Reflux Surgery (Nissen Fundoplication)
Gastro-oesophageal reflux is the backflow of stomach contents into the oesophagus. Medication and lifestyle change are enough for most patients. Surgery is considered when symptoms persist despite treatment or when the hiatal hernia is large.
When surgery is needed for reflux
- When symptoms continue despite an adequate dose and duration of medication.
- When medication controls symptoms but the patient does not wish to take it lifelong.
- When stomach contents reaching the lungs cause cough, hoarseness or recurrent chest infections.
- When a large hiatal hernia, oesophageal narrowing or Barrett's oesophagus has developed.
- Endoscopy and, where needed, pH monitoring and manometry are performed before the decision.
How the operation is performed
Through the keyhole approach the abdominal portion of the oesophagus is mobilised. The widened diaphragmatic opening (hiatus) is narrowed with sutures and, where a hernia is present, the stomach is returned to the abdominal cavity.
The upper part of the stomach is then wrapped around the oesophagus and sutured. This wrap acts as a one-way valve at the stomach inlet. Whether a full wrap (Nissen) or a partial wrap (Toupet) is used depends on the contraction strength of the oesophagus.
Investigations before surgery
Endoscopy assesses the lining of the oesophagus and stomach and establishes the size of any hernia and the presence of Barrett's change. Where there is doubt whether symptoms are truly acid-related, 24-hour pH monitoring is performed.
Manometry, which measures the contraction strength of the oesophagus, guides the choice of wrap. Omitting these studies increases the risk of swallowing difficulty after surgery.
What to expect afterwards
A sensation of food catching when swallowing and difficulty belching can occur in the first weeks; this generally eases as swelling settles. Eating begins with liquids and soft foods and returns to normal in stages.
In a substantial proportion of patients the need for acid-suppressing medication disappears or falls markedly. Surgery does not, however, replace a suitable diet and weight control.
Key facts
| Procedure | Nissen / Toupet fundoplication with hiatal repair |
|---|---|
| Method | Laparoscopic or robotic |
| Operating time | About 1–2 hours |
| Hospital stay | Usually 1–2 days |
| Diet | Soft and liquid-based for the first 2–3 weeks |
| Return to work | About 1–2 weeks |
Frequently asked questions
Will I still need medication after reflux surgery?
In most patients the need for medication disappears or is reduced. Where symptoms return, drug treatment may be reconsidered, which is why continuing follow-up matters.
Can a hiatal hernia resolve without surgery?
Small hernias are usually managed with medication and lifestyle change. The hernia itself does not shrink with medication; the decision to operate depends on its size and on symptoms.
Will I be able to vomit or belch afterwards?
Belching and vomiting can be more difficult in the early period because of the wrap. The sensation eases with time, and the looseness of the wrap is set carefully during surgery to avoid a lasting problem.
Is reflux surgery performed if I also have obesity?
In advanced obesity a gastric bypass may give a more durable result than a wrap alone, because excess weight is the underlying driver of reflux. The surgical plan is made accordingly.
The information on this page is for general guidance only and does not replace a consultation. The treatment that suits you can only be determined after examination and tests.
Appointments and enquiries
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