Sometimes patients with gastro-oesophageal reflux disease benefit from surgery to treat their symptoms. Laparoscopic fundoplication is the gold standard for anti-reflux surgery, and involves mobilisation of the fundus of the stomach which is then wrapped around the lower oesophagus. This is routinely a day-case procedure in Cornwall.
Once seen in clinic, the Upper GI surgeon can arrange pH/manometry and impedance studies for non-acid reflux. They may also need to repeat the OGD for surgical assessment.
Surgery is associated with a small risk of mortality (about 1%) and complications such as gas-bloat syndrome, post-operative dysphagia, strictures, or recurrence of reflux symptoms.
Follow up is with a nurse specialist in routine cases and with the consultant in complex cases.
Anti-reflux surgery is suitable for patients with:
Refractory reflux despite maximal treatment (See GORD Guidelines)
Daily reflux medication who would prefer to have surgery
- Particularly young patients, or older patients on high dose PPIs, or patients who are intolerant of medication
Patients with complications of reflux, e.g. ulcers or strictures
Patients with “volume” reflux
- These patients may vomit whenever they bend over, or are unable to lie flat due to their symptoms
Investigations prior to referral
OGD (may be normal - okay to refer these)
- Not a prerequisite for referral, but please see "In Shape for Surgery" for medical optimisation prior to surgery
Post-operative symptoms, including reflux years after the procedure
Recurrence of reflux symptoms can occur in 5-10% within 5-10 years and this is usually managed medically. Rarely is revision surgery necessary.
Unless the patient has red flags which would warrant an UGI 2WW referral, refer back to upper GI surgery as they would prefer to do the OGD themselves to look for specific complications of the surgery.
Review date February 2022
Next review date February 2023
GP Sifter Dr Laura Vines
Contributors Mr Mike Clarke