Reflux surgery focuses on the surgical treatment of chronic heartburn and its consequences – a condition that is far more than just an annoying burning sensation behind the breastbone. When medications are no longer sufficient or the backflow of stomach acid has already led to inflammation, mucosal damage, or a reduced quality of life, a surgical procedure can restore the natural barrier between the stomach and the esophagus.
:contentReference[oaicite:0]{index=0}, MD, Professor (USC), has established himself as one of the world’s leading experts in innovative reflux surgery, particularly through his expertise in minimally invasive surgery and groundbreaking techniques such as RefluxStop™. As Surgical Director at Swiss1Chirurgie and at the Hirslanden Clinic Beau-Site in Bern, he has made a significant contribution to the development and dissemination of new treatment approaches.
The editorial team of the Leading Medicine Guide had the opportunity to speak with Professor :contentReference[oaicite:1]{index=1} about this groundbreaking development.
Reflux surgery has existed since the 1950s and 60s, but it was not until the introduction of laparoscopic, i.e., minimally invasive surgery in the early 1990s that surgical treatment became widespread.
“The classic procedures were fundoplications, in which the stomach is wrapped around the esophagus – either as a complete wrap (Nissen) or a partial wrap (Toupet). These techniques are still used in many places today, but I now use them selectively because more modern methods are available.
One of these newer developments is the LINX-system, which originated in the United States nearly 20 years ago. It involves placing a chain of small magnets around the lower end of the esophagus. Unlike a fixed wrap, this is a dynamic system that reinforces the sphincter without permanently compressing it. As a result, patients can still belch or vomit after surgery – something that was often hardly or no longer possible after a classic fundoplication.
The LINX-system was also intended to cause less bloating and gas. However, it has been shown that swallowing difficulties can also occur because the implant encircles the esophagus. Therefore, LINX is only suitable for patients who have completely normal esophageal function prior to surgery and no dysphagia,” explains :contentReference[oaicite:2]{index=2}.
Professor :contentReference[oaicite:3]{index=3} not only helped develop the correct implantation technique for the LINX-system early on, but also became one of the most experienced users worldwide over many years. This makes his later shift toward RefluxStop™ all the more remarkable: it does not stem from a rejection of existing methods, but from a deep understanding of their limitations.
Anyone who uses a procedure extensively over many years gains a precise understanding of where it works – and where, despite all innovation, it reaches physiological limits. He sought a solution that does not work “against” the esophagus, but instead restores the original anatomy – correcting the cause rather than blocking the symptoms.
“After shaping the LINX system for over 15 years, I recognized the limits of mechanical barriers. LINX is a great step forward, but it relies on sphincter augmentation and therefore partial compression. My goal has always been pure physiology. RefluxStop™ fascinated me because it addresses the problem at its root: it restores the natural anatomy and the angle of His (a small but crucial anatomical angle between the esophagus and the entrance to the stomach) without constricting the esophagus.
It represents a shift from a mechanical barrier to anatomical reconstruction, minimizing swallowing difficulties and significantly improving quality of life. I first encountered the RefluxStop™ method in 2018, began using it in 2020, and contributed to refining the correct surgical technique. The procedure is based on a small silicone implant measuring approximately two by two centimeters, consisting of five interconnected spheres. However, what is decisive is not the implant alone, but the entire surgical technique.
First, the esophagus and any existing hiatal hernia are exposed, the lower end of the esophagus is mobilized, and repositioned into the abdominal cavity. The natural anti-reflux barrier is then reconstructed by restoring the angle of His between the esophagus and the stomach, thereby rebuilding the physiological reflux valve. The RefluxStop™ implant is then sutured into a gastric pouch and stabilizes this anatomical reconstruction, ensuring that the sphincter is once again positioned naturally within the abdominal cavity.
The major advantage compared to LINX and traditional fundoplications is that the esophagus is not wrapped, but rather the natural reflux mechanisms are restored,” explains :contentReference[oaicite:4]{index=4}, continuing:
“I first became familiar with the development of this method in Switzerland, and the initial studies were also conducted in Europe. My time in Los Angeles at USC (University of Southern California) taught me to constantly question established practices. For decades, classic fundoplication (wrap surgery) was the gold standard, but it often leads to side effects such as ‘gas-bloat syndrome’ or dysphagia (difficulty swallowing), as it artificially increases pressure on the sphincter.
With my experience from the United States, I wanted to establish a method in Switzerland that respects the functionality of the diaphragm. RefluxStop™ overcomes the limitations of the wrap by not encircling the esophagus with the gastric fundus, but instead using it as a natural buffer. Based on my own early results, I further refined the technique and published my first 20, later 40, and now 100 patients.
