Anti-Reflux Surgery (Fundoplication) in Gloucester

Living with chronic acid reflux can have a significant impact on your quality of life, making even simple meals or a good night's sleep a challenge. While many people manage their symptoms through lifestyle changes or medication, some require a more permanent solution.

Anti-reflux surgery, commonly called fundoplication (or Nissen fundoplication), is a surgical treatment for patients experiencing severe, persistent Gastro-Oesophageal Reflux Disease (GERD). It’s typically considered when other medical treatments have failed to provide adequate relief from symptoms. The good news is that modern laparoscopic fundoplication (keyhole surgery) techniques have made the surgery a safe and effective procedure, with excellent outcomes.

In this guide, we’ll explain what GERD is, the situations where anti-reflux surgery is typically suggested, and the different types of surgery available. We’ll also look at typical GERD surgery recovery times and what you can expect from a fundoplication operation with Ramsay Health Care.

Understanding GERD and acid reflux

Acid reflux is when stomach acid frequently flows back into your oesophagus (food pipe), causing symptoms like heartburn and chest discomfort. When this happens frequently and severely, it becomes Gastroesophageal Reflux Disease (GERD) – a chronic condition requiring medical attention.

Normally, the lower oesophageal sphincter (LES) acts as a valve, closing after food passes into your stomach to prevent acid from rising back up. In GERD, this muscle weakens or relaxes inappropriately, allowing persistent acid to reflux into the oesophagus.

Common symptoms include heartburn, regurgitation, chronic cough, chest pain, an unpleasant sour taste, and difficulty swallowing.

GERD often coexists with a hiatus hernia - a condition where part of your stomach pushes through the diaphragm opening into your chest cavity. This can weaken the LES further and worsen reflux symptoms.

Not everyone with GERD will need anti-reflux surgery. Most patients are recommended other treatments first, including making lifestyle modifications and medication. However, if these don’t help or if you wish to be free of long-term medication, fundoplication surgery can be an effective solution.

When is anti-reflux surgery recommended?

Fundoplication surgery is typically recommended after other treatments have been tried without adequate success. Your specialist may suggest anti-reflux surgery when:

• Symptoms remain inadequately controlled: Despite maximum medical therapy, including high-dose proton pump inhibitors (PPIs), your GERD symptoms persist.

• You wish to discontinue long-term medication: Some patients, particularly younger people, may prefer a one-time surgical procedure rather than taking daily medication indefinitely.

• Medications cause problematic side effects: You experience intolerance or severe side effects from reflux medications.

• You have a large hiatus hernia: While small hiatus hernias can often be managed medically, larger ones causing significant symptoms typically require surgical repair alongside fundoplication.

• GERD complications have developed: You have severe oesophagitis (inflammation of the oesophagus), strictures (narrowing of the food pipe), or Barrett’s oesophagus (cellular changes in the oesophageal lining).

• You have reflux-related respiratory symptoms: Atypical symptoms such as chronic cough, hoarseness, or asthma-like issues have been confirmed as reflux-related.

• Quality of life is significantly affected: Your daily activities, including eating, sleeping, and leisure, are substantially affected by GERD despite treatment.

Types of anti-reflux surgery

GERD surgery can be performed in several ways, including Nissen fundoplication, partial fundoplication, and laparoscopic fundoplication. 

Your surgeon will recommend the most suitable approach for you based on your symptoms, the results of your diagnostic tests, and your overall health.

Nissen fundoplication

This is the most common type of anti-reflux surgery and is considered the "gold standard" for treating GERD.

Nissen fundoplication involves wrapping the upper part of the stomach (the fundus) 360° around the lower oesophagus. This creates a new one-way valve that prevents acid from refluxing while still allowing food to pass into the stomach. If a hiatus hernia is present, your surgeon will typically repair this during the same procedure.

Nissen fundoplication offers several key advantages. It has a high success rate for reflux control, provides durable long-term results, and is cost-effective compared to lifelong medication use. It’s particularly effective for patients with severe reflux symptoms and normal oesophageal motility (where the muscles of the oesophagus can move normally to push food through it).

After the procedure, some patients may initially find it difficult to burp or vomit. Some may experience gas-bloat syndrome (GBS) with severe abdominal bloating, though this typically improves with time, especially after making dietary modifications.

A Nissen fundoplication is usually recommended for most GERD patients who require surgery and have normal oesophageal motility.

