Anti-Reflux Surgery (Fundoplication) in Melbourne

The total cost of fundoplication includes the surgeon’s fee, anaesthetist’s fee, and hospital facility charges. Medicare provides a rebate toward the surgical fee when the procedure is performed for a confirmed diagnosis of GORD. Private health insurance typically covers hospital and anaesthesia costs, subject to your policy level, health fund, and any applicable waiting periods.

Out-of-pocket costs for privately insured patients commonly range from $500 to $3,000, depending on your insurer, hospital, and whether a hiatal hernia repair is performed at the same time. Patients without private health insurance may incur higher out-of-pocket expenses. Your specific costs will be outlined clearly during your consultation, and we recommend contacting your fund before your appointment to confirm your level of cover.

Approximately 85-90% of appropriately selected patients achieve significant and sustained improvement in GORD symptoms following laparoscopic fundoplication ^[3].

Success rates are highest in patients with classic heartburn and regurgitation who have objective evidence of GORD on pH monitoring. Outcomes can be less predictable in patients with predominantly atypical symptoms or reduced oesophageal motility. A minority of patients experience symptom recurrence over time and may require a return to PPI therapy or revisional surgery ^[8].

Nissen fundoplication creates a complete 360º wrap of the stomach around the lower oesophagus, providing strong anti-reflux control.

Toupet fundoplication uses a 270-degree partial posterior wrap, which carries a lower risk of post-operative dysphagia and gas-bloat. Your surgeon will select the most appropriate technique based on your oesophageal manometry results, hiatal anatomy, and symptom profile. If a hiatal hernia is present, it will be repaired at the same time as the fundoplication ^[6].

Both are effective treatments for GORD. Long-term PPI therapy is generally safe but does not correct the underlying anatomical defect and requires daily medication. Fundoplication provides durable structural correction and allows most patients to discontinue PPIs ^[4].

Randomised controlled trial follow-up data show that surgery provides equivalent or superior symptom control compared to medical therapy at 10 years in appropriately selected patients.⁵ Surgery is generally preferred when large hiatal hernias, significant volume regurgitation, or Barrett’s oesophagus are present. For patients with other upper GI conditions, our team also assesses and treats achalasia and other oesophageal disorders.

Most patients are discharged the morning after surgery. A soft diet is followed for 2-6 weeks, and most patients return to desk-based work within 1-2 weeks. Heavy lifting and vigorous exercise are restricted for 4-6 weeks. Most patients return to their normal routine within 3-4 weeks, with swallowing progressively improving over the first 3 months as post-operative swelling resolves.

Nissen fundoplication (360-degree wrap) significantly reduces the ability to belch and vomit in most patients. Many patients adapt over time and can achieve some degree of belching after the first few months. Gas-bloat is more common after Nissen fundoplication than after Toupet fundoplication. If this is a concern, your surgeon will discuss whether a partial wrap may be more suitable for your circumstances ^[6].

Fundoplication is a Medicare-eligible procedure when performed for a confirmed diagnosis of GORD. Private health insurance generally covers hospital admission and anaesthesia costs, subject to your policy level and any applicable waiting periods. We recommend confirming your entitlements with your fund before your consultation.

Symptom recurrence following fundoplication is investigated with upper endoscopy, oesophageal manometry, and 24-hour pH monitoring to determine whether the wrap has failed or migrated. Management options include resuming PPI therapy, endoscopic assessment, or revisional fundoplication, depending on the clinical findings. Revisional surgery is more technically demanding than primary fundoplication and is performed by our upper gastrointestinal surgeons with specific experience in redo procedures ^[8].

Barrett’s oesophagus occurs when chronic acid exposure replaces the normal oesophageal lining with intestinal-type cells. It is a recognised complication of longstanding GORD and requires regular endoscopic surveillance because of a small but elevated risk of oesophageal adenocarcinoma.

Fundoplication effectively controls acid reflux in patients with Barrett’s oesophagus, though it does not reverse the pre-existing changes. Endoscopic surveillance continues after surgery in line with current clinical guidelines. Patients with high-grade dysplasia or early oesophageal cancer may be assessed for oesophageal removal surgery.

For the first 1-2 weeks, a soft or pureed diet is required. Over the following weeks, most foods can be gradually reintroduced. Long-term, most patients eat a largely normal diet with modest modifications. Carbonated drinks are generally avoided to reduce gas and bloating. Eating slowly, taking smaller portions, and chewing thoroughly support a comfortable recovery, particularly in the first 3 months after surgery.