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 is the laparoscopic repair of a hiatal hernia and control of gastro-oesophageal reflux. Three steps define it: returning the stomach to the abdomen, closing the diaphragmatic hiatus and a fundoplication (wrapping the fundus around the lower oesophagus).
The fundoplication restores the anti-reflux mechanism; its type is chosen based on oesophageal motility.
When is it needed?
It is indicated for reflux refractory to medication, complications (oesophagitis, stricture) or drug intolerance, and for large/paraoesophageal hiatal hernias (risk of volvulus).
Preparation
Work-up includes endoscopy, manometry (oesophageal motility) and pH monitoring (documenting reflux), plus imaging — to choose a full or partial fundoplication.
How it's done
Laparoscopically, the stomach is reduced, the sac is excised and the hiatus closed; for large defects reinforcement may be used. A fundoplication follows: full (Nissen 360°) for strong control with good motility, or partial (Toupet 270°) for less dysphagia in motility disorders.
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, with a staged diet (liquids → soft → normal). Mild, transient dysphagia in the first weeks is common as swelling settles.
Risks & outcomes
With correct patient selection, outcomes are very good. Possible, usually transient: dysphagia, gas-bloat, difficulty belching; less often recurrence or wrap slippage. Careful technique limits these risks.
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.