Partial fundoplication

With a partial fundoplication, the upper stomach (fundus) is only wrapped part of the way around the lower oesophagus, less than the full 360-degree wrapping of a Nissen fundoplication.

A partial fundoplication usually takes one of two forms:

• Toupet fundoplication: A 270° posterior wrap. 

• Dor fundoplication: A 180° anterior wrap. 

Partial fundoplications are typically performed for patients who have mildly impaired oesophageal motility (where the muscles of the oesophagus don’t move entirely as they should to push food through the oesophagus). This is especially the case with elderly patients, who may be at risk of experiencing swallowing difficulties if they have a full Nissen fundoplication.

A partial fundoplication offers a trade-off for suitable patients. The partial wrapping of the upper stomach around the lower oesophagus reduces the risk of swallowing issues and complications, like difficulties burping or vomiting, or gas-bloat syndrome (GBS). However, there is a slightly higher risk of reflux recurrence compared to the full Nissen procedure.

It is usually recommended when patients have mildly impaired oesophageal motility, in complex cases, or as a revision procedure (a corrective operation performed after an earlier anti-reflux surgery).

Laparoscopic (keyhole) vs. open fundoplication surgery

Fundoplication surgery can be performed as a keyhole operation (laparoscopic surgery) or as a more traditional open surgery operation:

• Laparoscopic fundoplication surgery: This is now the standard approach for most patients. The surgeon makes five small incisions (usually 0.5cm–1cm) in the abdomen to insert a camera (laparoscope) and surgical instruments. This minimally invasive technique offers less pain, smaller scars, faster recovery, shorter hospital stay, and quicker return to normal activities, with success rates equivalent to open surgery. 

• Open fundoplication surgery: This involves a single large incision in the abdomen rather than keyhole incisions. Open fundoplication surgery is rarely performed today, but it may still be the best option in complex cases or if a patient has extensive scarring from previous abdominal surgeries. 

• Robotic-assisted fundoplication surgery: Available at some specialist centres, this offers potential advantages in surgical precision and may be an option in complex cases. 

The fundoplication procedure: What to expect

While the details of every fundoplication surgery can vary, in broad terms, you can expect the following:

Before your fundoplication surgery

Before the operation, you’ll have a pre-operative assessment with your surgeon. They’ll review any tests or other diagnostic procedures you’ve had relating to your GERD to ensure they have a complete understanding of your condition and can plan the best surgical approach.

Your Ramsay Health Care team will give you specific instructions on what to do before you come to us on the day of your anti-reflux surgery, but this commonly involves:

• Stopping smoking at least six weeks before your operation, as this is essential for healing.

• Reducing your weight, if needed.

• Stopping taking certain medications in a certain time frame, including not taking Proton Pump Inhibitor (PPI) medication for two weeks beforehand (to allow for accurate assessment of your GERD).

• Following fasting instructions, such as avoiding food for 6 hours and water for two hours before the procedure.

• Arranging transport home, as due to the effects of the anaesthesia, you won’t be able to drive yourself after the procedure.

• Arranging for someone to stay with you for a few days after your surgery, as you’ll need help with daily activities during initial recovery.

• Arranging time off work for you to recover.

• Stocking up on soft, easily digestible food at home.

During your fundoplication surgery

Your fundoplication surgery will be performed under general anaesthesia, so you’ll be asleep throughout the operation. The procedure typically takes between one and a half and three hours, depending on the details of your surgery.

If you’re having laparoscopic fundoplication surgery, it will typically be performed as follows:

• Five small incisions (between 0.5cm–1cm) are made in your upper abdomen.

• Carbon dioxide gas is pumped into your abdomen to inflate it, to create more working space for the surgeon.

• A laparoscope, a thin tube with a camera on the end, is inserted into your abdomen. Video from the camera is shown on a screen to the surgeon or an eyepiece.

• If you have a hiatus hernia, it will be repaired first. Your surgeon will return the stomach to the abdomen and narrow the opening in the diaphragm with stitches. 

• The fundus (upper part of the stomach) is cut away from its surrounding attachments.

• The surgeon then wraps the fundus around the lower oesophagus. How far this happens will depend upon the type of fundoplication surgery you’re having – 360° with a Nissen fundoplication, 270° for a Toupet fundoplication, and 180 ° for a Dor fundoplication.

