Surgery for reflux

Heartburn is a very common condition. It is due to reflux of acid from the stomach into the oesophagus (gullet). It may be possible to deal with symptoms of reflux by adopting lifestyle changes and / or using medication. However these measures are not always effective and a significant percentage of people may require surgery to control symptoms. In addition many, particularly younger, people are unhappy to stay on medication long-term or for life. General practitioners may be reluctant to prescribe the best medication because of cost. There is now a very effective keyhole operation for such patients called a laparoscopic fundoplication. This is an operation designed to prevent acid refluxing into the oesophagus. Many patients with reflux have a hiatus hernia and the operation will deal with this at the same time.

Reflux of acid irritates and eventually causes damage to the oesophagus. The main symptom is heartburn. This often occurs after a heavy meal or when lying flat at night. The pain of heartburn is felt in the chest but may also be felt in the back or neck. If untreated reflux can result in permanent damage to the oesophagus. The gullet may become narrowed (a stricture) resulting in difficulty with swallowing. Also a change in the lining layer of the oesophagus (known as Barrett's change) may result from prolonged reflux and can result in the growth of a cancer.

The first investigation for reflux symptoms is usually an endoscopy. This is where the doctor passes a camera on the end of a long flexible tube into the gullet. If there is any damage to the oesophagus it can be easily seen and a biopsy may be taken to assess the damage. More sophisticated tests may be needed, particularly where surgery is being considered.

Treatment in the first instance consists of simple lifestyle changes including weight loss, avoidance of stooping, raising the head of the bed and avoiding large late night meals. Most patients however require some form of medication, either from time to time or regularly. These range from simple antacids for mild cases to a group of drugs called proton pump inhibitors.

If medical treatment fails or symptoms return rapidly after stopping medical treatment then it is worth considering a surgical solution. Reflux is primarily a mechanical problem and whilst tablets can control symptoms they do nothing to the underlying cause which is a deficiency in a valve mechanism at the lower end of the oesophagus. The only way to correct this mechanical problem is by an operation, the most common of which is a laparoscopic fundoplication. The operation is highly effective and should also be considered for patients who require lifelong treatment or who do not wish to remain on medication long-term. Another group of patients for whom surgery should be considered are those who have developed complications of reflux such as stricture or Barrett's change.

This is an advanced keyhole operation and it is important that you ensure that your surgeon is skilled in this technique.

For more information please visit our 'Patient Information' page where you can download information sheets relating to the specific operations.