Fundoplication
Your health expert: Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon
Content editor review by Pippa Coulter, December 2021
Next review due December 2024
Fundoplication is an operation to treat gastro-oesophageal reflux disease (GORD). It involves wrapping the top part of your stomach around your lower oesophagus (the tube that carries food from your mouth to your stomach).
About GORD and fundoplication
Gastro-oesophageal reflux disease (GORD) is a condition where the contents of your stomach regularly leak back into your oesophagus. Your stomach contents are acidic, so they can irritate the lining of your oesophagus when they come into contact with it. This can cause symptoms such as heartburn – when you get a burning feeling rising up from your stomach towards your neck.
To treat GORD, your doctor will usually suggest trying indigestion medicines called proton pump inhibitors and making some lifestyle changes. These might include making changes to your diet and losing any excess weight if you need to. For most people, these measures control the symptoms of GORD well. But sometimes, you may find proton pump inhibitors don’t fully control your symptoms, or you can’t take them long-term because of side-effects. In this case, fundoplication surgery could be an option for you.
If your doctor thinks you may benefit from fundoplication surgery, they’ll refer you to a surgeon for an assessment. Fundoplication is an effective procedure for many people and means they no longer need to take medicines for reflux. If you have a hiatus hernia, this will be repaired as part of the fundoplication operation. Hiatus hernia is a condition in which part of your stomach slides up into your chest. It’s a common cause of GORD.
Types of fundoplication
There are different ways of doing a fundoplication. Here are the most common.
- Nissen’s fundoplication. This is when your surgeon wraps the top part of your stomach all the way around the lower part of your oesophagus.
- Partial fundoplication. In this type, your surgeon wraps your stomach just part of the way around your oesophagus. This may be around the front (anterior fundoplication) or the back (posterior or Toupet fundoplication).
Fundoplication is usually done as keyhole (laparoscopic) surgery. This means it’s carried out through very small incisions in your skin. Occasionally, it may be necessary to have your fundoplication by open surgery. This involves your surgeon making a single, bigger cut in your abdomen (tummy).
Preparing for fundoplication
Deciding on surgery
At your first appointment, your surgeon will discuss exactly what’s involved in the procedure so you can decide if it’s right for you. This will include any potential complications and what to expect afterwards. Be sure to ask your surgeon any questions you have and take time to make your decision. If you decide to go ahead, you’ll be asked to sign a consent form, so it’s important to make sure you feel properly informed.
Getting ready for surgery
Your surgeon will explain how to prepare for your operation. If you smoke, your surgeon will advise you to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
Fundoplication is done under general anaesthesia, which means you’ll be asleep during the operation. You’ll need to stop eating and drinking a few hours before your operation. Your surgeon will give you clear instructions about this. It’s important to follow their advice.
You may need to stay in hospital overnight after your surgery, so be sure to make any necessary preparations. Your stay in hospital is likely to be longer if you have open surgery. Sometimes, you may be able to go home on the day of your procedure. If so, you’ll need someone to drive you home and stay with you overnight.
On the day
On the day of your procedure, your surgeon will meet with you to check you are well and still happy to go ahead. The staff at the hospital will do any final checks and get you ready for surgery. This may include asking you to wear compression stockings or having an injection of an anticlotting medicine to help prevent deep vein thrombosis (DVT).
What happens during fundoplication?
In keyhole surgery, your surgeon inserts small instruments and a tube-like camera through small cuts in the skin of your tummy. If you’re having open surgery, your surgeon will make one long cut from the bottom of your breastbone down to just above your tummy button. Sometimes your surgeon may need to convert from keyhole to open surgery during the procedure.
If you have a hiatus hernia, your surgeon will repair this first. To do the fundoplication, your surgeon wraps the top part of your stomach around the lower end of your oesophagus and sews this into place. They may wrap your stomach all the way around your oesophagus (Nissen’s fundoplication). Or, if you’re having a partial fundoplication, they’ll wrap your stomach just part of the way round.
At the end of the operation, your surgeon will close the cuts in your skin with stitches. These may be dissolvable.
What to expect afterwards
You’ll need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off. Once you’re ready, your nurses will encourage you to get up and move around. This will help to prevent complications. You’ll be able to start having drinks a few hours after your operation, but you won’t be able to eat anything until the following day.
Sometimes you can go home on the day of your operation, but you may need to stay overnight in hospital. If you’ve had open surgery, you’ll usually need to stay in hospital for longer – for between two and five days. Your nurse will give you some advice about caring for your healing wounds before you go home. They’ll give you some information about what you can eat and drink while you recover, too. They’ll also give you a follow-up appointment date.
If your surgeon used clips or non-dissolvable stitches, you’ll need to have these removed after about seven to 10 days. Dissolvable stitches don’t need to be removed – ask your surgeon how long it will take for them to dissolve.
Looking for prompt access to quality care?
With our health insurance, if you develop new conditions in the future, you could get the help you need as quickly as possible, from treatment through to aftercare.
To get a quote or to make an enquiry, call us on 0808 273 6216∧
Recovering from fundoplication
It can take up to six weeks for any initial discomfort and side-effects after your fundoplication to settle down. However, the time it takes to fully recover can vary from person to person. Recovery tends to be quicker after keyhole surgery than open surgery.
Side-effects after the operation can include the following.
- Feeling sick, which usually only lasts for a short time.
