Anti-reflux surgery (Nissen fundoplication)

What is anti-reflux surgery (Nissen fundoplication)?

Gastro-oesophageal reflux disease (GORD) is when stomach acid flows back up into the gullet (oesophagus), causing heartburn, an acid taste, or other symptoms. It is often linked to a weak valve at the top of the stomach and sometimes to a hiatus hernia, where part of the stomach slides up through the diaphragm. Most people are managed with lifestyle changes and acid-suppressing medicines such as proton pump inhibitors (PPIs).

Anti-reflux surgery is considered for a smaller group: people whose reflux is severe and confirmed on tests, who do not get enough relief from medicines, who cannot tolerate or do not want lifelong medicines, or who have complications. The most common operation is a fundoplication, where the surgeon wraps the top of the stomach around the lower gullet to strengthen the valve and, where present, repairs a hiatus hernia. A Nissen fundoplication uses a full (360-degree) wrap; a partial wrap (such as a Toupet) goes only part of the way around and may cause fewer swallowing and wind side effects.

Surgery can be very effective at controlling reflux, but it changes how the gullet and stomach work. Many people notice some early difficulty swallowing, more wind, bloating or difficulty bringing up food or being sick (vomiting). These often settle, but can persist. Reflux can also come back over the years, and some people return to medicines or need a further operation. Surgery does not treat conditions that only mimic reflux, so careful testing beforehand matters.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Medicines vs surgery for reflux

Most people with reflux are managed well with lifestyle changes and medicines. Surgery is for selected people after tests, and is a trade-off: it can reduce reflux and the need for medicines, but changes how the gullet works and can cause side effects.

Preparing for your surgery

• See an upper GI surgeon to confirm that reflux is the real cause of your symptoms and that surgery is appropriate.
• Expect tests beforehand, often a gastroscopy and measurements of acid and pressure in the gullet (pH study and manometry), to confirm the diagnosis and check how the gullet moves.
• Discuss honestly the realistic benefits, the chance of side effects such as swallowing difficulty or wind, and that reflux can return over time.
• Tell the team about all medicines, especially blood thinners, and about other health problems.
• Stop smoking as early as you can, as it raises the risk of chest, wound and healing problems.
• Follow instructions on stopping or continuing acid medicines, and on eating and drinking before the operation.
• Plan for a soft or liquid diet for a period afterwards, and stock suitable foods at home.
• Arrange time off work, help at home and a lift, as you should not drive for a period afterwards.

What happens

The operation is usually done by keyhole, under general anaesthetic, so you are asleep. The surgeon makes several small cuts and gently inflates the tummy with gas to see clearly. If there is a hiatus hernia, the stomach is repositioned and the opening in the diaphragm is tightened. The top of the stomach is then wrapped around the lower gullet — fully for a Nissen, or part-way for a partial wrap — and held with stitches to strengthen the valve.

If keyhole surgery is not safe or possible, the surgeon may convert to open surgery. Most people stay in hospital for one to a few nights. You will start on liquids and soft foods and build up gradually over the following weeks as any early swallowing difficulty settles. You will be given clear diet and activity advice before you go home.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The main trade-off is that controlling reflux can come at the cost of side effects such as early swallowing difficulty, more wind and difficulty being sick, which usually settle but can persist. A full (Nissen) wrap controls reflux strongly but has more of these side effects than a partial wrap. Reflux can also return over the years. Ask your surgeon how often they do this operation, whether a full or partial wrap is right for you, how they will check the diagnosis first, and what they would do if you had lasting swallowing problems or returning reflux.

Published figures to discuss

How well surgery controls reflux, and how often it causes side effects, depends on the type of wrap, the surgeon's experience, the size of any hiatus hernia and patient factors. A full (Nissen) wrap controls reflux strongly but has more swallowing and wind side effects than a partial wrap. The ranges below are cautious figures from surgical literature, not guarantees for any one person, and reported rates vary widely between studies.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from keyhole surgery is usually fairly quick in terms of pain and wounds, but the gullet needs time to settle. Most people follow a staged diet over several weeks while early swallowing difficulty and wind improve.

• Tight or uncomfortable swallowing in the first weeks, easing as the wrap settles
• More wind, bloating and difficulty belching, which often improve over months
• Feeling full quickly and needing smaller, slower meals at first
• Shoulder-tip pain after keyhole surgery that settles within days
• Some difficulty being sick, which is expected after a wrap

Aftercare

• Follow the staged diet advice, starting with liquids and soft food and building up gradually.
• Eat small amounts slowly, chew well and avoid fizzy drinks and large mouthfuls early on.
• Take pain relief as advised and reduce it as the pain settles.
• Keep wounds clean and dry and follow advice on showering and dressings.
• Walk a little and often to aid recovery and lower the risk of clots.
• Avoid heavy lifting and straining for the period your surgeon advises.
• Do not drive until you can perform an emergency stop comfortably and your insurer agrees.
• Watch for warning signs such as chest pain, fever or swallowing that is getting worse, and keep your follow-up appointments.