• The wrap will be secured with stitches.

• The surgical instruments will be removed, and the incisions will be closed and dressed.

• A nasogastric tube may be fitted whilst you remain in hospital – this is a thin, flexible tube inserted through your nose that runs into your stomach to remove fluids and air. If used, it will be removed before you’re discharged, usually within a day or two.

• In some cases, a surgical drain may be placed to remove excess fluid. If used, this will be removed before you leave the hospital.

Immediately after your fundoplication surgery

Once your fundoplication operation is complete, you’ll be taken to a recovery area where you’ll be monitored as you wake from your anaesthesia. You’ll be provided with pain medication to help manage whatever pain you're experiencing.

You’ll typically stay in the hospital for one to three nights, depending on the details of your operation, your health, and how well you initially recover. You’ll be encouraged to stand and walk gently from day one to help with your recovery.

You can usually drink clear fluids the evening of your surgery or by the next morning. Simple, soft food will typically be introduced the next day. You’ll be discharged when our medical team is happy that your pain is under control, you can eat comfortably, and you don’t have any complications.

Recovery after your fundoplication surgery

Recovery from fundoplication surgery is gradual, and your experience will depend on the complexity of your procedure and your overall health. However, most patients follow a similar timeline:

Hospital stay (1–3 days)

Most patients stay in the hospital for one to three days following their anti-reflux surgery.

Pain will usually be mild to moderate and is initially controlled with intravenous pain relief before switching to oral medication. Fluids are introduced gradually, followed by a soft diet as tolerated. Early movement is encouraged, as walking soon after surgery helps reduce the risk of blood clots and chest infections.

You may be taught breathing exercises (chest physiotherapy) to help support your lung function after the operation. You’re usually discharged from the hospital once you can eat and drink, your pain is well controlled, and there are no signs of complications.

The first 2 weeks at home

It’s normal to experience some pain and discomfort during the first two weeks after your GERD surgery. This may include mild pain around the incision sites, shoulder pain caused by the gas used during the operation (which usually settles within a few days), and bloating or abdominal discomfort. This can usually be managed well with pain medication, either prescription or over-the-counter, as required.

Your diet will be particularly important during your early recovery. For the first one to two weeks, you should have liquids and very soft foods only, like soup, yoghurt, puréed foods, scrambled eggs, and mashed potatoes.

You’ll need to eat small, frequent meals (around five to six per day) rather than larger ones, taking your time to chew food thoroughly. You should avoid drinks and food that will give you stomach gas, like carbonated drinks, and anything that may be hard to swallow, including bread and solid meat. You may notice a feeling of tightness or difficulty swallowing (dysphagia). This is common after fundoplication surgery and usually improves gradually over several weeks as swelling reduces.

Getting plenty of rest will be important during this time, but gentle walking will be encouraged to help you recover. You’ll need to avoid any heavy lifting or strenuous activity, but most people can manage stairs and light household tasks. 

You should be able to shower, and you will need to pat your incisions dry to avoid opening them.

Weeks 2-6 of your fundoplication recovery

Between weeks two and four, you can usually add more to your diet, although still focusing on softer foods, like well-cooked vegetables, fish, minced meat, and soft pasta.

From weeks four to six, foods with a more normal texture can often be gradually introduced. You’ll need to continue to eat small portions and slowly. You’ll still need to avoid food that’s harder to swallow, and that could make you burp, like tougher cuts of meat, crusty bread, and raw vegetables. There may be some foods you’ll never tolerate well after a fundoplication that you’ll need to eliminate from your diet permanently.

You should be able to gradually increase your activity levels, such as walking for longer, but you should still avoid more strenuous activity and heavy lifting. 

Many patients can return to work during this period. If you work at a desk or otherwise have a sedentary job, you may be able to return to work within one to three weeks. If your job is more physical, it may take up to six weeks or longer. Your surgeon will advise you on the appropriate timing based on your specific role and recovery progress.

You’ll likely be able to drive again in this period, with many patients able to get behind the wheel after two weeks or so, once you feel comfortable doing so and you can safely perform an emergency stop. You may also have to check with your car insurance company that you’ll be covered to drive.

Weeks 6-12 of your fundoplication recovery

Between weeks six and 12 after their surgery, most patients are close to returning to their normal lives. A largely normal diet is usually possible, although you may have to continue to make some modifications.