There is now a large European multicenter study involving more than 600 patients. In the United States, FDA approval (official authorization by the U.S. Food and Drug Administration) is still pending but is expected soon. In recent years, I have focused intensively on further developing the method so that it can be taught effectively – and today I am the surgeon with the greatest experience worldwide in RefluxStop™ surgery. I have also trained nearly all European centers, including numerous teams in Spain, Italy, France, England, Norway, Sweden, Germany, Austria, and Switzerland.”
The LINX system is a minimally invasive magnetic band implant that strengthens the lower esophageal sphincter and thus prevents chronic reflux (GERD). It consists of small titanium beads with a magnetic core that are placed like a flexible chain around the esophagus; they open during swallowing and then close again to stop acid reflux. RefluxStop™ follows precisely this paradigm shift. Instead of narrowing the esophagus, it stabilizes the anatomical position of the stomach below the diaphragm, thereby restoring the natural pressure barrier.
The question of how well a new surgical technique actually works can only be answered through systematic and long-term follow-up studies. This is precisely why the first RefluxStop™ patients were closely monitored and included in structured studies.
“Initially, the first patients were part of a safety study, primarily aimed at assessing whether the procedure could be performed with a low complication rate. This was followed by a subsequent study in which we systematically recorded how patients were doing before and after surgery – using questionnaires before the operation and after six months, one year, two years, and five years.
For the first 50 patients, six-month and two-year data are now available. In addition, before surgery, all patients underwent not only an endoscopy and a barium swallow study, but also manometry (a pressure measurement of the esophagus) and pH monitoring. These examinations were repeated after six months and after two years. The results showed that RefluxStop™ delivers excellent objective outcomes both after six months and after two years: in more than 94 percent of patients, acid no longer refluxes.
The questionnaires also reflect very high subjective satisfaction – more than 95 percent of patients are symptom-free or significantly improved. At the same time, we observed that in cases of very large hiatal hernias, the diaphragm itself remains the decisive weak point – regardless of the type of reflux surgery performed.
For this patient group, we therefore continue to rely more frequently on traditional fundoplications, as they may require a second or third diaphragmatic operation over their lifetime. In such cases, a mesh is often additionally used to reinforce the diaphragm,” emphasizes :contentReference[oaicite:5]{index=5}.
When selecting patients for RefluxStop™, anatomical and functional factors play a significantly more differentiated role than in traditional anti-reflux surgical procedures.
“In the past, the indication was often binary: surgery or lifelong PPI therapy (long-term use of proton pump inhibitors). Today, we make more nuanced decisions. For me, the decisive factors for RefluxStop™ are manometry data on esophageal motility and the anatomy of the diaphragmatic hiatus.
While a fundoplication can be risky in cases of very weak esophageal motility, RefluxStop™ allows us to treat a broader group of patients, as the food bolus does not have to overcome mechanical resistance. Today, we select based on function rather than just defect,” explains :contentReference[oaicite:6]{index=6}, outlining the practical approach:
“Before surgery, patients either come to me with prior diagnostic results, or we conduct all evaluations at our reflux center in Bern – including endoscopy, pH monitoring, esophageal manometry, and a barium swallow study. Once all findings are available, I discuss in detail with the patient which symptoms are present, how severe their discomfort is, how well they respond to acid blockers, how pronounced any esophageal inflammation is, and whether there are already mucosal changes that could be considered precancerous.
It is equally important to assess how well the esophagus functions and how large a hiatal hernia is present. In principle, almost all patients are candidates for the RefluxStop™ procedure – with the exception of those with very large hiatal hernias exceeding eight centimeters.
Given the excellent results I have observed with RefluxStop™ over the past one to two years, I now recommend this new method to most of my patients, as it offers equally good, often even better reflux control than previous procedures while causing significantly fewer swallowing difficulties and other side effects.”
The establishment of an entirely new anti-reflux surgical procedure is never a single step, but a long, multi-stage process – and this is exactly the path RefluxStop™ has taken before gaining international recognition. Crucial was the understanding that the procedure is not a “variation” of existing techniques, but a fundamentally new approach that reconstructs anatomy rather than compressing the esophagus.
Commenting on this, :contentReference[oaicite:7]{index=7} says: “The key was the triad of precision, publication, and persistence. It is not enough to have a good idea; it must be supported by prospective studies and long-term data. I have always advocated for new procedures to undergo independent peer-review processes. International acceptance came through demonstrating that with RefluxStop™ we reduce complication rates while increasing patient satisfaction. Trust in surgery grows only through transparent data.”
Professor :contentReference[oaicite:8]{index=8} achieves this advancement in minimally invasive techniques primarily because he does not view innovation as a purely technical project, but as an interplay of anatomy, physiology, surgical experience, and long-term patient benefit.
