Your Reflux Surgery Guide: Before and After Surgery

This guide is for patients having anti-reflux surgery. That includes:

• Nissen or Toupet fundoplication: the top of the stomach is wrapped around the lower esophagus.
• Hiatal or paraesophageal hernia repair: the stomach is moved back below the diaphragm and the opening is tightened.
• LINX magnetic sphincter augmentation: a small ring of magnetic beads is placed around the lower esophagus.

Most of the instructions apply to every operation. Where LINX differs, you'll see a LINX patients note. Always follow the specific instructions your surgical team gives you. If they differ from this guide, your team's instructions come first.

Part 1: Before Surgery

Why you need tests first

Reflux surgery works best when testing proves that reflux is causing your symptoms. These tests also show us which operation suits your esophagus. Most patients have:

• Upper endoscopy (EGD): a camera exam of the esophagus and stomach. It checks for inflammation, Barrett's esophagus, and hernia size.
• pH or pH-impedance testing: measures how much reflux reaches your esophagus. You may be asked to stop your acid medication for 7 days before this test. Your team will tell you exactly when.
• Esophageal manometry: a thin tube measures the strength and coordination of your swallowing muscles. This test matters a great deal. It tells us whether your esophagus is strong enough for a full wrap or LINX, or whether a partial wrap is safer. It also rules out achalasia, a swallowing disorder that reflux surgery would make worse.
• Barium swallow: X-rays taken while you drink a contrast liquid. It shows hernia size and how food moves.

If you have chest pain, you may also need a heart evaluation before surgery.

Medications

Bring a complete list of all your medications and supplements to your pre-op visit. We'll tell you which to continue and which to stop.

• Blood thinners (warfarin, apixaban, rivaroxaban, clopidogrel, and others): don't stop these on your own. Your surgeon and prescribing doctor will give you a plan.
• Aspirin, ibuprofen, naproxen, and other anti-inflammatories: these are usually stopped before surgery. Ask first if you take aspirin for your heart.
• GLP-1 and weight-loss or diabetes injections (Ozempic, Wegovy, Mounjaro, Zepbound, Saxenda, Trulicity, Rybelsus, and similar): these medications slow how fast your stomach empties, which can raise the risk of breathing in stomach contents under anesthesia. Tell us if you take one. Your surgical and anesthesia teams will decide whether to hold it and for how long. You may be asked to follow a clear-liquid diet for 24 hours before surgery.
• Diabetes medications and insulin: you'll receive specific day-before and day-of instructions.
• Acid reducers (PPIs and H2 blockers): keep taking them until surgery unless you're told otherwise.

Getting your body ready

• Stop smoking and vaping. Smoking slows healing and raises the risk of complications. Even a few weeks without smoking helps.
• Treat coughing and constipation now. Straining and heavy coughing put pressure on the repair. Let us know about a chronic cough, allergies, or constipation so we can address them before surgery.
• Walk every day to build stamina for recovery.
• Stock your kitchen for the liquid and soft-food stages. Good choices include broth, protein shakes, yogurt, applesauce, pudding, cream soups, smooth hot cereal, and mashed potatoes.
• Buy liquid or chewable medications if you can. Large pills may be hard to swallow for the first few weeks.
• Arrange a ride home and someone to stay with you for the first 24 hours.

The night before and morning of surgery

• Follow your fasting instructions exactly: when to stop solid food and when to stop clear liquids.
• Take only the morning medications you were told to take, with a small sip of water.
• Shower. Don't apply lotion near your abdomen.
• Wear loose, comfortable clothing.
• Leave jewelry and valuables at home.
• Bring your ID, insurance card, medication list, and CPAP machine if you use one.

Part 2: The Day of Surgery

• Most reflux operations are done laparoscopically or robotically through 4 to 6 small incisions.
• The operation usually takes 1 to 3 hours. Large paraesophageal hernias take longer.
• Many patients go home the same day or the next morning. Large hernia repairs may need 1 to 2 nights.
• You'll be up and walking the day of surgery. Walking helps prevent blood clots and pneumonia and eases gas pain.
• You'll get medication to prevent nausea. Vomiting and retching in the first days can strain or loosen the repair, so we work hard to prevent them.
• Use your breathing exerciser (incentive spirometer) about 10 times every hour while you're awake.