- Having difficulty swallowing for the first few days or weeks.
- Bloating and discomfort after eating.
Follow any advice you’ve been given about what to eat while you recover. This usually involves starting with liquids and gradually moving onto soft foods. You’ll need to take your time when eating, and avoid very solid foods such as meat, bread and pasta for around six weeks. You shouldn’t have fizzy drinks because this can increase gas in your stomach making any bloating worse.
Don’t lift anything heavy for the first month or so after your operation. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen.
Complications of fundoplication
Complications are when problems occur during or after the operation. The possible complications of any operation include things like infection, bleeding or an unexpected reaction to the anaesthetic. Specific complications of fundoplication include the following.
- Difficulties with swallowing that continue for longer than normal. If you’re still having problems after around 12 weeks, you may need an examination to check whether or not everything is OK. Sometimes you may need another operation.
- Bloating and increased wind is common but can be more severe in some people. Your doctor may be able to give you medicines to help with this. Rarely, you may need another operation.
- Rarely, your stomach, oesophagus or other nearby organs, such as your spleen, could be damaged during the operation. If you have severe pain or are being sick constantly, contact the hospital where you had the operation straight away.
- You may find that the symptoms of GORD come back after your operation. If this happens, you might need a second operation or treatment with medicines.
What are the alternatives to fundoplication?
Your doctor will only offer you a fundoplication operation if you’ve already tried lifestyle measures and medicines first. The main alternative to having the operation is to continue taking medicines (such as proton pump inhibitors) long-term.
Some surgeons are now performing a new procedure for GORD, which involves inserting a ring of magnetic beads around your oesophagus. This allows you to swallow food, but keeps your oesophagus closed afterwards so no acid can leak back up from your stomach. It’s only available in certain centres at the moment.
You’re likely to have some mild pain and discomfort after fundoplication surgery. It’s quite common to feel sick and have some trouble swallowing at first. You might have some bloating and increased wind too. Most of these problems wear off within a few weeks. For more information, see our sections on recovering from fundoplication and complications of fundoplication above.
You won’t feel any pain while you’re having the fundoplication surgery because it’s carried out under general anaesthesia. This means you’ll be asleep and won’t feel anything. You’re likely to have some discomfort for a few weeks after the procedure. You can take painkillers to manage any pain.
Fundoplication is surgery that involves wrapping the top part of your stomach around the lower end of your oesophagus. There are different ways to do the procedure. Nissen’s fundoplication means wrapping your stomach all the way around your oesophagus. Other methods involve just wrapping it part of the way around. For more information, see our section on types of fundoplication above.
Did our Fundoplication information help you?
We’d love to hear what you think.∧ Our short survey takes just a few minutes to complete and helps us to keep improving our health information.
∧The health information on this page is intended for informational purposes only. We do not endorse any commercial products, or include Bupa's fees for treatments and/or services. For more information about prices visit: www.bupa.co.uk/health/payg
This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
Any information about a treatment or procedure is generic, and does not necessarily describe that treatment or procedure as delivered by Bupa or its associated providers.
The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.
- Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. National Institute for Health and Care Excellence (NICE). nice.org.uk, updated 18 October 2019
- Laparoscopic Nissen fundoplication. Medscape. emedicine.medscape.com, updated 14 May 2020
- Upper gastrointestinal surgery. Oxford Handbook of Operative Surgery. Oxford Medicine Online. oxfordmedicine.com, published online May 2017
- Dyspepsia – proven GORD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2017
- Gastro-oesophageal reflux disease. BMJ Best Practice. bestpractice.bmj.com, last reviewed 4 October 2021
- Hiatus hernia. Patient. patient.info, last edited 14 April 2020
- Gastro-oesophageal reflux disease. Patient. patient.info, last edited 19 March 2020
- Open Nissen fundoplication. Medscape. emedicine.medscape.com, updated 11 March 2019
- Laparoscopic insertion of a magnetic titanium ring for gastro-oesophageal reflux disease. National Institute for Health and Care Excellence (NICE). nice.org.uk, published July 2017
- Good surgical practice. The Royal College of Surgeons. www.rcseng.ac.uk, published September 2014
- Preparing your body. Royal College of Anaesthetists. www.rcoa.ac.uk, accessed 5 November 2021
- Joint briefing: smoking and surgery. Action on Smoking and Health, the Royal College of Anaesthetists, the Royal College of Surgeons of Edinburgh and the Faculty of Public Health. ash.org.uk, April 2016
- You and your anaesthetic. Royal College of Anaesthetists. www.rcoa.ac.uk, February 2020
- Palser TR, Ceney A, Navarro A, et al. Variation in laparoscopic anti-reflux surgery across England: a 5-year review. Surg Endosc 2018; 32(7):3208-14. doi:10.1007/s00464-018-6038-y
- Caring for someone recovering from a general anaesthetic or sedation. Royal College of Anaesthetists. www.rcoa.ac.uk, November 2021
- Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. National Institute for Health and Care Excellence (NICE). nice.org.uk, last updated 13 August 2019
- Deep vein thrombosis (DVT) prevention. MSD Manuals. msdmanuals.com, last full review/revision February 2021
- Surgical wounds – principles of wound management. Oxford Handbook of Adult Nursing. Oxford Medicine Online. oxfordmedicine.com, published online June 2018
- Personal communication, Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon, 30 November 2021