“For me, innovation means mastering the complexity of the procedure for the surgeon in order to reduce the burden on the patient. We optimize the technique using high-resolution 4K laparoscopy and the most refined instruments. The key lies in standardizing each step: the more precisely we reconstruct the diaphragm and place the RefluxStop™ device, the more stable the long-term outcome.
Safety arises from the perfect symbiosis of technology and surgical finesse. Recently, I have also been working extensively with the Da Vinci surgical robot, because the future of surgery lies in robotics and AI,” he adds:
“From a surgical perspective, the RefluxStop™ operation is initially a very interesting and elegant method because it works functionally and significantly improves quality of life for many patients. However, the real challenge lies less in the procedure itself and more in ensuring that only truly experienced surgeons perform this technique. Patients cannot naturally assess how well a surgeon operates, which is why we take great care to ensure that the procedure is only performed by specialists who have already gained extensive experience in reflux surgery and perform at least 25 to 50 such procedures per year.
If surgeons express interest – for example, after hearing about our results at conferences – training begins with online courses, webinars, and video materials. They then come to Bern to my clinic to observe two to three surgeries live, including all tips and tricks. Only after that do they begin in their own centers, and for the first two to four procedures, I am personally present on-site to ensure maximum patient safety. In addition, the first 20 operations are documented on video and evaluated.
From data, including from Germany, we now know that there is a clear learning curve for this more complex operation: a surgeon needs about ten procedures to feel confident, and after 25 to 30 operations, they can begin teaching the method themselves. The procedure is performed laparoscopically and now takes me between 50 and 60 minutes. I also frequently work with the Da Vinci surgical robot, which I consider a key part of the future of surgery, as it enables the integration of robotics and artificial intelligence – a path that will decisively shape the further development of our field.”
Professor :contentReference[oaicite:9]{index=9} often describes the learning curve of RefluxStop™ as a kind of “return to functional anatomy” – albeit at a significantly higher level of precision than required for traditional wrap procedures.
“Hundreds of procedures have sharpened my perspective that the diaphragm is not a rigid barrier, but a dynamic valve. That is precisely why surgical experience is so crucial in RefluxStop™: one must understand the geometry of the hiatus precisely without making it rigid. While a wrap can sometimes mask minor inaccuracies, RefluxStop™ requires precise placement of the implant to fully preserve esophageal mobility.
It is delicate surgical work that requires a deep understanding of pressure dynamics in the thoracic and abdominal cavities. To date, I have operated on more than 250 patients in Switzerland, including international patients who greatly value my experience as a leading surgeon in this procedure. With well over a thousand procedures in esophageal and gastric surgery, and as one of the world’s leading experts in LINX and RefluxStop™, I have the necessary experience to select the best individualized treatment for each patient.
In our centers in Bern, Solothurn, and Valais, we have long since moved beyond the learning curve of new technologies and now set standards for safety and long-term treatment success,” says :contentReference[oaicite:10]{index=10}, adding:
“The use of the Da Vinci system does indeed involve an additional learning process. I have been working with the Da Vinci robot in the United States since 2012, took a break in between, and then focused intensively on the latest generation. In this context, I also standardized the technique for performing RefluxStop™ surgery using the robot. Later this year, we will publish what the standard technique for this operation looks like – both in the laparoscopic version and with the Da Vinci surgical robot.”
Reflux surgery has evolved rapidly in recent years – and with it, patient expectations, as people increasingly seek out recognized specialists. At the same time, the question arises as to how trust is built when a method requires high technical precision and only a few surgeons worldwide have comprehensive experience.
“Many patients come across my work during their research and recognize that my large number of procedures and long-standing specialization give me particular expertise in reflux surgery. This is understandable, as these operations require a deep anatomical understanding and a high level of surgical precision. At the same time, it is important that patients can also trust other treating physicians.
I have been working in reflux and reflux surgery for 25 years and spent seven years at the University of Southern California with Tom DeMeester, where I also received my professorship. This academic career has earned me a high international reputation among surgeons, colleagues, and referring physicians. However, only in the past ten years, through social media, have I seen how many patients additionally find me through personal testimonials. Today, patients rely less on studies and more on the experiences of others – previously through direct conversations, now through blogs, forums, and social networks.
In addition, many now use AI-powered search systems to find experts and come across me due to my decades of experience and the large number of successfully treated patients. Accordingly, the proportion of patients who deliberately choose me has increased significantly. Although the Swiss healthcare system is very expensive and I therefore primarily treat Swiss patients, the number of international patients has grown significantly over the past three years – I now operate several times a month on patients from around the world who consciously choose the surgeon with the most experience in this method,” explains :contentReference[oaicite:11]{index=11}.
