Acid reflux is a manageable condition for many people, especially with the right combination of lifestyle changes and medication. It is a common condition that affects many individuals, often causing discomfort after meals or while lying down. In most cases, symptoms can be managed with medication and lifestyle changes. However, for some individuals, reflux becomes chronic and significantly disrupts daily life. When other treatments are no longer effective, anti-reflux surgery may be recommended as a long-term solution.

Dr. Niruben Rajasagaram, an experienced gastroesophageal reflux disease specialist in Melbourne, provides effective solutions for acid reflux and gastroesophageal reflux disease (GERD). With a patient-centred approach, Dr. Niruben provides personalised guidance on treatment options. If surgery is needed, he may recommend procedures like laparoscopic fundoplication surgery to help manage acid reflux effectively.

This blog will help you understand acid reflux, when surgery is needed, how the procedure works, and how to prepare for it.

What Is Acid Reflux?

Acid reflux occurs when stomach acid flows back into the oesophagus (food pipe). This occurs when the lower oesophageal sphincter (LES), a ring of muscle between the stomach and the oesophagus, becomes weak or relaxes when it shouldn’t.

As a result, the acid from the stomach rises into the oesophagus and causes a burning sensation in the chest, known as heartburn. While occasional acid reflux is common, frequent occurrences may be a sign of gastroesophageal reflux disease (GERD).

What Causes Acid Reflux?

Several factors can contribute to acid reflux, including:

• Weakness of the lower oesophageal sphincter (LES)

• Obesity

• Pregnancy

• Smoking

• Certain foods and drinks (such as spicy foods, alcohol, chocolate, and coffee)

• Large meals or lying down soon after eating

• Hiatal hernia (a condition where part of the stomach pushes up into the chest)

Gastroesophageal Reflux Disease Symptoms

GERD is a serious, long-term form of acid reflux. Its symptoms are often more frequent and intense. Common signs include:

• Frequent heartburn (burning in the chest)

• Regurgitation (acid or food coming back up into the mouth)

• Difficulty swallowing

• A chronic cough or sore throat

• Hoarseness

• Feeling of a lump in the throat

• Chest pain (often mistaken for heart issues)

If lifestyle changes and medications do not relieve these symptoms, we may recommend surgery as a more effective GERD treatment.

Treatment Options for Acid Reflux Disease

Initial treatment for acid reflux and GERD includes:

• Dietary and lifestyle changes (avoiding trigger foods, weight management, quitting smoking)

• Over-the-counter medications like antacids

• Prescription medications such as proton pump inhibitors (PPIs) or H2 blockers

• Avoid eating late at night

• Elevating the head of the bed

However, when symptoms persist despite these treatments, or if complications like oesophageal damage, strictures, or Barrett's oesophagus develop, anti-reflux surgery may be necessary.

What Is Anti-Reflux Surgery?

Anti-reflux surgery is a procedure designed to control stomach acid from passing backwards into the oesophagus. The most commonly performed type of anti-reflux surgery is called fundoplication surgery.

Fundoplication Surgery Explained

In fundoplication, the upper part of the stomach (the fundus) is wrapped around the lower part of the oesophagus. This reinforces the lower oesophageal sphincter (LES) and prevents acid from building.

This procedure is often done laparoscopically (keyhole surgery), which involves small cuts and a quicker recovery.

There are different types of fundoplication depending on how much of the stomach is wrapped:

• Nissen Fundoplication (360-degree wrap), the most common and complete form

• Toupet Fundoplication (270-degree wrap), partial wrap, used in selected patients

• Dor Fundoplication (anterior partial wrap), used for specific cases

Who Needs Anti-Reflux Surgery?

You may be a candidate for anti-reflux surgery if you:

• Have chronic GERD symptoms not controlled by medications

• Are unable or unwilling to take long-term medication

• Experience side effects from GERD medications

• Have complications such as oesophagitis, strictures, or Barrett’s oesophagus

• Have a large hiatal hernia contributing to reflux

Dr. Niruben, a GERD specialist in Melbourne, will assess your condition using endoscopy before recommending surgery.

What to Expect Before, During, & After the Surgery?