Objective: To compare the clinical efficacy of laparoscopic Dor versus Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (RGERD). Methods: This retrospective study included 102 RG-ERD patients treated between January 2023 and January 2025. Patients were assigned to either the Dor (n=50) or the Nissen (n=52) groups based on the surgical approach. Outcomes compared included overall clinical efficacy, perioperative indicators (intraoperative blood loss, operative time, and hospital stay), time to symptomatic improvement (reflux, burning epigastric discomfort, and retrosternal pain), esophageal manometry (integrated relaxation pressure [IRP] and lower esophageal sphincter resting pressure [LESP]), esophageal pH monitoring (reflux duration, reflux episodes, and DeMeester score), Gastroesophageal Reflux Disease Questionnaire (GERDQ) score, adverse events during hospitalization and at 1-year follow-up (heartburn, constipation, eructation disorder, acid regurgitation, bloating, and dysphagia), and patient satisfaction. Results: The two surgical techniques demonstrated no marked difference in overall efficacy rates, perioperative parameters, time to symptomatic improvement, incidence of adverse events (8.00% vs. 13.46%), or treatment satisfaction (82.00% vs. 76.92%; all P>0.05). Both groups showed significant postoperative increases in IRP and LESP and marked reductions in reflux duration and episodes, as well as DeMeester and GERDQ scores (all P<0.05), though no statistical inter-group differences were identified (P>0.05). Conclusions: Dor and Nissen fundoplication demonstratede equivalent effectiveness and safety in the treatment of RGERD.