Reflux surgery (fundoplication) at Leeds Hospital

  • Overview

Book online

Reflux surgery, also called fundoplication or anti-reflux surgery, strengthens the valve between your food pipe (oesophagus) and stomach to stop stomach acid flowing back upward. The surgeon wraps the top part of the stomach around the lower oesophagus, tightening the area to work as a valve again.

What conditions does reflux surgery treat? 

Reflux surgery treats gastro-oesophageal reflux disease (GORD, also written as GERD), a condition where stomach acid repeatedly flows up into the oesophagus and causes heartburn or a burning sensation in the throat or mouth. Over time, this acid can inflame or scar the lining of the oesophagus. 

Reflux often happens because the ring of muscle where the oesophagus meets the stomach does not close tightly enough. A hiatus hernia, where part of the stomach bulges upward through an opening in the diaphragm, can make symptoms worse and is often repaired at the same time as the main procedure. 

Surgery is generally considered when: 

  • Medication such as PPIs (proton pump inhibitors) or H2 blockers has not sufficiently controlled your symptoms 
  • You experience side effects from long-term reflux medication, or would prefer not to rely on tablets indefinitely 
  • You have developed complications such as scarring, narrowing, ulcers, or bleeding in the oesophagus 
  • Reflux is causing problems beyond heartburn, including a chronic cough, hoarseness, or aspiration pneumonia (a lung infection caused by inhaling stomach contents) 
  • Part of your stomach has become twisted or stuck in your chest (a para-oesophageal hernia). 

What are the benefits? 

The main benefit of reflux surgery is a significant improvement in symptoms, with many people able to stop taking reflux medication afterwards. Around 20% of UK adults experience problems with severe acid reflux, and for some, the condition significantly affects quality of life, causing pain, regurgitation, difficulty swallowing, disrupted sleep, and in some cases, damage to teeth and gums. 

Reflux surgery also reduces the risk of developing Barrett's oesophagus, a condition caused by long-term acid exposure that can, in some cases, lead to oesophageal cancer. 

Types of reflux surgery 

Fundoplication is one of the main types of procedure for acid reflux. It involves wrapping the upper part of the stomach (the fundus) around the base of the esophagus and stitching it into place. This reinforces the lower esophageal sphincter, creating a valve that prevents stomach acid from flowing backward. Here are the different types of fundoplication :

  • Nissen fundoplication (360-degree wrap) is the most established approach. The surgeon wraps the entire upper part of the stomach fully around the lower oesophagus. 
  • Toupet fundoplication (270-degree wrap) wraps the stomach around the back portion of the oesophagus rather than all the way round. 
  • Dor fundoplication (180-degree wrap) reconstructs the section of the oesophagus next to the diaphragm and wraps the stomach halfway around the lower oesophagus, attaching it to the diaphragm. 
  • Endoluminal fundoplication is performed without any external cuts. A camera on a flexible tube (endoscope) is passed down through the mouth into the oesophagus, and the surgeon places small clips or stitches at the point where the oesophagus meets the stomach. 

Your surgeon will recommend which type of wrap is most suitable based on your anatomy and symptoms. 

Other types of reflux surgery:

  • LINX procedure is a surgical alternative to fundoplication. A ring of small magnetic beads is placed around the lower oesophagus, creating a valve effect that opens to let food pass and closes to stop acid rising.
  • RefluxStop is a newer option, first offered on the NHS by Imperial College Healthcare NHS Trust. Rather than wrapping tissue around the oesophagus, a small silicone device is placed on the outside of the upper stomach wall to hold it in its natural position, without putting pressure on the passage food travels through. This can be a suitable option for people who have both reflux and swallowing difficulties, where traditional fundoplication is more likely to add pressure on the food pipe. Early NHS patients treated with this device have been able to eat normally again and have stopped taking reflux medication. 

