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GERD Surgical Treatment (Nissen Fundoplication)

Antireflux surgery for reflux patients unresponsive to medical treatment or with large hiatal hernia.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is GERD Surgical Treatment (Nissen Fundoplication)?

Gastroesophageal reflux disease (GERD) is a chronic digestive system disease causing chest and stomach symptoms due to backflow of stomach contents into the esophagus. It affects up to 20% of the population, and most patients are successfully treated with proton pump inhibitors (PPI). However, 10-15% of patients may require long-term surgical treatment.

Surgical indications include: disease unresponsive to high-dose PPI, avoiding drug side effects or dependence, large hiatal hernia, Barrett's esophagus, and patients choosing surgery due to long-term drug costs. Preoperative evaluation includes esophagogastroduodenoscopy, 24-hour pH monitoring, esophageal manometry, and barium upper gastrointestinal series if needed.

The gold standard surgery is laparoscopic Nissen fundoplication. In this method, the gastric fundus (upper portion) is wrapped 360 degrees around the lower part of the esophagus to create a new antireflux barrier. To reduce dysphagia risk, partial fundoplications (Toupet 270°, Dor 180°) may be preferred in selected cases. If hiatal hernia is present, crural repair is performed.

Symptoms

Chest burning sensation (heartburn)
Stomach contents rising to the mouth (regurgitation)
Retrosternal pain increasing after meals
Chronic cough, throat clearing, and hoarseness
Nocturnal reflux and sleep disturbance
Difficulty swallowing (dysphagia)
Tooth enamel erosion and bad breath

Risk Factors

Obesity and abdominal adiposity
Presence of hiatal hernia
Smoking and alcohol use
Consumption of fatty, spicy, and acidic foods
Habit of eating immediately before lying down
Pregnancy
Certain medications (calcium channel blockers, nitrates, anticholinergics)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent symptoms despite maximum PPI therapy
  • Dysphagia and chest pain
  • Recurrent aspiration pneumonia
  • Esophagitis, stricture, or Barrett's esophagus on endoscopy
  • Desire to avoid long-term medication use

Treatment Methods

01
Laparoscopic Nissen fundoplication (360°): gold standard surgery
02
Partial fundoplication (Toupet 270°, Dor 180°): in cases with high dysphagia risk
03
Crural repair and mesh use when hiatal hernia coexists
04
LINX magnetic sphincter augmentation: alternative in selected cases
05
Weight loss, avoiding food triggers, and head-of-bed elevation
06
Confirmation of indication and technique with preoperative pH-metry and manometry

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.