Reflux Surgery (Fundoplication): Surgical Treatment of Reflux Disease and Heartburn

Reflux disease occurs when the sphincter muscle between the esophagus and the stomach does not function properly, causing stomach contents or gastric juices to flow back into the esophagus.
The most common symptom is heartburn, often accompanied by acid regurgitation or difficulty swallowing. These symptoms are becoming increasingly common in the Western world and can significantly impair quality of life.

In many cases, lifestyle changes—such as eating smaller meals, losing weight, or avoiding acidic foods—as well as medication with proton pump inhibitors (PPIs) to reduce stomach acid production can help.
However, if this conservative treatment does not provide sufficient relief or if the symptoms keep recurring, reflux surgery (fundoplication) is recommended.

Reflux occurs when the sphincter muscle between the stomach and the esophagus does not function properly @ AntonioDiaz /AdobeStock

In this surgical procedure, a portion of the stomach is formed into a cuff that is placed around the lower end of the esophagus. This so-called fundus cuff stabilizes the sphincter and prevents stomach contents from entering the esophagus.
This permanently prevents the reflux of stomach acid, and patients are usually symptom-free again.

Reflux surgery (fundoplication) is now performed almost exclusively as a minimally invasive keyhole procedure (laparoscopic). During the procedure, the surgeon inserts a camera and fine surgical instruments through several small incisions in the abdomen. This minimally invasive surgical technique allows for precise surgical treatment of reflux disease with significantly less pain, minimal blood loss, and faster wound healing.
Patients also benefit from a shorter recovery time and a quicker return to their daily routines.

The Nissen anti-reflux surgery is the standard surgical procedure for preventing reflux @ Pepermpron /AdobeStock

Reflux surgery is recommended when conservative treatments—such as dietary changes or medication with proton pump inhibitors (PPIs)—do not provide sufficient relief from symptoms.
Patients with chronic heartburn, frequent acid regurgitation, or difficulty swallowing—in whom the reflux of stomach acid into the esophagus persists despite treatment—can benefit significantly from surgical treatment (reflux surgery).

Reflux surgery is also frequently performed in combination with hiatal repair for a hiatal hernia—a gap in the diaphragm through which part of the stomach slides upward. In this procedure, the diaphragm is surgically reconstructed and the junction between the esophagus and the stomach is stabilized.
This combination eliminates the anatomical cause of the reflux of stomach contents into the esophagus and enables most patients to live symptom-free permanently after reflux surgery.

In experienced clinics specializing in visceral surgery, a decision is made on a case-by-case basis as to which surgical procedure—such as Nissen fundoplication or Toupet fundoplication—is best suited for the individual patient.
Modern minimally invasive procedures are now considered safe and effective, particularly for patients undergoing reflux surgery who are seeking a long-term solution to reflux disease.

As with any surgical procedure, certain risks and side effects can occur with reflux surgery (fundoplication). However, thanks to modern laparoscopic techniques and experienced surgeons, complications are rare.
The most common symptoms in the first few days after reflux surgery include:

• Swelling or pain around the surgical incision
• A feeling of fullness or temporary pressure in the upper abdomen
• Difficulty swallowing, belching, or vomiting due to the digestive system readjusting
• Bruising or minor postoperative bleeding around the sutures
• Wound infections or irritation in the surgical area
• In rare cases: injury to the diaphragm, esophagus, stomach, or other adjacent organs

These side effects usually subside after a few days to weeks. Thanks to the minimally invasive, gentle surgical technique, the risk of serious complications is extremely low today.
Specialized centers for visceral surgery place great emphasis on safe surgical procedures, ensuring that treatment for reflux disease is successful in over 90% of cases.

Prognosis for Reflux Surgery

Reflux surgery is a successful method for permanently curing reflux disease. According to a study, it is more successful in the long term than drug therapy. 

For younger patients, reflux surgery offers a cost advantage over long-term (permanent) medication. Approximately 90% of patients who undergo reflux surgery no longer experience reflux or heartburn after the procedure.

In 8% of patients, reflux surgery is unsuccessful. In these cases, the sleeve cannot stop the reflux. 

It is not uncommon for patients to complain of aftereffects of the procedure despite successful reflux surgery, such as:

• a feeling of fullness
• Difficulty belching
• Vomiting

Reflux surgery (fundoplication) is currently one of the most effective procedures for treating gastroesophageal reflux disease (GERD). It is usually performed under general anesthesia and is considered a permanently effective surgical treatment when acid blockers or proton pump inhibitors do not provide sufficient relief.
In many patients, heartburn persists despite conservative treatment, or symptoms return after discontinuing the medication.

During reflux surgery, the upper part of the stomach is wrapped around the esophagus in such a way that the esophageal sphincter is strengthened and the backflow of stomach acid into the esophagus is permanently prevented.
As a result, stomach contents can no longer flow upward, which reliably eliminates typical symptoms such as heartburn, difficulty swallowing, and acid regurgitation.
The goal of the surgery is to prevent the reflux of stomach contents into the esophagus and to restore the natural reflux barrier.

Long-term studies show that approximately 90% of patients are symptom-free after reflux surgery. The procedure is particularly beneficial for severe heartburn or a hiatal hernia, as it addresses the anatomical cause and enables long-term healing.
In specialized clinics for visceral surgery, the procedure is performed laparoscopically—that is, using a minimally invasive approach—which requires only small incisions in the abdominal wall. The surgery is generally gentle and safe, with a short recovery time and significantly fewer postoperative symptoms.

About a week after surgery, most patients are largely back to their normal activities. A gastroscopy can be performed after a few months to monitor healing.
Compared to medication, reflux surgery offers a lasting solution because it addresses the root cause of the condition rather than merely alleviating the symptoms of heartburn.

For many patients, reflux surgery means a significant improvement in quality of life—they can eat, lie down, and sleep normally again without stomach contents flowing back into the esophagus.
The treatment of their reflux disease is thus permanently successful, and with proper follow-up care, most patients remain symptom-free in the long term.