There are many reasons why you could develop GORD:

• Smoking
• Being overweight
• Developing a hiatus hernia
• Pregnancy
• Eating large meals or eating late at night
• Eating certain foods, such as fatty or fried food
• Drinking certain beverages such as coffee or alcohol
• Stress

The main symptoms of GORD are heartburn and acid reflux:

• Feeling of or being sick
• A sense of feeling bloated or repeated belching
• A sore, inflamed oesophagus, sore throat and hoarseness
• Bad breath
• The contents of your stomach ‘repeating’ by coming back up the oesophagus causing an unpleasant taste
• Difficulty swallowing and/or pain on swallowing

Most treatments involve making a change to your current lifestyle; for example, losing weight, stopping smoking and drinking less alcohol can all make a big difference to the discomfort you experience. Some foods are more likely than others to trigger heartburn symptoms so you may find it helpful to look at how you eat as well as what you eat.

You may also need to take medication either in the short or  long-term but there are some people for whom drug treatment is not suitable. In such cases, your GP may refer you to our Gastroenterology Department for their advice.

If your GORD symptoms haven’t been controlled by medicines, your consultant may recommend fundoplication surgery. Your consultant will discuss the treatment and the risks and potential complications of the surgery with you.

Fundoplication surgery may be an option if:

• Treatment with medication causes side effects that you can’t tolerate, or you are reluctant to take medication on a long-term basis
• You have symptoms that don’t adequately improve when treated with medication. Examples of these symptoms are asthma, hoarseness, or cough along with reflux

When fundoplication surgery is successful, it may end the need for long-term treatment with medication.

Fundoplication surgery is most often used to treat GORD symptoms that are likely to be caused in part by a hiatus hernia. In most people who have laparoscopic (keyhole) surgery for GORD, the surgery improves symptoms and heals the damage done to the oesophagus.

Surgery can cause new and troublesome symptoms. Over time, some people have trouble swallowing, have increased flatulence (gas), and/or have trouble belching.

Risks or complications following fundoplication surgery include:

• Difficulty swallowing
• Developing a hernia near the wound sites
• Tear of the stitches holding a stomach wrap
• Damage to internal organs
• Heartburn that comes back
• Bloating and discomfort from gas build-up because the person is not able to burp
• Risks of anaesthesia
• Risks of major surgery (infection or bleeding)

For some people, the side effects of surgery - bloating caused by gas build-up, swallowing problems, pain at the surgical site - are as bothersome as GORD symptoms. The fundoplication procedure cannot be reversed, and in some cases, it may not be possible to relieve the symptoms of these complications, even with a second surgery.

GORD can be annoying and even painful, but it’s not a dangerous disease. For any GORD treatment to be worth trying, it needs to be very safe. For many people, especially those who have few problems taking medicine, surgery is not recommended. 

Surgery to treat GORD is rarely done on people who: 

• Are older adults, especially if they have other health problems in addition to GORD
• Have weak squeezing motions (peristalsis) in the oesophagus. These motions are important to move food down the oesophagus to the stomach. Surgery may make this problem worse, causing food to get stuck in the oesophagus
• Have unusual symptoms that might be made worse by surgery

In special cases, other surgeries such as partial fundoplication or gastropexy may be done instead of fundoplication surgery.

Before surgery, additional tests will usually be done to be sure that surgery is likely to help cure GORD symptoms and to diagnose problems that could be made worse by surgery.

A general anaesthetic is used, which means you sleep through the operation. 

During fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the oesophagus and sewn into place so that the lower portion of the oesophagus passes through a small tunnel of stomach muscle. This surgery strengthens the valve between the oesophagus and stomach (lower oesophageal sphincter), which stops acid from backing up into the oesophagus as easily. This allows the oesophagus to heal. 

• This procedure can be done through the abdomen or the chest. The chest approach is often used if a person is overweight or has a short oesophagus.
• This procedure is often done using a laparoscopic surgical technique. Outcomes of the laparoscopic technique are best when the surgery is done by a surgeon with experience using this procedure.

If your condition has been caused by a hiatus hernia, it will also be repaired during this surgery.

The operation will take between 60 and 90 minutes and is usually a keyhole operation with around 5 small incisions, usually less than 1cm in size. It’s possible that a larger incision might be needed to safely perform your operation - for example, if there is internal scar tissue or complications such as bleeding – but this is rare.

If you have keyhole surgery, you’ll most likely be in the hospital for only one day. Some patients can go home the same day. You’ll have less pain after surgery because there’s no large incision to heal. After laparoscopic surgery, most people can go back to work or their normal routine in about two to three weeks, depending on their work.

If you have open surgery (which requires a large incision), you’ll most likely spend several days in hospital, and you may need four to six weeks to get back to work or your normal routine.

After either surgery, you may need to change the way you eat. You may need to eat only soft foods until the surgery heals and you should chew food thoroughly and eat more slowly to give the food time to go down the oesophagus.

Over time, some peoples’ symptoms return and may need to take medicine for symptoms or have another operation. 

Second surgeries are harder to do, are less successful, and are riskier. So, it’s extremely important that you consider carefully whether fundoplication surgery is the right treatment for you.