Before proceeding to anti-reflux surgery, we will need to carry out a series of tests (unless your physician has already done so) in order to confirm the diagnosis of gastro-oesophageal reflux, to assess what damage this might have caused to the gullet, and to rule out other possible explanations for your symptoms or complaints. These tests include:

Endoscopy: This test involves the passage of a camera through the mouth and down the gullet to look at the oesophagus and assess the degree of damage that is being caused by the acid.

Oesophageal manometry: This test determines how your gullet works. It demonstrates whether the sphincter between your oesophagus and the stomach is functioning well and ensures that your gullet is working normally (has normal peristalsis).

24-hour oesophageal pH monitoring: In this test a fine probe is placed in the lower part of your oesophagus so that the amount of acid that flows into it can be measured over a 24 hour period. This shows just how much acid refluxes each day. Your symptoms are examined against the reflux events to see if there is a good correlation between the two, which would then predict a favourable outcome from surgery.

Ultrasound of abdomen: Some patients complain of various symptoms, some of which may not necessarily be related to acid reflux, and could possibly be related to gallstones. An ultrasound of the abdomen can answer this question.

Surgery is performed laparoscopically (keyhole approach). The operation is performed through 5 very small incisions. In anti-reflux surgery, the top part of the stomach is mobilised using special instruments. This part of the stomach is then passed around the lower part of the oesophagus (gullet) and the stomach is sutured to form a partial wrap of stomach around the lower part of the gullet (fundoplication). This acts as a valve that prevents the acid contents of the stomach refluxing back into the gullet. In case of a large hiatal hernia the use of a mesh (prosthesis) may be required.

Following laparoscopic anti-reflux surgery you should feel abdominal discomfort for 1-2 days and minimal pain thereafter. A fundoplication usually involves an overnight stay in hospital though some patients may be discharged home on the same day. 

Complications may occur after the operation such as wound infection, although this is very rare, and chest infection. Dysphagia and bloating can develop after such an operation short to long term. The main side effect that may occur is an increased passage of wind (flatus) per rectum. This may be a permanent situation and is called the “gas bloat syndrome”. One of the problems of inserting a valve between the stomach and the gullet is that air cannot be freely belched out. This means that the air passes through the intestines and leads to more air being produced per anus. After laparoscopic anti-reflux surgery it is important to chew food completely and to eat slowly.

In the long term, 1 in 10 patients (10%) may have recurrence of the reflux symptoms and require a proton pump inhibitor to decrease the stomach acidity or revision surgery.

Those with sedentary jobs should be able to resume work within 1-2 weeks and for heavy manual work, within 3-4 weeks. 

You need to follow a specific diet for the first 4-6 weeks after the operation. The diet details will be discussed during the consultation. Usually you will be drinking fluids a few hours after the surgery. It is advisable to avoid bread and read meat for the first 2-3 months. Fizzy drinks should be avoided for at least 6 months. You will often notice during the first few weeks that food tends to stick. It is very important therefore, to eat slowly and to chew food thoroughly. For a few days after the operation you may need some gentle painkillers. These should not be necessary after about 5-7 days. Your anti-reflux medication should be stopped at the time of the operation and should not be necessary thereafter.