Upper GI surgery · UK
Laparoscopic Nissen fundoplication, the gold standard for medically-refractory GORD.
A 360° wrap of the fundus around the lower oesophagus, done through four or five keyhole ports by a specialist upper GI surgeon - with the partial-wrap and LINX alternatives openly on the table.
Why patients choose us
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A specialist upper GI surgeon, not a generalist
A named consultant upper GI surgeon who does anti-reflux work weekly - with a full pre-op work-up (OGD, pH-impedance, manometry) before anyone picks up a scalpel.
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The partial and LINX alternatives on the table
Nissen is the gold standard, but Toupet 270°, Dor 180° and LINX magnetic sphincter augmentation are discussed openly. We say which one fits your motility and your reflux - not just the one the surgeon prefers.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private laparoscopic Nissen fundoplication costs in the UK.
Indicative ranges across our partner upper GI units. Send the details and we quote firm figures across the surgical alternatives.
In short
A private laparoscopic Nissen in our network: £8,000–£14,000, home in 1–2 nights.
| Procedure | Indicative range | Typical duration | Hospital stay |
|---|---|---|---|
| Laparoscopic Nissen fundoplication (360°) | £8,000–£14,000 | 90–150 min | 1–2 nights |
| Laparoscopic Toupet fundoplication (270° posterior) | £8,000–£13,500 | 90–140 min | 1–2 nights |
| Laparoscopic Dor fundoplication (180° anterior) | £7,500–£12,500 | 90–130 min | 1–2 nights |
| LINX magnetic sphincter augmentation | £10,000–£16,000 | 60–90 min | 1 night |
| Nissen with hiatus hernia repair + mesh | £10,000–£16,000 | 2–3 hours | 1–3 nights |
| Pre-op work-up (OGD + pH-impedance + manometry) | £1,800–£3,200 | Two visits | 7–10 days |
Prices vary by hospital, by which upper GI surgeon does the case, by whether mesh is used for a hiatus hernia, and by how many nights you stay. NHS pathways cover the operation through upper GI surgery - we help you decide whether private makes sense for you.
The problem
The right surgeon, the right operation, the right expectations.
Anti-reflux surgery is one of the operations most often done for the wrong reason, on the wrong physiology, by the wrong surgeon. A proper work-up, a specialist upper GI surgeon and an honest conversation about dysphagia and gas-bloat fix all three.
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Not sure surgery is needed?
For most people optimised PPI is enough. Surgery is for the ones it is not - and the work-up decides.
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Worried about the operation?
A specialist upper GI surgeon in a proper theatre, not a generalist doing the occasional wrap.
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Want the alternatives on the table?
Toupet 270°, Dor 180° and LINX are discussed openly - the right operation is the one your motility and symptoms point to.
The journey
From enquiry to recovery - what happens, in order.
One clinician from first message through work-up, surgery and the diet-progression window.
Phase 1 · Before your operation
Concierge and pre-op work-up
Phase 2 · Admission and surgery
One to two nights in hospital
Phase 3 · After
Diet progression and review
- 01
Before
You tell us what is going on
A short, confidential form. Reflux history, PPI trial, symptoms - heartburn, regurgitation, cough, laryngitis - and any hiatus hernia on prior imaging.
- 02
Before
We come back with a recommendation
Within one working day: which surgeon, which anti-reflux operation (Nissen, Toupet, Dor or LINX), which tests you still need, and an indicative price.
- 03
Before
Pre-op work-up
OGD to exclude Barrett’s and grade oesophagitis, 24-hour pH-impedance monitoring (DeMeester score >14.7 confirms pathological reflux), high-resolution manometry to rule out achalasia or severe dysmotility. Barium swallow if a hiatus hernia is suspected.
- 04
In hospital
Admission and anaesthetic
Same-day admission. GA with the anaesthetist, DVT prophylaxis, single-dose antibiotic, urinary catheter for the case.
- 05
In hospital
The laparoscopic operation
90–150 minutes. Four or five ports, liver retractor, both crura mobilised, hiatus repaired posteriorly, short gastric vessels divided, a floppy 360° wrap over a 56–60Fr bougie, sutured to the right crus and oesophagus.
- 06
In hospital
One to two nights in hospital
Sips of clear fluids the same evening if comfortable. Free fluids day 1. Home on day 1 or 2 once eating, drinking, mobile and pain-controlled on oral analgesia.
- 07
After
Recovery and review
Liquid diet 1–2 weeks, soft 2–4 weeks, normal texture from 4–6 weeks. Office work at 1–2 weeks, no heavy lifting for 6 weeks, gym from 4–6 weeks. Surgeon review at 2 and 6 weeks.
Typical end-to-end: 3–4 weeks from enquiry to surgery. Full diet recovery: 4–6 weeks.
