Laparoscopic reflux surgery (fundoplication) at Hereford Hospital

What is acid reflux?

Acid reflux, also known as indigestion, heartburn or GERD (gastroesophageal reflux disease), occurs when stomach acid travels up your oesophagus (gullet). This acid can cause a burning sensation in your chest.

Acid reflux can happen if the valve between your stomach and your oesophagus isn't working properly.

Is laparoscopic reflux surgery right for me?

Medication that lowers the acid content in your stomach may resolve this condition.

However, if conservative methods aren't working for you, your surgeon may recommend laparoscopic anti-reflux surgery.

Because keyhole surgery is minimally invasive, your hospital stay will be shorter than open surgery. 

What happens during laparoscopic reflux surgery?

This procedure is usually performed under general anaesthetic and takes 1–2 hours.

Laparoscopic (keyhole) surgery is associated with less pain and scarring than open surgery, as well as a faster return to normal activities.

In some cases, laparoscopic surgery can't be performed, and you may need to have open surgery instead. Your surgeon will carefully assess you beforehand. 

Before the procedure

There are a few things you can do in the lead up to the procedure to make sure everything goes as smoothly as possible:

• Let your doctor know about any medication you take and follow their instructions
• If you smoke, stop smoking several weeks before the operation
• Try to maintain a healthy weight
• Exercise regularly 
• In the week before the operation, don't shave or wax the area where a cut is likely to be made
• Try to have a bath or shower either the day before or on the day of the operation
• If you are diabetic, keep your blood sugar levels under control around the time of your procedure.

During the procedure

1. Once you're under anaesthetic, your surgeon will make a small cut on or near your belly button and insert an instrument to inflate your abdominal cavity with carbon dioxide
2. They'll make a few more cuts on your abdomen so they can insert surgical instruments, as well as a laparoscope (tiny telescope), via thin tubes
3. Your surgeon will hold your liver out of the way and free up the upper stomach and lower oesophagus, along with the muscular part of your diaphragm
4. Then they'll stitch your diaphragm to reduce the size of the hole your oesophagus passes through
5. Next they'll wrap and stitch the top part of your stomach around your lower oesophagus to create a valve effect
6. Finally, they'll close your wounds with stitches or staples.

After the procedure

Once your operation is over, you’ll be taken to the recovery room where you'll wake up. A nurse will be there to check your wounds, blood pressure and pulse.

You may have a drain in your abdomen to remove any fluid. This will be removed before you leave hospital.

You may also have a drip (infusion) going into your arm. This will keep you hydrated until you're able to drink.

When you're ready, a nurse will take you to your room.

Recovery form laparoscopic reflux surgery

Most people return to normal activities after 2–3 weeks. You'll need to change what you eat after the procedure, but you should be able to return to a normal diet after 6 weeks.

Short-term recovery

Back in your room, you'll be given anti-sickness medication and painkillers. You'll be able about to drink from the first day, and then you'll go on a diet of soft foods.

You should be able to go home the same day or you may need to spend one night in hospital. If you home on the day of the procedure, for the first 24 hours:

• you’ll need someone to take you home and stay with you overnight
• don’t drive, operate machinery, or do any potentially dangerous activities (like cooking) until you’ve fully recovered feeling, movement and co-ordination
• you shouldn’t sign legal documents or drink alcohol.

Managing your recovery at home

You should get plenty of rest to begin with, but then it’s important to stay active to avoid blood clots. Make sure you follow the instructions from our healthcare team on medication or special compression stockings. 

Here are a few more things you can do to make sure you recover well:

• Eat slowly and chew your food thoroughly
• Avoid fizzy drinks
• Follow any other guidance we give you on what to eat and drink 
• Take any pain relief medication we've prescribed
• Avoid strenuous activity for the first 2 weeks
• Exercise regularly
• Don't do any heavy lifting for a few weeks.

If you notice any of the following symptoms, let the healthcare team know straightaway as it can be a sign you have a serious complication.

• Pain that gets worse over time or is severe when you move, breathe or cough
• A high temperature or fever
• Dizziness, feeling faint or shortness of breath
• Feeling sick or not having an appetite, which gets worse after the first 1–2 days
• Not opening your bowels and not passing wind
• Swelling in your abdomen
• Difficulty passing urine.

Time off work

You should be able to return to work after a few weeks, depending on your recovery and the type of work you do. 

Complications of laparoscopic reflux surgery

As with any surgery there's a small chance of complications, such as:

• pain
• bleeding
• infection of the surgical site (incision)
• scarring
• blood clots (DVT - deep vein thrombosis).
  

Specific complications of laparoscopic anti reflux surgery can include:

• damage to internal organs
• developing a hernia near your wound sites
• difficulty swallowing
• air in chest cavity
• tear of the stitches holding the stomach wrap
• liver damage
• recurrence of reflux.
  

The healthcare team will do their best to minimise any risks. Make sure you discuss any concerns you have about these complications with your consultant.