Part 3: At Home, the First 6 Weeks

What's normal

• Mild to moderate pain at the incisions, in the upper abdomen, or in the shoulders. Shoulder pain comes from the gas used during surgery and usually fades in 2 to 3 days.
• Difficulty swallowing (dysphagia). This is expected, because the area around the repair is swollen. It often feels like food "sticks" low in the chest. It usually improves steadily over 6 to 12 weeks.
• Feeling full quickly, and mild bloating or gas.
• Mild weight loss of 5 to 10 pounds is common in the first month.
• Fatigue for 1 to 2 weeks.

Pain control

• Take pain medication as prescribed. Many patients need prescription medication for only a few days.
• Use liquid or crushed forms if pills are hard to swallow. Ask your pharmacist first, because some pills, especially extended-release ones, must not be crushed.
• Prescription pain medication can cause constipation. Use a stool softener or gentle laxative as directed so you don't strain.
• Don't drive while taking prescription pain medication.

Preventing nausea and vomiting

This is one of the most important parts of your recovery.

• Take your anti-nausea medication as prescribed. Don't wait until you feel sick.
• Eat small amounts slowly.
• Stop eating as soon as you feel full.
• Call us right away if you are vomiting or retching.

Incision care

• You may shower 24 to 48 hours after surgery. Let soapy water run over the incisions and pat them dry.
• No baths, hot tubs, or swimming until your team clears you, usually after about 2 weeks.
• Skin glue or small strips fall off on their own in 1 to 2 weeks.

Part 4: Eating After Surgery

Fundoplication and hiatal hernia repair

Your diet moves slowly from liquids to solids over about 4 to 6 weeks while the swelling goes down. Your team may adjust the timing.

• Clear liquids (day of surgery to day 1): water, broth, sugar-free gelatin, diluted juice, decaf tea
• Full liquids (days 1 to 7): protein shakes, milk, smooth yogurt, cream soups, thin hot cereal, pudding
• Pureed and very soft foods (weeks 2 to 3): scrambled eggs, cottage cheese, mashed potatoes, applesauce, hummus, soft flaked fish, blended soups
• Soft foods (weeks 3 to 6): tender ground meat, soft-cooked vegetables, pasta, ripe bananas, canned fruit, soft casseroles
• Regular diet (about 6 weeks): add other foods back one at a time

Foods to avoid for the first 4 to 6 weeks. These are the foods most likely to get stuck:

• Fresh or doughy bread, bagels, and rolls
• Steak, chicken breast, pork chops, and other dry or tough meats
• Rice
• Raw vegetables, salads, and fruit skins
• Nuts, seeds, popcorn, and chips
• Carbonated drinks: soda, sparkling water, beer

Swallowing tips:

• Take small bites, about the size of a fingertip.
• Chew each bite thoroughly before swallowing.
• Eat slowly. A meal should take 20 to 30 minutes.
• Sit fully upright while eating and for 30 minutes afterward.
• Eat 5 to 6 small meals a day instead of 3 large ones.
• Sip liquids between bites to help food pass.
• Get protein at every meal. Protein shakes help when solid food is limited.
• If food feels stuck, stop, stand up, walk around, and sip warm liquid. Don't force more food down.

Gas and bloating: after a fundoplication, you may find it hard to belch, and you may have more gas. These symptoms are usually worst in the first few months, and most improve within the first year. To reduce them:

• Avoid carbonated drinks, chewing gum, and drinking through straws.
• Eat slowly, so you swallow less air.
• Limit gas-producing foods: beans, broccoli, cabbage, onions.
• Ask your team whether simethicone is right for you.

LINX patients: the diet is different

The LINX device needs to open and close many times a day while it heals, so it stays flexible. A thin layer of scar tissue forms around the device in the first weeks. Regular swallowing keeps that scar from becoming tight.

• Start eating soft solid foods right away. Don't stay on liquids.
• Do "swallow therapy" for the first 6 to 8 weeks. Eat a few bites of soft food every 2 to 3 hours while you're awake, between meals as well as at meals.
• Swallowing often becomes harder 1 to 3 weeks after surgery. This is when scar tissue is forming. It's normal, and it's not a reason to stop eating solids. It usually eases by 6 to 8 weeks.
• If food passes slowly, wait about 30 seconds between bites.
• You can still belch and vomit after LINX.
• Call us if you can't keep liquids down or can't stay hydrated.