Before your operation 

You will attend a pre-assessment appointment, where a nurse or anaesthetist will review your medical and surgical history, check which medicines you take, and review your blood test results. This confirms you are fit and ready for surgery and gives the team a chance to discuss your home arrangements and support after discharge. 

Your surgeon may also arrange tests to check the condition of your oesophagus and confirm whether a hiatal hernia is present, including: 

  • Manometry, which measures the pressure and movement in your oesophagus 
  • pH monitoring, which checks how much acid reaches your oesophagus 
  • Upper endoscopy, a camera examination of the oesophagus and stomach 
  • Gastrointestinal X-rays 

To prepare for surgery: 

  • If you smoke, stopping beforehand reduces your risk of complications and supports long-term health 
  • Try to reach and maintain a healthy weight, as this lowers your risk of complications during and after surgery 
  • Your surgeon may recommend a special diet for around two weeks before the operation to reduce the size of your liver, since the liver needs to be carefully held aside during the procedure and a smaller liver reduces the risk of bleeding 
  • Regular exercise beforehand can help your recovery; ask your healthcare team before starting or changing an exercise routine 
  • You will be told when to stop eating and drinking before surgery, and which medications to pause temporarily 

What happens during the procedure? 

Reflux surgery is carried out under general anaesthetic, so you are fully asleep throughout. Most operations are done using keyhole (laparoscopic) surgery, though open surgery is used in some cases. 

  1. Make several small cuts in your abdomen (sources vary on the exact number, typically between 3 and 6) 
  2. Use a harmless gas (carbon dioxide) to gently inflate your abdomen, creating space to work; this gas leaves your body naturally afterwards 
  3. Insert a laparoscope (a thin tube with a camera) and surgical instruments through the cuts 
  4. Carefully move the liver aside and free up the upper stomach, lower oesophagus, and the muscular part of the diaphragm 
  5. Repair any hiatal hernia by stitching the diaphragm to reduce the size of the opening; a small piece of mesh is sometimes used to reinforce this repair 
  6. Wrap the top part of the stomach around the lower oesophagus and secure it with stitches, creating the valve effect 
  7. Close the small cuts with stitches 

In open surgery, the same wrap is performed through one larger cut in the abdomen, and the incision is closed with staples. 

Sources give varying figures for how long the operation takes, ranging from around 1 hour to 3 hours. The exact duration depends on your anatomy, whether a hiatal hernia needs repairing, and which surgical approach is used. 

Recovery from reflux surgery 

In hospital 

Many people are able to go home the same day or the day after surgery. Others may stay slightly longer depending on their individual recovery and the extent of the procedure. 

At home 

Most people return to work within a few weeks, though the exact timing depends on your recovery and the type of work you do. Gradually building up regular exercise, with guidance from your healthcare team, supports a full recovery. 
Most people make a full recovery, with reflux symptoms resolved or substantially improved. 

Risks and complications 

Your surgical team will discuss the risks relevant to your individual case before you consent to surgery. Risk can be higher if you are older, living with obesity, a smoker, or have other health conditions such as diabetes, heart disease, or lung disease. 

