To determine whether gastrostomy and fundoplication prevent aspiration pneumonia in mentally retarded individuals, 105 cases of feeding gastrostomy were examined; 21 subjects had preoperatively diagnosed gastroesophageal reflux. Thirty-nine patients had gastrostomy and fundoplication, 66 patients had gastrostomy alone, and 60 subjects had had aspiration pneumonia before surgery. Recurrent aspiration pneumonia was least in those without preoperative gastroesophageal reflux and who had gastrostomy and fundoplication. Feeding gastrostomy does not prevent aspiration pneumonia. Gastrostomy with fundoplication reduces the likelihood of aspiration pneumonia but still allows a significant number to develop it.