Reflux & Foregut Surgery

Understanding GERD

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the esophagus, causing persistent heartburn, regurgitation, and other symptoms. While occasional acid reflux is common, GERD is a chronic condition that can damage the esophageal lining over time.

Most patients with GERD are initially managed with lifestyle changes and medications — primarily proton pump inhibitors (PPIs). However, some patients do not achieve adequate symptom relief with medication, experience intolerable side effects, or prefer not to take daily medication indefinitely. For these patients, surgery may offer a durable, long-term solution. Dr. Abbassi provides expert evaluation for GERD surgery at his Rockwall and McKinney, TX practice.

When Is Anti-Reflux Surgery Recommended?

Surgery for GERD is typically considered when:

• Symptoms persist despite optimal medical therapy
• The patient develops complications of GERD, including esophagitis, stricture, or Barrett's esophagus
• The patient has a large hiatal hernia contributing to reflux
• The patient prefers a surgical solution to lifelong medication
• Side effects of PPI medications (such as bone density concerns or nutrient malabsorption with long-term use) are a factor

Before recommending surgery, Dr. Abbassi requires objective testing — typically an upper endoscopy, esophageal pH monitoring, and esophageal manometry — to confirm the diagnosis and ensure the patient is an appropriate surgical candidate.

Hiatal Hernias

A hiatal hernia occurs when the upper portion of the stomach pushes upward through the diaphragm into the chest cavity. Small hiatal hernias often cause no symptoms. Larger hiatal hernias and paraesophageal hernias — where a significant portion of the stomach herniates alongside the esophagus — can cause severe reflux, chest pain, difficulty swallowing, and in some cases can become incarcerated, which is a surgical emergency.

Surgical repair involves reducing the hernia (returning the stomach to its normal position), closing the diaphragmatic defect, and typically performing a fundoplication to prevent recurrent reflux.

Surgical Procedures

Nissen Fundoplication

The Nissen fundoplication is the most established anti-reflux operation. The upper portion of the stomach (fundus) is wrapped 360 degrees around the lower esophagus, reinforcing the lower esophageal sphincter and preventing acid from refluxing. This procedure is performed laparoscopically or with robotic assistance.

Partial Fundoplication (Toupet or Dor)

In patients with impaired esophageal motility, a partial wrap (180 or 270 degrees) may be preferred to reduce the risk of post-operative dysphagia (difficulty swallowing). The choice between a full and partial wrap is based on preoperative manometry results.

Hiatal Hernia Repair

Hiatal hernia repair involves reducing the hernia content back below the diaphragm and closing the enlarged hiatal opening with sutures, sometimes reinforced with mesh for large defects. This is typically combined with a fundoplication to address the associated reflux.

Recovery

• Hospital stay: Most patients go home the same day or after one night
• Diet: A modified diet (soft foods and liquids) is followed for two to four weeks to allow healing at the surgical site
• Symptom relief: The majority of patients experience significant or complete resolution of reflux symptoms
• Return to activity: Light activity within days; full activity typically within three to four weeks

Is Anti-Reflux Surgery Right for You?

If you have been living with chronic reflux that is not adequately controlled by medication, a consultation with Dr. Abbassi in Rockwall or McKinney, TX can help determine whether surgical treatment is appropriate. The evaluation includes a thorough review of your symptoms, medical history, and the results of objective diagnostic testing.

Frequently Asked Questions

Will I still be able to eat normally after reflux surgery?

Yes. After a brief recovery period on a modified diet (two to four weeks), the vast majority of patients return to a completely normal diet. Some patients note they cannot eat as large a single meal as before, but overall dietary enjoyment is preserved.

How effective is fundoplication for GERD?

Studies show that 85–90% of patients who undergo Nissen fundoplication achieve significant or complete resolution of reflux symptoms. Most patients are able to discontinue PPI medications after surgery.