Oesophageal Reflux Surgery

Summary:

Anti-reflux surgery is surgery to correct a problem with the muscles at the bottom of the oesophagus (the tube from your mouth to the stomach).
This surgery can also repair a hiatal hernia.
Price: up to $500 with adequate Private Health Insurance (self-pay options are available)

Gastro-Oesophageal Reflux Disease (GORD)

‘Gastro oesophageal Reflux Disease’ refers to abnormal amounts of acid produced by the stomach coming up the oesophagus and causing typical symptoms such as heartburn or acid taste in the mouth, which can be aggravated by fatty foods, alcohol, eating large meals, and lying down or bending over after eating.

This occurs because the normal mechanisms that prevent acid reflux have failed – usually due to age, genetics, stretching of the tissues, weight gain and, rarely, trauma.

Over time the acid damages the oesophagus and can lead to narrowing/scarring or potentially even precancerous or cancerous changes.

Anti-acid medication reduces the production of acid, which means the reflux liquid does not cause as much damage. However, if the antiacid medication is not taken, all the symptoms return. In some cases the medication might help but not completely make the symptoms go away. This is because medication does not address the anatomical reasons for reflux. Surgery, on the other hand, aims to correct these factors to get rid of the reflux, allowing patients to get off these tablets.

Anti reflux surgery is best known as the laparoscopic Nissen fundoplication, and is also searched for as reflux surgery, GORD surgery or heartburn surgery. Because the operation usually includes repair of a hiatus hernia, it overlaps with our hiatus hernia repair page, which covers the hernia side in detail. Our Melbourne surgeons perform the full range of fundoplication techniques, and the right operation for you depends on your assessment and testing.

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Oesophageal reflux anti-reflux surgery diagram

A procedure called fundoplication is the most common type of anti-reflux surgery. During this procedure your surgeon will:

First repair the hiatal hernia with stitches. The surgeon will tighten the opening in your diaphragm to keep your stomach from bulging through.
Then use stitches to wrap the upper part of your stomach around the end of your oesophagus. This creates pressure at the end of your oesophagus and helps prevent stomach acid and food from flowing back up.
Surgery is done while you are under general anaesthesia (asleep and pain-free). Surgery usually takes 2 to 3 hours.
This surgery can be performed very safely in a ‘minimally invasive/keyhole’ way. In rare circumstances open surgery may be required, particularly if there has been previous surgery in the area.

Nissen and Partial Fundoplication: Which Wrap?

In a Nissen fundoplication, the top of the stomach is wrapped fully around the lower oesophagus, creating the strongest barrier against reflux. In a partial fundoplication, such as the Toupet or anterior wrap, the stomach is wrapped only partway around, which can reduce side effects such as gas bloat and difficulty swallowing.

Which wrap suits you depends on your symptoms and on how well your oesophagus pushes food along, which is exactly what oesophageal manometry measures before surgery. Your surgeon will recommend the technique that balances reflux control against side effects for your oesophagus, and keyhole surgery is used in almost all cases, with robotic assistance available where appropriate. You can read about the pre surgery tests on our manometry and pH studies page.

Gas bloat, which makes it hard to burp or vomit. It also causes bloating after meals.
These symptoms slowly get better for most people.
Pain and difficulty when you swallow, for some people. This is called dysphagia. For most people, this goes away in the first 3 months after surgery.
Damage to the stomach, oesophagus, liver, or small intestine. This is very rare.
Respiratory complications, such as a collapsed lung. This is also rare.
Recurrence of the hiatal hernia.

Reflux Surgery Recovery

The operation itself takes around 2 to 3 hours under general anaesthesia, and your hospital stay depends on the size of the repair, which your surgeon will discuss with you beforehand. In the early weeks a softer diet is recommended while swallowing settles, progressing back to normal foods as comfort allows.

Most patients return to light activities within a couple of weeks, with heavy lifting avoided for around six weeks while the repair strengthens. Any difficulty swallowing usually resolves within the first three months, and your surgeon will review your progress through follow up.

What tests will be needed:

Blood tests upper endoscopy.
Almost all people who have this procedure have already had this test. If you have not, we will need to arrange this.
Other tests, such as Manometry (to assess the function of your oesophagus) and pH monitoring (to see how much stomach acid rises into your oesophagus).

