- Patients with refractory reflux despite maximal treatment
- Patients on daily reflux medication who would prefer to have surgery- particularly young patients, or older patients on high dose PPIs, or patients who are intolerant of medication
- Patients with complications of reflux- e.g. ulcers or strictures
- Patients with “volume” reflux- these patients may vomit whenever they bend over, or are unable to lie flat due to their symptoms
Investigations prior to referral
- OGD (may be normal- okay to refer these)
Once seen in clinic the Upper GI surgeon can arrange pH/Manometry at RCH, also impedance studies for non-acid reflux. They may also need to repeat the OGD for surgical assessment.
Laparoscopic fundoplication is the gold standard for anti-reflux surgery, and involves mobilization of the fundus of the stomach which is then wrapped around the lower oesophagus. This is now routinely a day-case procedure in Cornwall.
Surgery is associated with a small risk complications such as gas-bloat and transient dysphagia. Recurrence of reflux symptoms can occur within 5-10 years in 5-10%, this is usually managed medically. Rarely is re-do surgery necessary.
Follow up is with a nurse specialist in routine cases and with the consultant in complex cases.
Post- operative symptoms, including reflux years after the procedure
Unless the patient has red flags, refer back to upper GI surgery as they would prefer to do the OGD themselves to look for specific complications of the surgery.