When it helps
When a Nissen fundoplication is the right step.
The NICE-guidance situations we see most, and the one contraindication that means a different operation is safer.
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GORD refractory to PPI
Heartburn or regurgitation that persists despite an optimised PPI trial - the classic surgical indication.
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PPI-intolerant reflux
Side effects, allergy or long-term safety concerns (bone, kidney, absorption) making lifelong PPI unappealing.
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Barrett’s oesophagus with dysplasia
Complicated GORD with metaplasia and dysplasia - surgical control of reflux alongside endoscopic surveillance.
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Peptic stricture or ulceration
Recurrent oesophageal stricture needing dilatation, or persistent ulceration despite full acid suppression.
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Laryngopharyngeal reflux
Cough, hoarseness, laryngitis or aspiration pneumonia driven by proven acid or non-acid reflux on pH-impedance.
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Large symptomatic hiatus hernia
A hiatus hernia with reflux - Nissen combined with hiatal repair (see hiatus hernia repair).
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Patient preference to stop PPI
A younger patient looking at 30–50 years of PPI and choosing a definitive operation instead.
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Not for you: dominant dysphagia
If manometry shows achalasia, severe hypomotility or the main symptom is swallowing trouble, Nissen is the wrong operation. A partial wrap or a different procedure is safer.
Procedure options
A Nissen 360° is not the only anti-reflux operation.
What each option on the table actually involves - and which physiology it suits.
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Nissen 360° (this page)
The gold-standard wrap. Best durability of reflux control; small trade-off in dysphagia and gas-bloat in the first months.
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Toupet 270° posterior partial
For borderline oesophageal motility. Less post-op dysphagia and gas-bloat than Nissen; slightly less durable reflux control long-term.
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Dor 180° anterior partial
Most often added after a Heller myotomy for achalasia. Rarely used as a primary anti-reflux operation.
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LINX magnetic sphincter augmentation
A ring of titanium beads around the lower oesophagus. Less invasive, preserves belching and vomiting. See /treatments/linx-reflux-surgery.
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Hiatus hernia repair + wrap
A large or para-oesophageal hiatus hernia is repaired first, often with mesh, and a wrap added as the anti-reflux component.
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Redo anti-reflux surgery
For wrap slippage, disruption or recurrent reflux after a previous fundoplication - technically harder and best done by a high-volume surgeon.
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Lifelong PPI (non-surgical)
Effective for most patients. The debate is long-term safety - dementia, fracture, malabsorption signals are debated rather than settled.
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Consultation only
An honest discussion of whether surgery is right, which operation, and whether the work-up is complete - no obligation.
Our vetted UK network
A small panel of upper GI surgeons, we picked them.
High-volume consultant upper GI surgeons across London and the major UK cities. Not listed publicly - introductions are made privately, once the work-up is complete and the MDT view is clear.
Selection criteria
How we choose every upper GI surgeon in our network.
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Consultant upper GI surgeons on the AUGIS specialist register
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High-volume anti-reflux practice - Nissen, Toupet and LINX all offered
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Full pre-op work-up (OGD, pH-impedance, high-resolution manometry) insisted on
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MDT decision-making before booking, and a clear conversation about dysphagia and gas-bloat
Safety, complications and recovery
What to expect afterwards - honestly.
A Nissen fundoplication is safe and effective in specialist hands, but dysphagia and gas-bloat are real trade-offs. Realistic expectations matter as much as the surgeon.
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Early dysphagia is common - and usually settles
30–40% of patients notice difficulty swallowing solids for the first 2–6 weeks. Persistent dysphagia beyond three months affects 5–10% and may need endoscopic dilatation.
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Gas-bloat syndrome
A 360° wrap can make belching harder, leaving 20–30% of patients bloated in the short term and 5–10% long-term. Less common with Toupet or LINX - worth weighing before you choose Nissen.
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Wrap slippage or disruption
Around 5–10% of wraps loosen or slip over 10 years. A minority need redo surgery - technically harder and best done by a specialist.
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Recurrent reflux
10–15% of patients have some reflux back at 10 years. Often controlled with intermittent PPI; occasionally a redo operation.
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Rare but serious complications
Splenic injury (occasionally needing splenectomy), oesophageal perforation (<1%), pneumothorax, DVT/PE, wound infection, and conversion to open surgery in <5%.
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Diet progression
Liquids 1–2 weeks, soft 2–4 weeks, normal texture 4–6 weeks - adjust to your own swallowing. Eat slowly, chew thoroughly, sit upright for 30 minutes after meals.
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Time off work and exercise
Office work at 1–2 weeks. No heavy lifting for 6 weeks. Gym from 4–6 weeks, guided by your surgeon.
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Outcomes are good - with realistic expectations
90%+ symptom relief at 5 years, PPI freedom for 80–90% of patients. Efficacy declines slowly over a decade; the operation is not a permanent cure for everyone.