During the week before your surgery:

You may be asked to stop taking aspirin, ibuprofen, vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs or supplements that affect blood clotting several days to a week before surgery.
Ask your doctor which drugs you should still take on the day of your surgery. Your doctor or nurse will tell you when to arrive at the hospital.

On the day of your surgery:

Do not eat or drink anything after midnight the night before your surgery.
Take your drugs your doctor told you to take with a small sip of water.
Shower the night before or the morning of your surgery.

Anti-reflux surgery is a safe operation.
Heartburn and other symptoms should improve after surgery. But you may still need to take drugs for your heartburn after surgery.
Some people will need another operation in the future to treat new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the oesophagus too tightly, the wrap loosens, or a new hiatal hernia develops.

For most patients with adequate private health insurance, out of pocket costs for laparoscopic fundoplication are up to $500. Without private health insurance, out of pocket costs are higher and depend on the hospital. In both cases, full informed financial consent is provided after your consultation and before you commit to surgery. The detail below explains how the costs work.

With Private Health Insurance

There is no waiting list. If you wish, your operation can usually be performed within a week or two or planned at a time of your choosing. For most patients with full private health insurance there will be some extra costs not covered by Medicare or your health fund. The cover provided by your health fund will vary according to which fund and which level of cover you are on and in some cases you may have to pay an “excess”. It is your responsibility to check with your health fund prior to surgery. Full financial details will be provided to you prior to surgery. Occasionally other tests, procedures or specialist consultations may be necessary and some other costs incurred.

Without Private Health Insurance

Public hospital waiting lists are very long and the surgery is usually carried out by trainee surgeons under the supervision of one of the specialist surgeons appointed by the hospital. There is no choice of surgeon in the Public Hospital and your LapSurgery Australia surgeon cannot be involved in your operation.

If you do not have private health insurance, you can expect to have high out of pocket costs. Following your consultation with our surgeon our staff will be able to give you an informed financial consent prior to going ahead with surgery.

Hospitals used by LapSurgery Australia for this surgery are:

Mulgrave Private Hospital – Mulgrave
Knox Private Hospital – Wantirna.
Peninsula Private Hospital – Frankston.
St John of God Berwick Hospital – Berwick.

Reflux Surgery Questions

Frequently Asked Questions

Common questions about anti reflux surgery

For most patients with adequate private health insurance, out of pocket costs are up to $500, with health fund cover and any excess varying by fund and level of cover. Without insurance, out of pocket costs are higher and depend on the hospital. Full informed financial consent is provided after your consultation. Contact us for a written estimate.

An operation for reflux in which the top of the stomach is wrapped fully around the lower oesophagus, recreating the valve that stops acid flowing back up. It is performed as keyhole surgery under general anaesthesia and usually includes repair of any hiatus hernia at the same time.

A Nissen wraps the stomach fully around the oesophagus for the strongest reflux control, while partial wraps such as the Toupet go only partway around, reducing side effects like gas bloat and swallowing difficulty. Your manometry results and symptoms guide which wrap your surgeon recommends.

That is the aim. Surgery corrects the anatomical causes of reflux that medication cannot, and heartburn and other symptoms should improve after surgery, allowing many patients to come off daily tablets. We are honest that some patients still need medication afterwards, and your surgeon will discuss realistic expectations for your case.

The operation usually takes 2 to 3 hours under general anaesthesia, performed as keyhole surgery in almost all cases. Your hospital stay depends on the size of the repair and will be discussed at your consultation.

The most common are gas bloat, which makes it hard to burp and causes bloating after meals, and some difficulty swallowing. Both improve for most people, with swallowing usually settling within the first three months. Rare risks and the possibility of recurrence are covered openly in the risks section above and at your consultation.

Not privately. With private health insurance your operation can usually be performed within a week or two, or planned at a time of your choosing. Public hospital waiting lists are very long, with no choice of surgeon.

Have more questions? We're here to help.

The team at LapSurgery Australia are recognised for their exceptional and major contribution to the Government sponsored Bariatric Safety Registry (BSR). The BSR tracks surgical complications and provides an unbiased safety record for weight loss surgery.

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