When is surgery needed for acid reflux?

Acid reflux can disrupt daily life — from constant heartburn to sleep disturbance. While most cases respond well to lifestyle changes and medication, surgery may help when symptoms persist. Doctify helps patients find trusted general surgeons and gastroenterologists who can assess when surgical intervention is appropriate.

Understanding Acid Reflux and Hiatal Hernia

Acid reflux, also known as gastro-oesophageal reflux disease or GORD, means regurgitation or pulling up of liquid from your stomach into your esophagus (gullet), which can often be felt in the throat or even in the mouth. This movement of stomach contents back up into the gullet can lead to heartburn. Common symptoms include: heartburn, regurgitation, chest discomfort, and a chronic cough. The symptoms can be worsened in the presence of a hiatal hernia. A hiatal hernia is when the stomach pushes into the chest cavity.

The common risk factors include: weight gain especially around the midriff, eating late at night, eating heavy meals, having carbonated drinks or fizzy drinks.

Dr Reshma Rakshit

When medication isn’t enough?

Most patients manage symptoms with antacids, proton pump inhibitors (PPIs), and diet adjustments. Nevertheless, sometimes medications and diet adjustment aren’t enough and surgery should be contemplated. Surgery is considered when:

• Symptoms persist despite optimal medical therapy.
• There’s dependence on high-dose PPIs.
• A large hiatal hernia is contributing to reflux.
• Complications occur, such as oesophagitis or Barrett’s oesophagus.

The role of surgery in reflux management

The principal goal of the anti-reflux surgery is to restore the natural barrier between the stomach and oesophagus. Among its common goals are:

• Prevent stomach acid from flowing back up.
• Strengthen the lower oesophageal sphincter (LES).
• Reduce the size of any hernia.

Fundoplication: The most common procedure

• Nissen fundoplication: It is the acid-reflux procedure most performed. The upper part of the stomach is wrapped 360° around the LES to reinforce it. Usually performed laparoscopically (keyhole surgery) for quicker recovery.
• Partial fundoplication (Toupet or Dor): It is the same as Nissen fundoplication, but instead of wrapping the upper part of the stomach 360º, it is wrapped 180–270° around the LES. It is recommended for patients with weaker oesophageal motility.

Both techniques are very good in restoring the pressure control and preventing reflux, while preserving swallowing comfort.

What to expect before and after surgery

• Before surgery: Each patient will be evaluated with endoscopy, manometry, and pH testing. As well, some imaging (e.g., barium swallow) will be made for hernia assessment.
• After surgery: The patient might feel a mild swallowing discomfort for a few days, but completely normal. The patient should have a soft diet for 2–4 weeks and avoid heavy lifting until healed. Full recovery usually takes 2–4 weeks, and most patients report major symptom relief.

Risks and Considerations

Fundoplication is safe but, as with any operation, carries some risks such as: temporary difficulty swallowing, bloating or gas symptoms (“gas-bloat syndrome”), and rare risk of hernia recurrence. It is important to consult an experienced surgeon and proper patient selection for best outcomes.

Alternatives to surgery

If you don’t want a surgery, here are some alternatives:

• Endoscopic treatments (e.g., LINX magnetic ring) offer less invasive options for select patients.
• Continue lifestyle changes:
  • Avoid late meals, caffeine, and alcohol.
  • Maintain a healthy weight.
  • Elevate the head of the bed.

Regular GP and gastroenterology reviews are key to ongoing management.

When to See a Specialist

If you have any of the following, please consult a specialist:

• Persistent reflux symptoms despite medication.
• Difficulty swallowing, vomiting, or unintentional weight loss.
• Recurrent chest pain not linked to heart disease.

Use Doctify to find a verified general surgeon or gastroenterologist specialising in reflux and hiatal hernia repair.

Conclusion

For patients whose reflux won’t settle with medication, surgery can offer lasting relief and improve quality of life. Modern procedures like laparoscopic fundoplication are effective, safe, and tailored to individual needs. We invite you to consult a trusted specialist through Doctify to discuss whether anti-reflux surgery could help them feel better and breathe easier again.

Feel free to consult a general surgeon through Doctify for personalised advice whenever you want, we will be happy to help you! Find the best General surgeons in the United Kingdom or search for the best specialists globally:

• General surgeons in the United Arab Emirates
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Medically Reviewed
Last reviewed on 08/11/2025