The foreshortened, strictured esophagus resulting from chronic gastroesophageal reflux presents a therapeutic challenge. The fundic patch procedure, combined with fundoplication, may be uniquely suited to this problem since the fundoplication is effective even in the thorax. The first child reported to have an intrathoracic fundoplication continues to have a good result seven years later. Two other children have had effective treatment by the combined Thal-Nissen procedure. Further clinical trials with this operation in children appear to be warranted.