Reflux surgery is a surgical treatment designed to prevent stomach contents from flowing back into the esophagus. This procedure may be considered, particularly in patients diagnosed with gastroesophageal reflux disease (GERD) whose symptoms persist despite medication or who develop certain complications.
Under normal circumstances, a muscular structure called the lower esophageal sphincter, located between the stomach and the esophagus, prevents stomach acid from flowing upward. However, when this mechanism does not function properly, stomach acid can reach the esophagus and, over time, cause symptoms such as heartburn, a burning sensation in the chest, and a sour or bitter taste in the mouth.
The main goal of reflux surgery is to strengthen the natural barrier between the stomach and the esophagus, thereby reducing the backward flow of stomach contents.
No. Reflux surgery is not necessary for every patient with reflux.
Many people can control their symptoms through lifestyle changes, dietary adjustments, and medication prescribed by a physician. Surgical treatment is planned for patients considered suitable following a detailed evaluation.
Therefore, the decision to proceed with surgery is made by the relevant specialist after evaluating the patient's symptoms, diagnostic test results, overall health, and other available treatment options.
Surgical treatment is not planned in the same way for every patient. Selecting the appropriate patients is essential to achieving successful outcomes.
Following a medical evaluation, reflux surgery may be considered in the following situations:
Symptoms persist despite medication.
Symptoms continue to affect quality of life despite long-term medication use.
Damage develops in the esophagus due to reflux.
A large hiatal hernia is present alongside reflux.
Recurrent inflammation of the esophagus (esophagitis) occurs due to reflux.
The risk of developing reflux-related complications needs to be assessed.
The decision to proceed with surgery is individualized, and the same approach is not suitable for every patient.
A detailed assessment is required before surgery is planned. The aim is to determine whether the symptoms are genuinely caused by reflux and to select the most appropriate treatment method.
When considered necessary by the physician, the following tests may be performed:
Endoscopy
The esophagus, stomach, and duodenum are examined using a specialized camera. Endoscopy can help identify conditions such as irritation, ulcers, or Barrett's esophagus.
24-Hour pH Monitoring
The amount and frequency of stomach acid entering the esophagus are measured to help confirm the diagnosis of reflux.
Esophageal Manometry
The contractions of the esophagus and the functioning of the lower esophageal sphincter are evaluated. This test can provide important information for surgical planning.
Imaging Methods
Additional imaging methods may be used in some patients to evaluate a hiatal hernia.
Today, reflux surgery is most commonly performed using the laparoscopic (minimally invasive) approach.
During laparoscopic surgery, a camera and surgical instruments are inserted through small incisions in the abdominal wall. Because this method involves smaller incisions than open surgery, it may contribute positively to the patient's recovery process.
During the procedure, the barrier between the stomach and the esophagus is strengthened to help reduce the upward flow of stomach contents.
The surgical technique used may vary depending on the patient's anatomy, the severity of reflux, and the physician's assessment.
Potential advantages of laparoscopic reflux surgery for some patients may include:
Smaller surgical incisions
Less postoperative pain
A quicker return to daily activities
A shorter hospital stay
Smaller scars from a cosmetic perspective
These advantages may not apply equally to every patient. The treatment plan is determined following an individual assessment.
One of the most frequently used surgical techniques for reflux is fundoplication.
During this procedure, the upper part of the stomach is wrapped around the lower portion of the esophagus to create a new barrier. The aim is to reduce the backward flow of stomach acid into the esophagus.
Different fundoplication techniques are available, and the method used is determined according to the patient's clinical condition.
The duration of reflux surgery may vary depending on the surgical technique, the patient's anatomical characteristics, and any accompanying conditions.
The procedure is generally completed within a few hours. The exact duration is assessed individually by the surgical team performing the operation.
Following laparoscopic reflux surgery, patients may be discharged within a few days if their general health and postoperative progress are considered satisfactory by their physician.