You’ll gradually resume most of your normal activities, including exercise and work, although you may still have to be careful with strenuous exercise and heavy lifting.

You may still have some lasting but temporary side effects, such as bloating or difficulty burping, but these should continue to improve as your healing progresses (internal healing is still ongoing during this time).

Long-term fundoplication recovery (12 weeks and beyond)

After around three months, most patients are fully healed and have adapted to new eating patterns. Reflux symptoms are usually well-controlled or completely resolved.

Most side effects settle over time, although you may need to continue to avoid certain foods over the long term. You should be able to resume all your previous activities and be back to living the life you did before your surgery, although with much reduced symptoms of GERD, or even no symptoms at all.

If you experience any persistent symptoms or concerns during your recovery, contact your surgical team for advice.

The risks and complications of anti-reflux surgery

Fundoplication surgery is generally a safe and effective procedure with high success rates. However, as with all surgical procedures, there are potential risks and side effects. Your surgical team will discuss these with you in detail before your operation and will take steps to minimise these risks. Common issues include:

Common temporary side effects

The following effects are relatively common after fundoplication surgery and are considered a normal part of recovery rather than true complications:

• Difficulty swallowing (dysphagia): It is caused by swelling and tightness around the surgical site and usually improves gradually over three to six months.

• Gas-bloat symptoms: Some patients experience bloating, trapped wind, or discomfort after meals. This usually improves with time as the body adapts.

• General abdominal bloating or a feeling of fullness: This is common in the early recovery period, but typically improves within the first few weeks.

• Inability to burp or vomit: This can occur initially after surgery and is often temporary, although for some patients this may be a long-term effect of the surgery.

• Shoulder pain: Some patients experience shoulder pain caused by the carbon dioxide gas pumped into their abdomen during keyhole surgery, but it typically settles within a few days.

Most of these issues resolve as your body heals and adapts to the changes. You can help minimise discomfort by eating slowly, taking small bites, chewing thoroughly, and following all the dietary guidance provided by your Ramsay team.

Less common risks and complications

While rare, the following complications can occur with fundoplication surgery:

• Bleeding: Significant bleeding, which is rare but may require transfusion or reoperation.

• Infection: At the surgical site or internally.

• Damage to nearby organs: Including the spleen (splenic injury/infarction), liver, bowel, or blood vessels.

• Pneumothorax: Air leakage around the lung from damage to the lining during dissection. This may require treatment with a chest drain, but it usually resolves fully.

• Anaesthesia risks: Reactions or complications from general anaesthesia.

• Slipped fundoplication: The wrap moves off the oesophagus (usually months or years after surgery), causing reflux to return.

• Tight fundoplication: The wrap is too tight, causing persistent severe dysphagia and gas bloat that may require corrective surgery.

• Oesophageal stricture: Narrowing at this surgical site that may require dilation.

How to reduce your risk

The risk of complications can be reduced through:

• Having surgery performed by an experienced upper GI surgeon.

• Preparing for your operation as advised.

• Following all your post-operative instructions carefully, particularly the dietary advice, during your recovery.

When to contact your surgeon or seek medical advice

Most patients recover from fundoplication surgery without complications. However, you should contact your surgical team or seek medical advice if you experience:

• Severe or persistent difficulty swallowing that doesn’t improve over time

• An inability to keep food or fluids down, or persistent vomiting

• Significant or unintended weight loss

• A return of severe reflux symptoms

• Severe or worsening abdominal pain

• Fever above 38°C (100.4°F)

• Chest pain or difficulty breathing

• Redness, swelling, or discharge from incision sites

• Any other signs of infection or other serious complications

In an emergency, such as severe chest pain or difficulty breathing, call 999 or go to A&E immediately.

Alternatives to fundoplication

Fundoplication surgery is a highly effective treatment for GERD, but it is not the only option. Depending on your symptoms, overall health, and personal preferences, your doctor may discuss the following alternatives:

Medical management

Many patients with GERD can successfully manage their reflux symptoms with lifestyle changes and anti-reflux medication, most commonly proton pump inhibitors (PPIs). These medications are suitable for many patients and reduce stomach acid effectively.

PPIs are generally safe for long-term use. However, concerns have been raised about the potential effects of lifelong PPI use, including possible impacts on bone health, nutrient absorption, and a slightly increased risk of certain infections. Some patients also prefer to avoid taking long-term medication**, find that their symptoms are not fully controlled, or experience side effects, and therefore seek surgical options.

