Nissen fundoplication (anti-reflux surgery) in Turkey

Nissen fundoplication is the standard operation for acid reflux that medication no longer controls. The top of the stomach is wrapped around the lower end of the oesophagus to rebuild the valve that has stopped working, and any hiatal hernia, the stomach sliding up through the diaphragm, is repaired at the same time. The floppy Nissen is the modern version of the full wrap: short and loose, calibrated over a tube in the oesophagus, so that it stops reflux without making swallowing difficult. It is done laparoscopically, through small incisions, with a night or two in hospital.

The operation works well for the right patient and badly for the wrong one, and the difference is made before surgery, not during it. It is for people whose reflux has been proven by objective testing, who respond to acid-suppressing drugs but do not want to take them for life or cannot control symptoms with them, or who have a large hernia or complications such as regurgitation. It is not for heartburn that has never been investigated, and a clinic that offers it on the strength of symptoms alone is offering an operation to a diagnosis it has not made.

The classic Nissen wraps the stomach fully around the oesophagus. The floppy Nissen keeps the full wrap but makes it short and loose, calibrated over a tube, which is what most surgeons now mean by Nissen. The Toupet is a partial wrap covering about two thirds of the circumference, used where the oesophagus is weak, with fewer swallowing problems and slightly less reflux control. The choice between them is made from the manometry study, not from preference.

Magnetic sphincter augmentation, a ring of magnetic beads placed around the lower oesophagus, is an alternative for selected patients with smaller hernias; it preserves belching and vomiting but has its own removal rate and is not suitable for everyone. Endoscopic procedures done through the mouth exist and have less durable results. Medication remains a legitimate long-term option for many people, and the operation is a choice, not an obligation.

• Difficulty swallowing. Expected early, usually settling over weeks to months; a minority need the wrap stretched or revised.
• Gas-bloat and inability to belch or vomit. The new valve works both ways. Common, often improving, sometimes permanent.
• Recurrence. The wrap can loosen, slip or the hernia can come back. A share of patients return to medication over the years and some are re-operated.
• Surgical risks. Bleeding, infection, injury to the oesophagus, stomach or spleen, and the risks of general anaesthesia; rare with experienced laparoscopic surgeons.
• Wrong operation for the oesophagus. A full wrap on a weak oesophagus causes lasting swallowing trouble. This is a work-up failure, not bad luck.
• Symptoms that were never reflux. Functional heartburn and other causes are not helped by surgery. Testing before the operation is what prevents this.
• Travel after surgery. A long flight soon after abdominal surgery adds clot risk, and early swallowing problems are managed better near the surgeon.

• Bring or arrange the tests. Gastroscopy, pH study and manometry; if the centre cannot do manometry, ask how it chooses the wrap.
• Ask who operates. An upper gastrointestinal or bariatric surgeon who does anti-reflux surgery regularly, in an accredited hospital.
• Ask which wrap and why. Floppy Nissen or Toupet, based on your manometry, with the reasoning explained.
• Ask about the hernia. How large it is, how it will be repaired and whether reinforcement is planned.
• Plan the stay. A night or two in hospital, a review before flying, and enough days for swallowing to settle and the clot risk of a long flight to fall.
• Ask what happens at home. Who manages swallowing trouble, who investigates recurrent symptoms, and what the re-operation policy is.

• Society of American Gastrointestinal and Endoscopic Surgeons, guidelines for the surgical treatment of gastroesophageal reflux disease.
• European Association for Endoscopic Surgery, recommendations on the management of gastro-oesophageal reflux disease.
• National Institute for Health and Care Excellence, guidance on gastro-oesophageal reflux disease and dyspepsia, and on laparoscopic insertion of a magnetic bead band.
• National Health Service, heartburn and acid reflux: treatment and surgery.
• Republic of Türkiye Ministry of Health, register of healthcare providers authorised for international health tourism.