Gastroesophageal reflux disease (GERD) is a prevalent condition with a global prevalence of 13.98% as of 2020. Proton-pump inhibitors (PPIs) remain the primary treatment, sometimes combined with prokinetics, antacids, or newly developed agents. However, antireflux surgery (ARS) is an alternative for patients with “proven” GERD who are refractory to medical therapy or unwilling to continue long-term PPI use. The Lyon Consensus 2.0 introduced the concept of “actionable GERD”, advocating surgical intervention in severe cases. Despite PPIs being a first-line treatment, nearly 40% of patients experience persistent symptoms, necessitating surgery. ARS has demonstrated efficacy comparable or superior to PPIs, particularly in severe cases, hiatal hernia, or refractory GERD. Various fundoplication techniques, such as Nissen, Toupet, and Dor, aim to restore esophagogastric junction integrity, preventing reflux. Laparoscopic and robot-assisted ARS show similar outcomes, with robotic surgery still being more expensive. The magnetic sphincter augmentation device presents an alternative for select patients. Studies indicate that ARS provides long-term symptom relief, though careful patient selection is crucial. Personalized surgical approaches, technological advancements, and objective diagnostics are essential in optimizing GERD management and ensuring effective and durable outcomes.