The operation reduces the hiatal hernia, closes the diaphragmatic hiatus and adds a fundoplication (wrapping the top of the stomach) to control reflux. It is performed laparoscopically, with a gradual return to eating.
What is the operation?
It treats a hiatal hernia and gastro-oesophageal reflux: returning the stomach to the abdomen, closing the diaphragmatic hiatus and a fundoplication to reinforce the anti-reflux mechanism.
When is it needed?
It is indicated for reflux refractory to medication, complications (oesophagitis, stricture) or drug intolerance, and for large/paraoesophageal hiatal hernias.
Preparation
Work-up includes endoscopy, manometry (oesophageal motility) and pH monitoring (documenting reflux), plus imaging as appropriate — to choose the type of fundoplication.
How it's done
Laparoscopically, the stomach is returned to the abdomen, the sac is removed and the diaphragmatic hiatus is closed. The top of the stomach is wrapped around the lower oesophagus (full or partial fundoplication), according to motility.
Nissen (360°)
A full wrap — strong reflux control, for patients with good oesophageal motility.
Toupet (270°)
A partial wrap — less dysphagia, ideal for motility disorders.
Paraoesophageal hernia
Reduction of a large hernia and hiatal closure, with mesh in selected cases.
Recovery
Discharge is usually in 1–2 days. A staged diet is followed (liquids → soft → normal); mild difficulty swallowing in the first weeks is common and settles.
Risks & outcomes
With correct patient selection, outcomes are very good. Possible, usually transient, effects: dysphagia, gas-bloat, difficulty belching; recurrence in a small proportion.
Frequently asked questions
Will I stop my stomach medication?
The aim is to control reflux without daily medication. Many patients stop their drugs, though this is individualised.
Will I have trouble swallowing?
Mild dysphagia in the first weeks is common and usually settles as swelling reduces. A staged diet helps.
Nissen or Toupet?
The choice depends on oesophageal motility, as shown by manometry. The partial wrap (Toupet) causes less dysphagia.
Is it done laparoscopically?
Yes, the operation is done chiefly laparoscopically, with small incisions and rapid recovery.