The 223 children who underwent antireflux surgery for primary reflux were evaluated. Preoperative phylonephritic scarring was more commonly present with greater degrees of reflux. Antireflux surgery was successful in all cases. Postoperative infection occurred in 21 per cent with almost all episodes being clinical cystitis. Postoperatively, a statistically significant increase in renal growth was noted, which was thought to be related to the extent of preoperative nephron loss.