Procedure · Laparoscopic

Laparoscopic anti-reflux surgery, for severe GERD

Hiatus hernia repair · Apollo Speciality Hospitals, Nellore

Severe gastro-oesophageal reflux disease (GERD) and large hiatus hernias that do not respond to medication can be definitively treated with laparoscopic anti-reflux surgery. Dr. Dwarakanath Reddy performs Nissen fundoplication and crural repair at Apollo Speciality Hospitals, Nellore, for patients who need a long-term solution beyond daily PPIs.

Send your reports on WhatsApp

01 · Laparoscopic

What is laparoscopic anti-reflux surgery?

Laparoscopic Nissen fundoplication is the standard surgical treatment for severe acid reflux. The upper part of the stomach (fundus) is wrapped around the lower oesophagus to recreate a competent valve, preventing acid from refluxing upward. When a hiatus hernia is present, the stomach is first reduced from the chest back into the abdomen and the diaphragmatic opening is repaired (cruroplasty).

02 · Laparoscopic

Who needs this procedure?

Anti-reflux surgery is considered for:

Severe GERD requiring lifelong daily PPIs (proton pump inhibitors)
Reflux symptoms that recur whenever medication is stopped
Side effects from long-term PPI use, or intolerance to medication
Hiatus hernia larger than 5 cm, or causing obstructive symptoms
Reflux complications: oesophagitis, Barrett's oesophagus, stricture, aspiration
Atypical reflux symptoms, chronic cough, hoarseness, sleep disruption, confirmed by 24-hour pH study

Surgery is not for mild reflux that responds to lifestyle changes or occasional medication. A 24-hour pH study, oesophageal manometry, and an endoscopy are usually completed before surgery is offered.

03 · Laparoscopic

How Dr. Reddy performs it

01 Five small incisions (5 to 10 mm) are made in the upper abdomen
02 The abdomen is inflated with CO2 to create working space
03 If a hiatus hernia is present, the stomach is reduced from the chest into the abdomen
04 The diaphragmatic opening (hiatus) is closed with sutures, sometimes reinforced with mesh
05 The upper stomach (fundus) is mobilised and wrapped 360° around the lower oesophagus (Nissen), or 270° (Toupet) if dysmotility is present
06 The wrap is secured with sutures and tested for tightness
07 Cuts are closed with absorbable sutures and skin glue

The procedure typically takes 90 to 120 minutes. The decision between Nissen (full wrap) and Toupet (partial wrap) is based on pre-operative manometry findings.

04 · Laparoscopic

Recovery timeline

Day of surgery	Inpatient. Sips of clear fluid in the evening. Walking by night.
Day 1 to 2	Soft pureed diet, oral painkillers. Discharge after one or two nights.
Week 1 to 2	Soft, blended diet, soups, dal, mashed food. Avoid carbonated drinks. Office work in 7 to 10 days.
Week 3 to 6	Gradual return to normal solid food. Avoid heavy lifting for 4 weeks.
Month 3	Full diet including all textures. Reflux medication usually stopped by now.

Some patients experience temporary difficulty swallowing solid food in the first 4 to 6 weeks. This settles as the wrap loosens slightly. Bloating from inability to belch (gas-bloat syndrome) is the most common long-term side effect, usually mild.

05 · Laparoscopic

Risks and complications

Laparoscopic fundoplication is safe in expert hands. Risks include difficulty swallowing (dysphagia, usually temporary), gas-bloat syndrome, recurrence of reflux (5 to 10 percent at 10 years), wrap migration or slippage, injury to surrounding structures (rare), and very rarely conversion to open surgery. Dr. Reddy discusses individual risk based on your symptoms, anatomy, and prior surgery.

06 · Laparoscopic

Why Dr. Reddy for anti-reflux surgery

DrNB qualified surgical gastroenterologist with focused upper GI training
Decision based on full work-up: endoscopy, manometry, and 24-hour pH study
Tailored choice between Nissen and Toupet based on motility findings
Cruroplasty with mesh reinforcement when indicated for large hernias
Apollo Nellore infrastructure for any rare complication

07 · Laparoscopic

Frequently asked questions

Will I be able to stop my acid reflux medication after surgery?

Most patients are off PPIs within a few weeks of surgery. Around 90 percent remain medication-free at one year, and 80 to 85 percent at ten years. A small minority need occasional or low-dose medication for residual symptoms.

Will I be able to belch and vomit normally after surgery?

Belching is reduced after a Nissen wrap. This is part of how the surgery works. Many patients find this an inconvenience initially. Vomiting is possible but more difficult; this is why we ask you to be careful with overeating in the first weeks.

What if my reflux comes back?

Recurrence rates are around 5 to 10 percent over a decade. Most recurrent reflux is mild and managed with low-dose medication. Revision surgery is possible but technically harder than the first operation.

Is this the same as bariatric surgery?

No. Anti-reflux surgery treats acid reflux and is not a weight-loss procedure. However, in patients with both severe reflux and obesity, gastric bypass is sometimes a better solution because it addresses both problems.

Will my insurance cover this surgery?

Most cashless and reimbursement plans cover laparoscopic anti-reflux surgery when documented as medically necessary (failed PPI therapy, oesophagitis, large hernia). Send your reports on WhatsApp for a pre-authorisation check.

Related conditions

Conditions this procedure treats.

ICD-10 · K21

Gastro-oesophageal Reflux Disease (GERD)

Chronic acid reflux from the stomach into the oesophagus. Causes heartburn, regurgitation, and over time, oesophagitis or Barrett's oesophagus. Severe GERD that fails medical therapy is a surgical indication.

About this condition →

Next step

Have severe reflux or a hiatus hernia on imaging? Share your reports on WhatsApp for a surgical opinion.

Send your reports on WhatsApp