing lesion is of primary importance in the former, whereas preliminary intensive medical management in the latter is emphasized. Discontinuation of reflux was noted in somewhat over half of the primary type with adequate medical management. Results of antireflux surgery were considered excellent in 41, no change in 12, and poor in 4.