Laparoscopic fundoplication is considered the surgical treatment of choice for gastroesophageal reflux disease. Despite the excellent surgical outcomes associated with this procedure, with reported long-term efficacy rates of 85–90% when performed in experienced centers, cases of failure or complication do exist. The incidence of laparoscopic fundoplication failure is variably reported in the literature, mainly due to the lack of a precise definition; it is generally referred to as the persistence, recurrence, or occurrence of new adverse gastrointestinal symptoms after surgery. The causes of laparoscopic fundoplication failure can be ascribed to the presence of functional complications, such as recurrence of reflux symptoms, persistent dysphagia, gas-bloat syndrome, or structural complications. The esophagogastric junction is a highly complex dynamic anatomical region that undergoes mechanical stresses, and fundoplications are at risk of disruption, herniation, or slippage. Revisional surgery after laparoscopic fundoplication is technically demanding and is associated with higher morbidity and mortality, along with less satisfactory results than primary procedures; therefore, the indications for revisional surgery should be carefully evaluated.