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Surgery for reflux disease aims to rebuild the natural barrier between the stomach and the oesophagus when that barrier no longer holds stomach acid down. The operation is usually performed laparoscopically through small abdominal incisions. It involves repairing a hiatal hernia if one is present, by returning the herniated part of the stomach to the abdomen and narrowing the opening in the diaphragm, and then wrapping the upper stomach around the lower oesophagus so that it acts as a valve against reflux. The decision is never made on symptoms alone. A full pre-operative assessment is required: upper endoscopy to evaluate inflammation and any change in the oesophageal lining, oesophageal pH monitoring to prove that the symptoms really are caused by acid reflux, manometry to measure oesophageal motility because severely weak motility rules out certain types of wrap, and sometimes a contrast swallow study to define the size of the hernia. Without these steps an operation may be performed on someone whose complaint comes from an entirely different cause. Typical candidates include people whose symptoms persist despite appropriate medical treatment, those who cannot tolerate medication, those facing indefinite long-term drug use who want an alternative after a frank discussion, and those with a large hiatal hernia or complications such as oesophageal narrowing or repeated chest infections from acid aspiration. Final suitability is settled by clinical examination and the results of that assessment, not by reading about it. The limits of the operation must be clear before you consent. Surgery treats acid reflux; it **does not treat delayed gastric emptying, irritable bowel syndrome, food intolerance, or abdominal pain that is not caused by reflux**, and atypical symptoms such as cough, hoarseness and chest pain improve less reliably than heartburn and regurgitation. It is **not a weight-loss operation**, and someone whose reflux is driven by a very high body weight may be offered a different surgical pathway to discuss. Some patients still need acid-lowering medication years later, and results deteriorate if the hernia recurs or if the drivers of reflux continue, such as smoking, excess weight and a heavy meal close to bedtime. There are expected after-effects that are better understood than feared: bloating and gas with difficulty belching or vomiting in the early weeks, temporary difficulty swallowing that requires a staged diet moving from liquids to purée and then to normal food, and sometimes a feeling of early fullness. Most of this eases gradually, though a small part may persist, which is why the patient must understand the trade-off and accept it knowingly.
Upper endoscopy is performed, along with pH monitoring to link the symptoms to reflux and manometry to assess motility; a contrast swallow may be added to define the hernia. Medication, weight and smoking are reviewed and the aim of surgery is discussed frankly.
Pre-operative blood tests and, where needed, heart and lung assessment are completed, and diabetes and anticoagulant medicines are managed by written instruction. The operation is done under full general anaesthesia; small ports are placed and the abdomen is inflated with gas to allow vision and working space.
The herniated portion of the stomach is returned to the abdomen, enough length of lower oesophagus is mobilised, and the diaphragmatic opening is narrowed with sutures; a tissue reinforcement may be used in large hernias at the surgeon's judgement during the operation.
The upper stomach is wrapped around the lower oesophagus and secured with sutures so that it works as a valve. The type and tightness of the wrap are chosen according to the manometry result, because a tight wrap on a poorly motile oesophagus causes lasting swallowing difficulty.
You are monitored after anaesthesia and encouraged to walk the same day. Intake begins with liquids, then purée, then soft food over some weeks as the team directs, avoiding fizzy drinks, large pieces and dry bread at first.
Bring your endoscopy, pH study and manometry reports along with any earlier imaging, because the operation is not decided without them. Tell the surgeon about every medicine you take, especially blood thinners and anticoagulants, diabetes drugs, steroids, supplements and herbal products, and follow the written instructions exactly on which to stop and when; never stop anything on your own. Mention asthma, heart disease, sleep apnoea, previous anaesthetic problems or past abdominal operations. Stop smoking some weeks before surgery if you can, as this reduces lung and wound complications. Observe the fasting period specified by the anaesthetic team. Arrange purée food and liquids at home in advance and someone to accompany you after discharge, and discuss your expectations openly with the surgeon: what the first weeks will feel like, and what the operation will not change.
Walk little and often from the first day, since this lowers the risk of clots and adhesions, and avoid heavy lifting and hard exertion for the period your surgeon specifies. Follow the staged diet exactly as written: liquids, then purée, then soft food, with small mouthfuls and long chewing, no fizzy drinks or straws at first, and never lie down straight after eating. Expect bloating, gas, difficulty belching and early fullness in the first weeks, with mild swallowing difficulty that improves gradually. Keep the wounds clean and dry, and discuss with your doctor when to stop or adjust acid-lowering medication rather than deciding alone. Maintain a healthy weight and stay off tobacco, because their return weakens the result of surgery. **Go to the emergency department immediately for** **fever or shivering, or abdominal pain that keeps increasing**, **a racing pulse, breathlessness or chest pain**, **complete inability to swallow, persistent vomiting or severe pain on swallowing**, vomiting blood or black stools, redness or pus from the wounds, a distended abdomen with no passage of gas or stool, or swelling and pain in a leg.
The operation usually takes one and a half to three hours depending on hernia size and adhesions, with a hospital stay of one to three days, return to usual activity in two to four weeks, and a staged diet lasting several weeks.
الدكتور داوود محمود داوود — استشاري جراحة السمنة والمناظير والجراحة العامة في الأردن، وحاصل على البورد الأردني في الجراحة العامة، وعضو في جمعية الجرّاحين الأردن…
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