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Red flags after surgery
Chest pain, breathlessness, fever, uncontrolled vomiting, inability to swallow saliva, or heavy bleeding - call the surgical team or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever wrap was chosen, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your surgical review, just ask.
- 01 Header
Indication and operation chosen
Why the operation was done - refractory GORD, hiatus hernia, Barrett’s - and which anti-reflux procedure was agreed (Nissen 360°, Toupet 270°, or wrap plus hiatal repair).
- 02 Technique
Laparoscopic technique
Number of ports, whether short gastric vessels were divided, size of bougie used (56–60Fr), how the crura were repaired, and whether mesh reinforcement was placed.
- 03 Findings
Hiatus, oesophagus and stomach
Size of any hiatus hernia, appearance of the oesophagus and stomach, presence of oesophagitis or Barrett’s, and any incidental findings.
- 04 Impression
Diet, recovery and review timing
Read this first: your diet plan (liquid → soft → normal), when to return to work and exercise, and when the surgeon will see you again.
Recognised by major UK insurers
Laparoscopic Nissen fundoplication is usually covered by UK private medical insurance when medically indicated, subject to pre-authorisation and the standard reflux work-up. We confirm cover before booking.
Frequently asked
Everything we get asked about laparoscopic Nissen fundoplication.
Quick answers on the operation, the alternatives, dysphagia and gas-bloat, PPI freedom, and cost.
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What is a laparoscopic Nissen fundoplication?
It is the gold-standard anti-reflux operation. The upper part of the stomach (the fundus) is wrapped 360° around the lower oesophagus and stitched in place, recreating the valve at the top of the stomach so acid cannot flow back up. It is done through four or five small keyhole ports under general anaesthetic.
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Who is a Nissen fundoplication for?
Adults with proven GORD that has not settled on a full PPI trial, patients who cannot tolerate PPIs, people with complicated reflux (Barrett’s with dysplasia, stricture, aspiration, laryngopharyngeal reflux), and those with a large symptomatic hiatus hernia. The decision is made after OGD, 24-hour pH-impedance and high-resolution manometry.
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Nissen, Toupet, Dor or LINX - which one should I have?
Nissen 360° gives the most durable reflux control but the highest risk of dysphagia and gas-bloat. Toupet 270° is a partial wrap for patients with borderline motility - less bloating, slightly less durable. Dor 180° is mostly used after a Heller myotomy. LINX is a magnetic ring - less invasive, preserves belching, but the UK long-term evidence is thinner. Your manometry findings and your symptom profile decide.
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How long is the operation and hospital stay?
The operation takes 90–150 minutes. Most patients stay one or two nights in hospital and go home once they are eating soft food, mobile and pain-controlled on oral analgesia.
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What does recovery look like?
Liquid diet for 1–2 weeks, soft food for 2–4 weeks, normal texture by 4–6 weeks. Office work at 1–2 weeks. No heavy lifting for 6 weeks. Gym from 4–6 weeks. Some early dysphagia and gas-bloat are expected and usually settle over the first two months.
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Will I be able to stop my PPI?
About 80–90% of patients come off daily PPIs after a successful Nissen. Some need occasional acid suppression over the following decade as the wrap loosens slightly. Symptom control at five years is 90%+; at ten years, 10–20% of wraps have failed and a minority need a redo operation.
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What are the main risks?
Early dysphagia in 30–40% (settles in 2–6 weeks; persistent >3 months in 5–10%). Gas-bloat in 20–30% short-term, 5–10% long-term. Wrap slippage 5–10% over ten years. Recurrent reflux 10–15%. Rare: splenic injury, oesophageal perforation (<1%), pneumothorax, DVT/PE, wound infection, conversion to open (<5%).
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How much does it cost privately in the UK?
A laparoscopic Nissen typically runs £8,000–£14,000 self-pay. Add mesh-reinforced hiatal repair and the figure rises to £10,000–£16,000. LINX sits at £10,000–£16,000. The pre-op work-up (OGD, pH-impedance, manometry) is £1,800–£3,200 on top. On the NHS it is funded through upper GI surgery pathways.
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When should I seek urgent help after surgery?
Chest pain, breathlessness, fever, uncontrolled vomiting, inability to swallow saliva, or heavy bleeding are all reasons to call the surgical team or attend A&E the same day.
Related treatments
Looking for something else?
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LINX reflux surgery
Magnetic sphincter augmentation - the less-invasive alternative to a wrap.
Learn more -
Hiatus hernia repair
Crural repair with or without mesh, usually combined with a wrap.
Learn more -
Anti-reflux surgery overview
How Nissen, Toupet, Dor and LINX compare - one page.
Learn more -
All tests & procedures
Every test and procedure we arrange.
Learn more