• Soft and liquid foods stocked for the staged diet
• Pain relief in stock and a plan for taking it
• Loose, comfortable clothing
• Help arranged for shopping, lifting and chores for a couple of weeks
• Time off work booked (often around 2–6 weeks)
• Someone to drive you home and stay for the first day
• The clinic's contact number and a list of warning signs saved

Scars and how they heal

Keyhole surgery leaves several small scars on the tummy, usually including one near the navel, which fade over months to become discreet. If the operation is converted to open surgery, you will have one longer scar instead. Scars are pink and firm at first; sun protection helps them settle.

⚠ Get urgent help if…

• Severe or worsening chest or tummy pain
• A high temperature, shivering or feeling very unwell (possible infection or leak)
• Being unable to swallow even liquids or your own saliva
• Persistent vomiting, or vomiting blood
• Spreading redness, heat, swelling or discharge from a wound
• Breathlessness or fast breathing
• A swollen, hot or painful calf, or breathlessness or chest pain (possible clot — call 999)

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means heartburn and acid reflux are well controlled, any hiatus hernia is repaired, and you can eat a normal diet once the gullet has settled, often with little or no need for acid medicines. Early swallowing difficulty and wind usually improve over the first weeks to months.

Surgery cannot promise a permanent cure. Reflux can return over the years, and some people go back on medicines or need a further operation. It also will not help symptoms that are not actually due to reflux, which is why careful testing beforehand matters. A good surgeon is honest about both the benefits and the side effects, and checks the diagnosis before recommending surgery.

Many people enjoy good reflux control for years after fundoplication, and a full (Nissen) wrap tends to be the most durable. Over time, though, the wrap can loosen, slip or come undone, a hiatus hernia can recur (more likely with larger hernias), and reflux symptoms can return. A proportion of people restart acid medicines or, less often, need a revision operation. Keeping to a healthy weight and not smoking support a lasting result.

Combining with other procedures

Anti-reflux surgery is commonly combined with repair of a hiatus hernia in the same operation. It is not usually combined with unrelated procedures, and you should be cautious about add-on operations you did not come for. If you also have other upper GI problems, your surgeon will advise whether they should be addressed together or separately.

Follow-up & long-term care

You will usually be reviewed after the operation to check your swallowing, diet progress and symptom control, and to discuss any tests done beforehand. You should be told who to contact for swallowing problems, chest pain, fever or wound concerns, and have a clear route back to the team if reflux returns or side effects persist.

• Build back to a normal diet gradually, chewing well and eating slowly.
• Keep to a healthy weight, as excess weight makes reflux and hernia recurrence more likely.
• Stop smoking and limit triggers such as large late meals if they cause symptoms.
• Seek review if reflux returns, swallowing worsens, or wind and bloating remain troublesome.
• Discuss with your clinician before restarting or stopping acid medicines.

Revision and secondary surgery reality

• Some people restart acid-suppressing medicines if reflux returns after surgery.
• A revision (redo) operation may be needed if the wrap slips, comes undone or causes lasting side effects, and is more difficult and higher-risk than the first.
• Persistent swallowing difficulty occasionally needs a stretching (dilatation) procedure.
• A recurrent hiatus hernia may need further repair, more likely after large-hernia surgery.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• Clear written diet advice for the staged return to normal food, with dietitian support if needed.
• Specific warning signs (chest pain, fever, inability to swallow, vomiting blood) and what to do.
• A named contact and out-of-hours number for problems.
• Review of swallowing, symptom control and any pre-operative test results.
• A defined route back to the team for returning reflux or persistent side effects.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Surgeon's and anaesthetist's fees
• Tests needed beforehand, such as gastroscopy, pH study and manometry
• Theatre/facility time and the length of hospital stay
• Whether the operation is keyhole or open, and whether a hiatus hernia repair is needed
• Complexity, such as a large hernia or previous upper abdominal surgery
• Follow-up appointments and any later stretching (dilatation) procedure
• The policy if a complication occurs or a revision operation is later needed

• The surgeon's fee and the anaesthetist's fee
• The cost of pre-operative tests (gastroscopy, pH study, manometry)
• The hospital/facility and theatre fee, and expected length of stay
• Whether hiatus hernia repair is included
• Follow-up appointments and dietitian support
• The cancellation policy
• What happens, and who pays, if there is a complication or a revision operation is needed later

On the NHS? Anti-reflux surgery is available on the NHS for selected people with severe or hard-to-control reflux confirmed on tests; private care is sometimes chosen for speed or choice of surgeon, and most people with reflux are managed without surgery.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• How will you confirm that my symptoms are really due to reflux before recommending surgery?
• Would a full (Nissen) or partial wrap be better for me, and why?
• How likely am I to have lasting swallowing difficulty, wind or trouble being sick?
• How likely is it that my reflux will return, and what would we do if it did?
• How often do you do this operation, and how likely is conversion to open surgery?
• What diet should I follow afterwards, and for how long?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for anti-reflux surgery (nissen fundoplication)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Heartburn and acid reflux Guy's and St Thomas' NHS — Fundoplication surgery for severe acid reflux ARROW survey of anti-reflux practice in the UK (PMC) Long-term efficacy of total vs partial fundoplication — systematic review and meta-analysis (PMC) Management of complications after laparoscopic Nissen fundoplication (PMC) Persistent dysphagia and gas-bloat after laparoscopic Nissen fundoplication — PMC British Society of Gastroenterology

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.