LINX and MRI: the device is safe for MRI scanners up to 1.5 Tesla. Higher-strength MRI scanners can't be used. Older devices placed before mid-2015 are limited to 0.7 Tesla. Carry your LINX implant card at all times and tell every doctor and imaging center that you have a LINX device. Also tell us before any future abdominal surgery or if you're getting a pacemaker or defibrillator.

Part 5: Activity and Returning to Normal Life

• Walking: Starting the day of surgery, several times a day
• Showering: 24 to 48 hours after surgery
• Driving: When you're off prescription pain medication and can turn and brake comfortably, usually 1 week
• Desk work or working from home: Usually 1 to 2 weeks
• Light cardio (walking, stationary bike): Weeks 2 to 6
• Lifting more than 15 to 20 pounds: Avoid for about 6 weeks
• Sit-ups, crunches, heavy core work: Avoid for about 6 weeks
• Strength training and physical jobs: After about 6 weeks, once your surgeon clears you, building up gradually
• Sexual activity: When comfortable, usually after 1 to 2 weeks
• Air travel: Ask your team. Usually fine after 1 to 2 weeks

Protect your repair:

• Avoid straining: treat constipation early.
• Treat a cough quickly and support your belly with a pillow when you cough or sneeze.
• Use good lifting technique for life.

Part 6: Your Acid Medication After Surgery

• Most patients stop or taper their acid reflux medication after surgery. Your surgeon will tell you when and how.
• Don't restart acid medication on your own for heartburn-like symptoms. Many symptoms after surgery are not reflux, so we'll evaluate first.
• If reflux symptoms return months or years later, call us. The right next step is usually testing (endoscopy and pH monitoring), not simply restarting medication.

Part 7: When to Call

Call 911 or go to the nearest emergency room for:

• Chest pain or shortness of breath
• Sudden, severe pain in the chest, upper abdomen, or back
• Vomiting blood or material that looks like coffee grounds
• Fainting

Call our office right away for:

• Vomiting, retching, or dry heaving
• Inability to keep liquids down, or signs of dehydration: very dark urine, dizziness, very little urine
• Inability to swallow your own saliva, or food that's stuck and won't pass
• Fever over 101°F (38.3°C) or chills
• Incision redness, warmth, swelling, or drainage
• Pain that's getting worse instead of better, or isn't controlled by your medication
• Swelling, pain, or redness in one leg
• Black, tarry stools
• No bowel movement for 3 or more days despite stool softeners
• Difficulty swallowing that's getting worse, or that hasn't improved after 6 weeks

Office phone: 305-692-0392 during office hours (Mon–Fri 8:30 AM–5 PM). After hours: call our 24-hour line at 786-635-0400. For emergencies, call 911 or go to the nearest emergency room.

Part 8: Follow-Up and Long-Term Expectations

• Your first follow-up visit is usually 2 to 4 weeks after surgery. We'll check your incisions, your swallowing, and your diet progress.
• Most patients have excellent long-term reflux control. In long-term studies, about 9 out of 10 patients are satisfied with their operation many years later.
• Some patients have symptoms come back over time. In long-term studies, this happens to about 1 in 5 patients within 10 years. Many can be managed without another operation. A small number need revision surgery.
• Persistent swallowing difficulty is uncommon after the first few months. When it happens, a simple stretching procedure (esophageal dilation) often helps.
• Patients with Barrett's esophagus still need regular surveillance endoscopy after surgery.
• Keeping a healthy weight protects your repair and lowers the chance of reflux coming back.

Quick Recovery Checklist

• Walk several times a day, starting the day of surgery.
• Take anti-nausea medication as prescribed. Call if you're vomiting.
• Follow the diet stages. Avoid bread, tough meat, and rice for 4 to 6 weeks.
• LINX patients: eat a few bites of soft food every 2 to 3 hours for 6 to 8 weeks.
• Take small bites, chew well, and eat slowly and upright.
• No lifting over 15 to 20 pounds for 6 weeks.
• Prevent constipation and treat coughs early.
• Don't restart acid medication without talking to us.
• Keep your follow-up appointment.

This guide is general education. It doesn't replace the personal instructions from your surgical team.

‍