The dissemination of a new surgical technique depends not only on its outcomes, but above all on how consistently knowledge is transferred and surgical quality is ensured. This is why the structured training of international teams plays a central role – and it demonstrates how firmly RefluxStop™ has already been established in Europe.
“I have been training surgeons across Europe for years. In Spain, where I personally trained all centers, there is particularly close collaboration. Just a few weeks ago, the second RefluxStop™ user meeting was held in Madrid, the first having taken place about a year and a half ago. Such meetings are held every one to one and a half years: all surgeons working with the method come together, we review the technique step by step, discuss indications, tips and tricks, and new studies.
Similar meetings have taken place in Italy, England, and most recently in Vienna for the German-speaking region. This allows me to ensure that the method is applied correctly and that new surgeons are properly trained. In Germany, there are now around ten centers with solid experience – including in Frankfurt, Berlin, Munich, Friedrichshafen, and Mainz. Some smaller clinics have also mastered the technique. There are still some challenges with reimbursement by insurance companies, which vary by country; in Switzerland, this is currently not an issue.
Overall, however, the method continues to gain traction. I have also reoperated on patients who were previously treated with older methods such as Nissen or Toupet fundoplication or with LINX. These methods can work very well but may cause side effects such as bloating, gas, or swallowing difficulties in some patients. Overall, we have already successfully converted around 30 patients to RefluxStop™ and analyzed the results scientifically together with a German colleague. There are few limitations – the key factor is assessing intraoperatively whether the gastric wall at the site where the implant is sutured is healthy and well perfused. This cannot always be determined reliably in advance,” explains :contentReference[oaicite:12]{index=12}, adding:
“In Switzerland, I have now performed over 250 RefluxStop™ procedures. In the early years, there were fewer; today, I perform around 60 to 80 procedures per year. Reflux is a widespread problem: up to 20 percent of the population experience symptoms occasionally.
If these symptoms occur more frequently, significantly impair quality of life, or persist despite medication – for example due to volume reflux, chronic cough, dental erosion, hoarseness, or pain – then it is reasonable to consider a surgical solution. A thorough evaluation and treatment by an experienced specialist are always essential.”
Everyday tips for relieving reflux symptoms
- Eat dinner earlier: Avoid late, large meals; ideally, have dinner around 6 PM.
- Adjust sleeping position: Elevate the upper body – for example, with a second pillow or a special wedge pillow.
- Reduce reflux-triggering foods: Garlic, onions, spicy foods, citrus fruits, alcohol, carbonated beverages.
- Protect the sphincter: Coffee and nicotine weaken the lower esophageal sphincter and can worsen symptoms.
- Adapt your diet consciously: Many symptoms can be significantly reduced through small changes.
Sometimes the esophagus tells a very different story than the patient – and that is precisely what makes reflux so fascinating.
“There are indeed patients who have very severe reflux symptoms even though the esophageal mucosa appears completely normal and the hiatal hernia is barely pronounced. In such cases, pH monitoring is crucial to objectively determine how much the patient is truly affected.
On the other hand, there are patients with severe esophagitis or even suspicious mucosal changes who feel surprisingly little. For both groups, surgery is ultimately necessary to effectively treat reflux. I am glad that more and more patients are informing themselves online or with the help of AI, because there are indeed doctors who say, ‘There is nothing that can be done; you have to take medication.’ That is not correct. There is a surgical solution – not for everyone, but for many. And that is exactly why it is important for patients to consult a specialist who can determine whether they are suitable candidates for one of these methods,” emphasizes :contentReference[oaicite:13]{index=13}, bringing our conversation to a close.
Professor :contentReference[oaicite:14]{index=14}, thank you very much for these encouraging words on reflux treatment!
- Board-certified surgeon, specializing in visceral surgery
- Specialist in upper abdominal surgery, reflux surgery (GERD), and obesity/bariatric surgery
- Long-standing professor at the University of Southern California (USC), USA
- Leading expert in Europe for complex reflux surgeries and revision procedures
- The only surgeon in Switzerland with full expertise in all reflux surgery methods
- Minimally invasive and robotic surgery at the highest level
- Treatment of diseases of the esophagus, stomach, and tumors of the gastrointestinal tract
- Surgical treatment of complex hiatal and abdominal wall hernias
- Extensive experience with LINX™ and RefluxStop™ with excellent outcomes
- Founder of Swiss1Chirurgie AG, the largest private practice in Switzerland for reflux and obesity surgery
- Practices at multiple locations in Switzerland (including Bern, Thun, Solothurn, Valais)
- Care for approximately 3,500 patients per year within a specialized network
