Surgery (fundoplication)

Does it work?

Yes. Having surgery to strengthen the ring of muscle that sits between your stomach and your oesophagus can make you feel better, and it can help heal your oesophagus (the tube that carries food from your throat to your stomach).

But some people find that their symptoms come back after surgery and they still have to take tablets.

And all operations have risks. The chances of problems happening are higher if you have a type of surgery known as open surgery (in which the surgeon makes a large cut in your stomach area).

What is it?

/x/images/bh/en-gb/gord-ring-uk_default.gifThe ring of muscle at the top of your stomach stops acid flowing backwards into your oesophagus.The aim of surgery is to strengthen the ring of muscle that sits at the lower end of your oesophagus, where it joins your stomach.

This should stop acid flowing from your stomach into your oesophagus. It's this acid that causes the symptoms of GORD.

Your doctor may advise you to have this operation if drug treatment hasn't helped.

During the operation, the upper part of your stomach is pulled up and wrapped around the lower part of your oesophagus. It is then stitched into place. The stomach may be wrapped all the way around the oesophagus (a total wrap) or just around part of it (a partial wrap). The result is that part of the oesophagus passes through a ring of tight stomach muscle. And this helps keep the valve between the oesophagus and stomach closed.

This operation is called fundoplication. (The fundus is the upper part of the stomach.) There are a few ways to do this operation.

  • Your surgeon can make a cut either in your stomach area (your abdomen) or your chest. The cut is usually made in your abdomen. It may be made in your chest if you have a short oesophagus that doesn't reach into your abdomen.

  • The operation can be done through a large cut. This is called open surgery. Or the surgeon may make small cuts and pass a tiny camera and instruments through them. This is known as keyhole surgery or laparoscopic surgery.

Whichever kind of surgery you have, you will need a general anaesthetic. This means you will be asleep during the operation and will not feel anything.

Keyhole surgery is quicker than open surgery. So it may be better for people who have other health problems, such as a heart condition, that makes it risky to be asleep for a long time during surgery.[1]

Doctors are now also looking at ways to use an endoscope to strengthen the ring of muscle at the lower end of the oesophagus. An endoscope is a long thin tube with a camera and tiny instruments at the end. It can be passed down your throat and into your oesophagus, allowing your doctor to do surgery without making cuts to your body. However, these techniques are new and may not be available everywhere. To read more, see Surgery using an endoscope.

How can it help?

Having surgery can make you feel much better, heal the swelling (inflammation) in your oesophagus and stop GORD coming back.

The benefits of surgery may be long-lasting, but some people continue to have symptoms after surgery, and they may still need to take tablets.[2]

One large, good-quality study of people with GORD found that:[2]

  • After one year, 36 in 100 people who had surgery were still taking tablets, compared with 87 in 100 people who didn't have surgery

  • After five years, 41 in 100 people who had surgery were still taking tablets, compared with 82 in 100 people who didn't take tablets.

  • After one year, people who had surgery felt better than people who didn't, although after five years both groups felt about the same.

In another study, when doctors looked at the oesophaguses of people who had had treatment 10 years before, there was no difference between the people who had surgery and the people who took tablets.[1]

It doesn't seem to matter which type of surgery you have. A number of studies have found that surgery through small cuts in your abdomen (keyhole surgery) works as well as surgery through a large cut (open surgery).[3][4][5][6] However, one study found that people who have keyhole surgery are more likely to have their symptoms come back and to need another operation than those who have open surgery.[7]

You may be able to leave hospital sooner if you have keyhole surgery (after about three days) than if you have open surgery (after about five days).[8]

Studies have found that open surgery works better than drugs called antacids and H2 blockers.[9] It may also work better than a drug called omeprazole (a proton pump inhibitor), but we need more studies to know for certain.[10]

Studies have also found that keyhole surgery may work better than tablets.[11]

How does it work?

The ring of muscle at the lower end of your oesophagus works like a valve. When food reaches it, the ring of muscle opens to let the food pass into your stomach. Once the food has passed through, the muscle tightens up to stop the contents of your stomach going back into your oesophagus.

If you have GORD, the ring of muscle doesn't work properly. It opens even when food is not passing through or it may stay open too long. This means that acid from your stomach can flow into your oesophagus. Doctors call this backwards flow reflux or acid reflux. The acid from your stomach can irritate and damage the lining of your oesophagus. This is what causes heartburn and other symptoms.

If the valve is strengthened by surgery, it's less likely that acid will flow into the oesophagus.

Can it be harmful?

All operations have risks. Some common problems are blood clots, bleeding, and infection. Problems that happen after surgery are called complications.

This is what we know from the research on people with GORD.

  • About 7 in 100 people who have surgery needed more operations, to treat their symptoms or for complications.[2]

  • You may be more likely to have complications if you have open surgery than if you have keyhole surgery.[3]

  • In one study, more than 25 in 100 people who had open surgery had a complication. Only 10 in 100 people who had keyhole surgery had a complication.[3] People who had keyhole surgery tended to leave hospital sooner than people who had open surgery. They left after an average of three days instead of five days.[3]

  • In one study, people who had open surgery were more likely to have some problems than people who took tablets.[9] These problems were feeling too full and not being able to belch or vomit.

How good is the research?

How good is the research on surgery (fundoplication)?

Last updated: Oct 17, 2014