General risks of any operation: 
  • Bleeding during or after surgery 
  • Infection at the wound site 
  • An allergic reaction to equipment, materials, or medication 
  • A blood clot in the leg (deep vein thrombosis) or lung (pulmonary embolus) 
  • Chest infection 
  • A hernia developing at a scar or cut site 
  • In rare cases, complications can be serious and may be life-threatening 
Risks specific to keyhole surgery: 
  • Accidental damage to nearby structures such as the bowel, liver, or blood vessels while inserting instruments; this risk is higher if you have had previous abdominal surgery, and around 1 in 3 such injuries are not immediately obvious during the operation itself 
  • A hernia developing near one of the small cuts 
  • Surgical emphysema, a crackling sensation under the skin caused by trapped carbon dioxide 
  • Gas embolism, where carbon dioxide gas enters the bloodstream and blocks a blood vessel; this is rare 
Risks specific to fundoplication: 
  • A hole (perforation) in the oesophagus or stomach, which needs repairing 
  • The stitches used for the wrap tearing, which may need immediate further surgery 
  • Accidental damage to the liver while it is held aside, or to the spleen, which may need to be removed 
  • Air escaping into the space around the lung (pneumothorax) 
  • Difficulty swallowing for a few months after surgery 
Longer-term problems: 
  • Persistent difficulty swallowing most foods normally 
  • Gas bloat, where the stomach overfills with air or food and you are unable to relieve the pressure by burping or being sick; this usually improves gradually over time 
  • Reflux symptoms returning if the wrap loosens or was not tight enough 
  • Weight loss, which may require eating more frequent, smaller meals to help maintain your weight 
  • Ongoing abdominal discomfort or diarrhoea 
  • Adhesions, where scar tissue causes internal tissues to stick together abnormally 
  • Damage to the vagus nerve near the oesophagus and stomach, which can affect how the stomach functions 

If problems are severe and continue for more than three months, a further operation may be needed. Research cited by Cleveland Clinic found that around 10% of people who have this surgery need a second procedure. 

Frequently asked questions 

Will I still need to take reflux medication after surgery?

Many people are able to stop taking medication after successful reflux surgery, and this is one of the main reasons people choose surgery over long-term tablets. Your individual outcome will depend on your specific case, and your surgeon will discuss what to expect for you. 

What is the difference between a Nissen and a Toupet wrap?

A Nissen wrap goes all the way around the oesophagus (360 degrees), while a Toupet wrap covers around three-quarters of it (270 degrees) and a Dor wrap covers about half (180 degrees). Your surgeon will recommend the type best suited to your anatomy and symptoms. 

Is reflux surgery keyhole surgery?

Most reflux surgery is performed using keyhole (laparoscopic) technique, using several small cuts rather than one large incision. Open surgery, using a single larger cut, is used in some cases. A newer option called endoluminal fundoplication avoids external cuts entirely by working through the mouth using an endoscope. 

What is RefluxStop and how is it different from a wrap?

RefluxStop is a small silicone device placed on the outside of the upper stomach wall to hold it in its natural position, rather than wrapping stomach tissue around the oesophagus. It does not put pressure on the food pipe, which can make it a suitable option for people who have both reflux and swallowing difficulties. It was first offered on the NHS by Imperial College Healthcare NHS Trust. 

Can the reflux come back after surgery?

Yes, this is possible if the wrap becomes loose or was not tight enough to begin with. Research cited by Cleveland Clinic found about 10% of people who have this surgery need a second operation. If symptoms return and do not settle, your surgical team can discuss whether further treatment is needed. 

How long does it take to recover?

Many people go home the same day or the day after surgery and return to work within a few weeks, depending on their job and individual recovery. A full recovery, with reflux symptoms resolved or much improved, is the expected outcome for most people. 

Reflux surgery (fundoplication) consultants at Leeds Hospital

Leeds Hospital

2 Leighton Street, Leeds, LS1 3EB

0113 3227251

All self paying and insured patients and their guests can park of free of charge in our underground car park. Patients are also entitled to a 30% discount on parking at Q-Park, The Light, which must be pre-booked prior to arrival. Book your space and use promotional code NUFFLDS by following this link: https://www.q-park.co.uk/en-gb/cities/leeds/the-light/

Switchboard 0113 3227251

Ways to pay

Nuffield Health promise

Our prices are all-inclusive. We will equal any comparable price. There are no time limits on your aftercare.

Paying for yourself

There are no hidden costs in our treatment prices. The price you see is the price you pay.

Find out more

Personal medical loan

Spread the cost of your treatment with a 10, 12 or 24 month 0% personal medical loan.

Find out more

Medical insurance

We work with you and your insurance provider to get you the treatment you need quickly

Find out more