LINX® magnetic sphincter augmentation

The LINX device is a small ring of magnetic beads that’s placed around the lower oesophagus during a minimally invasive surgical procedure. The magnets allow the device to open when swallowing and close afterwards to help prevent reflux.

Potential advantages of the LINX device include the ability to still burp and vomit, which can be difficult after a full Nissen fundoplication. However, LINX is a newer technology with significantly less long-term outcome data compared to surgical fundoplication. Newer devices have improved MRI compatibility, though some restrictions may still apply, and the procedure may not be suitable for patients with large hiatus hernias.

Stretta procedure

The Stretta procedure is a minimally invasive, endoscopic treatment that uses radiofrequency energy applied to the lower oesophageal sphincter to remodel the tissue. It aims to improve reflux control by tightening and strengthening the sphincter muscle.

Current evidence for long-term effectiveness is limited, and the procedure is generally considered suitable only for carefully selected patients with mild reflux symptoms who do not have significant anatomical abnormalities, such as large hiatus hernias.

Transoral incisionless fundoplication (TIF)

TIF is an endoscopic procedure that creates a partial anti-reflux valve from inside the stomach, without any external incisions being made. It may be an option for select patients who wish to avoid traditional surgery.

However, long-term data on the effectiveness of TIF remain limited, and studies suggest it is generally considered less effective than surgical fundoplication for controlling reflux symptoms. It’s usually offered only to carefully selected patients with less severe disease.

Choosing the right treatment for you

The most appropriate anti-reflux treatment option for you will depend on several factors, including:

•  The severity of your GERD symptoms and their impact on quality of life
• Test results showing oesophageal function and anatomy
• The presence and size of any hiatus hernia
• Your response to previous medical treatments
• Your overall health and fitness for surgery
• Your personal preferences and lifestyle considerations
• The experience and expertise of your surgical team

For most suitable patients with severe or persistent GERD, surgical fundoplication remains the gold standard treatment with the most robust long-term evidence. 

A discussion with one of our experienced Ramsay Health Care upper GI surgeons can help you understand all your options and determine the most appropriate treatment for your individual situation.

Why choose private fundoplication surgery?

Opting to have your fundoplication surgery privately can offer a range of benefits, including:

• Enhanced privacy and dignity – Your own private room throughout your stay, ensuring comfort and discretion during your recovery.
• Faster access to treatment –Private care means you can schedule your surgery quickly, at a time that suits you, rather than being placed on a lengthy waiting list.
• Continuity of care – You'll be cared for by the same consultant surgeon from initial consultation through to follow-up care, building a relationship with a specialist who understands your individual needs and treatment plan.
• Flexible appointments – Appointments arranged at times that work around your schedule, from your initial consultation through to post-operative follow-up appointments.

How much does private fundoplication surgery cost?

The cost of fundoplication surgery will depend on the exact type of surgery you require, and your Ramsay hospital of choice.

Our enquiry centre and online booking platform will guide on the consultant fee for an initial consultation. You will then receive a formal quotation price following for your consultation, which will be valid for 60 days.

We have a number of funding options if you are paying for your anti reflux surgery yourself. These include:

• Interest-free finance – 0% payment plans available, no deposit required

• All-inclusive Total Care - one-off pre-agreed payment for access to all the treatment you need for complete reassurance.

• Pay as you go – flexible funding to pay for treatment as and when costs arise. Often used if your treatment costs are difficult to asse

Anti-reflux surgery at Ramsay Health Care

At Ramsay Health Care, we are a leading provider of fundoplication surgery and anti-reflux procedures, combining the expertise of experienced upper GI surgeons with the personalised support you need from consultation through to full recovery. 

Your Ramsay experience:

• Convenient locations across the UK, many with on-site parking.

• State-of-the-art facilities equipped with the latest laparoscopic surgical technology. 

• Comprehensive, personalised treatment plans tailored to your specific condition and needs.

• Dedicated patient support from consultation to full recovery, with easy access to your surgical team throughout your journey.

Ready to discuss your options? Contact us today to learn more about fundoplication surgery at Ramsay Health Care and to book a consultation. You can also research consultant availability and book online for a consultation. 

Anti-Reflux Surgery FAQs