The length of the hospital stay may vary depending on individual recovery and any additional health conditions.
The recovery process following reflux surgery may vary depending on the surgical technique used, the patient's overall health, and their clinical condition before the operation. Today, most reflux surgeries are performed laparoscopically (using a minimally invasive approach), allowing many patients to return to daily activities sooner than they might after open surgery.
After the operation, patients are closely monitored by their physician and healthcare team. During this period, pain management, the transition back to eating, wound healing, and overall health are assessed.
In the first few days, patients may experience mild throat irritation, abdominal discomfort, or slight difficulty swallowing. These symptoms are often temporary and may be considered part of the normal recovery process. However, if unexpected or severe symptoms develop, medical attention should be sought.
Diet is an important part of the recovery process after surgery. The eating plan is adjusted gradually to allow the stomach and esophagus to adapt to their new condition.
In the first few days, patients are generally started on clear liquids. If the physician considers it appropriate, patients then progress from liquids to puréed foods, followed by soft foods and, eventually, a normal diet.
The following recommendations may be helpful during recovery:
Eat small portions at each meal.
Eat slowly and chew food thoroughly.
Avoid carbonated beverages.
Avoid consuming excessive amounts of fluids while eating.
Follow the dietary plan recommended by your physician.
Dietary needs vary from person to person. Therefore, the postoperative diet should be followed according to the recommendations of a physician or dietitian.
Avoid heavy lifting for a period of time.
Take prescribed medications as directed by your physician.
Attend follow-up appointments as scheduled.
Avoid smoking.
Maintain a healthy weight.
Eat a balanced diet and consume sufficient fluids.
Every patient recovers differently. The timing of a return to daily activities should be planned in accordance with the surgeon's recommendations.
In suitable patients, reflux surgery may help control reflux-related symptoms and improve quality of life.
Potential benefits may include:
Reduced heartburn
Reduced backward flow of stomach contents into the esophagus
Improvement in reflux-related loss of quality of life
A reduced need for long-term medication in some patients
Help in controlling reflux-related irritation of the esophagus
As with any surgical procedure, reflux surgery may involve certain risks.
Some patients may temporarily experience:
Difficulty swallowing
Bloating
Difficulty burping
Increased gas
Although surgical treatment can provide long-term benefits for many patients, it cannot be guaranteed that reflux symptoms will disappear completely or never return.
Certain factors, including dietary habits, weight changes, and a hiatal hernia, may cause symptoms to reappear over time. For this reason, maintaining healthy lifestyle habits after surgery remains important.
Maintain a healthy weight.
Engage in regular physical activity.
Avoid smoking.
Limit alcohol consumption.
Avoid eating late at night.
Follow a balanced and regular eating routine.
Does reflux surgery provide a permanent solution?
It can provide long-term benefits in suitable patients. However, treatment outcomes vary from person to person.
Is reflux surgery painful?
Postoperative pain may generally be more limited after laparoscopic surgery.
When can patients return to a normal diet?
The timeline varies from person to person. Patients generally start with liquids and soft foods before gradually returning to a normal diet.
Do patients need to continue taking medication after surgery?
Some patients may need less medication. However, medications should only be discontinued on the advice of a physician.
Is there an age limit for reflux surgery?
Age alone does not determine whether surgery is appropriate. Overall health and surgical suitability are assessed together.
Reflux disease can be controlled in many people through lifestyle changes and medication. However, surgery may be considered for some patients. When the appropriate patients are selected, reflux surgery is an effective treatment option aimed at reducing the backward flow of stomach contents into the esophagus.
It is important that the decision to proceed with surgery is made by an experienced general surgery and gastroenterology team after considering the patient's symptoms, diagnostic test results, and overall health.
If reflux symptoms are affecting your daily life, persist despite medication, or you would like to learn more about surgical treatment, consult the relevant specialist for an appropriate evaluation and treatment plan.
Emsey Medical Editorial Board
