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Most people have had heartburn or acid reflux at some time in their life. Acid reflux occurs when contents of the stomach move upwards in to the gullet past the lower oesophageal sphincter. Acid reflux may damage the lining of the gullet. This whole process is called gastro-
The Lower Oesophageal Sphincter (LOS) is a ring of smooth muscle tissue, which acts as a two way valve between the stomach and the gullet. It allows food in to the stomach and prevents movement of the stomach contents in to the gullet. A weak LOS could lead to acid reflux. In some people weak LOS is associated with a hiatus hernia. The LOS also allows vomiting and belching as a normal physiological response.
When the LOS relaxes or closes partially, reflux can occur. Infrequent reflux can be annoying but does not lead to any harm. However, frequent reflux can cause serious damage to the gullet affecting health and quality of life. Frequent reflux of acid can damage the gullet lining causing oesophagitis. Rarely, recurrent oesophagitis can lead to a stricture (narrowing). Very small percentage can develop a pre-
In addition to a faulty LOS, GORD can be aggravated by:
• Delayed gastric emptying (food stays in the stomach for longer before it is passed in to the small bowel).
• Impaired oesophageal function (weaker gullet muscle function which pushes food forward in to the stomach)
• Low production of saliva (important in neutralising stomach acid)
• Smoking, excessive caffeine and alcohol consumption
What is the alternate option?
Surgery is designed to control acid reflux and get you off medication. The only other option would be to continue medication to control acid reflux.
Do I need any tests?
We usually perform the following tests before deciding your suitability for laparoscopic fundoplication.
Allows inspection of the oesophagus, the stomach and the duodenum (first part of small bowel). This is done with the patient sedated or by anaesthetising back of the throat with local anaesthetic spray. This technique allows your doctor to identify complications of GORD and obtain samples from the gullet and the stomach lining.
This is done (under local anaesthetic spray) by passing a fine probe via the nostril in to the gullet. This test is designed to assess gullet muscular movements.
24 hour Oesophageal pH monitoring:
This test is done by passing a very fine probe in to the gullet, which is left for 24 hours. This test is carried out immediately after the manometry test. The probe is connected to a small machine which looks like a Walkman. This allows to measure acid reflux in to the gullet. You will be asked to return after
24 hours for removal of the probe:
All these tests are carried out as out-
What is a Hiatus Hernia?
A Hiatus hernia occurs when part or whole of the stomach protrudes in to the chest through a weakness in the diaphragm. There are two types of Hiatus hernia: sliding or rolling. If you have a hiatus hernia, your surgeon may repair it during fundoplication.
What is the treatment?
The majority who suffer from GORD respond well to life style changes. If symptoms persist long term medication may be required. In some patients, surgery may be recommended because medication and life style changes have not been effective. Surgery may also be indicated in patients who do not wish to take long term medication because of side effects.
Surgery is designed to provide a cure for GORD. The name of the surgery is referred to as a laparoscopic fundoplication. The aim of the surgery is to create an artificial valve to prevent the stomach contents from moving upwards in to the gullet.
Do I need an operation?
You may need an operation to control acid reflux if you have any of the following:
• Oesophagitis despite being on high dose medication
• Persistent symptoms despite being on regular medication prescribed by your doctor
• Side effects from medication
• You do not wish to continue taking long term medication
Sliding Hiatus Hernia
Sliding Hiatus Hernia
What is a Laparoscopic fundoplication?
A laparoscopic fundoplication is a keyhole procedure performed under general anaesthesia. Five small cuts are made in the upper abdomen above the belly button. In order to obtain a good view of the inside of your abdomen, carbon dioxide is introduced to inflate the abdomen which will help to carry out the operation. Fundoplication involves wrapping the top end (fundus) of the stomach around the lower end of the oesophagus. Although we intend to carry out the procedure laparoscopically, occasionally we may need to convert to open surgery in order to perform a safer surgery.
There are different types of fundoplication depending on the type of wrap:
• Nissen fundoplication (360° wrap)
• Toupet fundoplication (270° wrap)
• Dor fundoplication (180° wrap)
Your surgeon will decide an appropriate type of fundoplication based on your test results. Your surgeon will be able to explain the procedures using some illustrations.
Do I need any preparation before the operation?
You will need a pre-
How long do I need to stay in the hospital?
What should I expect after the operation?
Though the operation cuts are small, some discomfort is normally expected. You will receive regular pain killers and anti-
Should I follow any special diet after the operation?
Generally speaking the lower end of the gullet and the top end of the stomach will swell up after the operation, making swallowing difficulty. To help with the healing process we advise a pureed diet for three weeks. After this period we advise you to slowly reintroduce solid food. You may lose some weight as a result of the diet restrictions in this period.
Should I continue my reflux medication?
You should be able to stop your medication after surgery.
What are the risks of a fundoplication?
Fortunately, major complications are rare after fundoplication. Laparoscopic Fundoplication is generally considered to be safe and effective. Approximately 90% of patients remain symptom free even after 10 years following the surgery.
As explained earlier, it is to be expected that your swallowing will get worse before it gets better. It is vital that you follow the dietary advice given to you.
Some of the possible risks associated with this specific procedure are:
• Long term difficulty in swallowing. This may need a further endoscopy to stretch the bottom of the oesophagus.
• Gas bloat. If the wrap works too well then you might not be able to burp or vomit. This happens in about 20% of patients. In this case you may often feel bloated and some people complain of passing more wind as a result!
• Failure to control the acid reflux. This happens in about 10% of people who have this operation.
• Bleeding. Some is expected during the operation and in the rare case of severe bleeding we might have to convert the operation to an open one.
• Damage to other abdominal organs. This is a rare complication.
Report to your surgeon or nurse specialist
Contact your team if you notice any of the following:
• Fever >38C or chills
• Bleeding from wounds
• Vomiting blood
• Increasing abdominal pains
• Increasing chest pain
• Difficulty swallowing
• Infection of the wounds
• Any concerns with the surgery
We’re here to help with any questions you have about any of the procedures we offer.
To find out more about Nu-
• Call us on 0845 257 5433
• Send an email to info@nu-
• Fill out our general enquiry form
• Make a consultation enquiry
• Visit our Frequently Asked Questions area
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