An Anterior Fundoplication involves Dr Balalis stitching your diaphragm tight to reduce the size of the area, and then re-creating the lower oesophagus valve by wrapping the fundus of your stomach around the lower oesophagus.

A Nissen’s Fundoplication involves a complete wrapping of the top part of your stomach around your oesophagus and is sometimes known as a ‘360 degree wrap’.

Both fundoplication surgeries are performed laparoscopically or via ‘keyhole’, and in hospital under a general anaesthetic.

Dr Balalis performs a laparoscopic fundoplication to treat acid reflux, in patients who do not have a hiatus hernia and:

• Struggle to manage their symptoms on acid-suppression medication (PPI)
• Do not want to take tablets for the rest of their life, or
• Have had ulcers or oesophagitis (inflammation of their oesophagus).

As with all surgical procedures, there are risks, and some complications are severe and, in rare cases, can cause death. Your surgeon will discuss risks with you in detail in your appointment.

Risks and side effects may include:

• General complications (as with any surgery) such as bleeding, surgical site infection, allergic reactions to medications, materials, or equipment; serious kidney injury, a hernia of the scar, blood clotting (to a leg or lung), and chest infection.
• The area around the hiatus hernia has large blood vessels, such as the aorta and vena cava, as well as nerves that help the oesophagus and stomach drain. Injuries are rare but can occur.
• Recurrence of the hernia can occur, and this risk depends on the size of the hernia and quality of the tissue. Note that the recurrence is usually not as large as the original hernia.
• Recurrence of reflux can also occur, and this depends on several factors, such as operation factors and patient factors. Again, the return of reflux is usually not as severe as previously.

• Some people find that they have more wind as the valve between the stomach and oesophagus is tighter. This can cause gas bloating, belching or increased flatulence. This is less of an issue with Anterior Fundoplication, compared to a Nissen’s Fundoplication.
• Complications specific to keyhole surgery include surgical emphysema (a crackling sensation in your skin caused by trapped carbon dioxide), damage to structures such as your bowel, bladder, or blood vessels, and developing a hernia near one of the cuts used to insert the ports and gas embolisms.
• Complications specific to hiatus hernia surgery include pneumothorax (where air escapes into the space around your lung), a hole in your oesophagus or stomach, a stitched tear, damage to your liver, damage to your spleen and difficulty swallowing for a few months.
• Additional long-term (but rare) consequences may include ongoing difficulty swallowing, inability to control reflux symptoms, weight loss, abdominal discomfort, diarrhoea, an abnormal valve, a faulty valve, abnormal merging of tissue join, pain and scarring.