Overview
When reflux outlives your medication.
Most patients with reflux do well on medication. A subset — about 30 to 40 percent in long-term studies — have ongoing symptoms despite daily PPI therapy. For these patients, the problem is usually mechanical: the lower esophageal sphincter is weak, often combined with a hiatal hernia. Medication reduces acid but doesn't fix the broken valve. Anti-reflux surgery rebuilds the valve and lets most patients stop their reflux medication entirely.
We offer three main anti-reflux operations: the Nissen (a full 360-degree wrap), the Toupet (a partial 270-degree wrap), and the LINX (a small magnetic ring placed around the lower esophagus). Each has trade-offs, and the right operation for you depends on your symptoms, your esophageal motility, and your goals. Pre-operative testing — endoscopy, manometry, and pH testing — helps us pick the operation that fits.
Who is a candidate?
Anti-reflux surgery works best in patients with documented acid reflux (positive pH study), a partial response to PPI medication, and a hiatal hernia that can be repaired at the same time. We also operate on patients with severe regurgitation symptoms even when their pH study is borderline. We are cautious in patients with severely impaired esophageal motility, who may do worse after a full wrap, and we adjust the operation accordingly. Obese patients often benefit more from a weight-loss operation, which addresses reflux as a side effect — we discuss that option openly when relevant.
How we perform it
All three operations are done robotically under general anesthesia through five small incisions across the upper abdomen. The hiatal hernia, if present, is repaired first. For a fundoplication, the upper stomach is wrapped around the esophagus (full for Nissen, partial for Toupet) and sutured in place. For LINX, a small string of magnetic beads is placed around the lower esophagus, where it allows food to pass and then closes to prevent reflux. The operation takes about 90–120 minutes, and most patients go home the same day.
Recovery
You'll start with clear liquids and progress through a soft diet over the first four weeks. Most patients are off all reflux medication immediately. You'll be back to desk work within 5–7 days and back to exercise within two to three weeks. Some swallowing difficulty in the first month is normal, especially with bread and dry meats — it improves as the wrap or LINX device settles. We see you back at two weeks and six weeks.
Why Florida Surgical
GERD surgery is a workhorse foregut operation, but it's done well only when matched to the right patient with the right preoperative workup. Dr. Decio is fellowship-trained in foregut surgery, performs manometry routinely, and offers all three of the standard anti-reflux operations. We don't push every patient toward the same operation — the choice between Nissen, Toupet, and LINX is made together in the office, with the data on hand.
Frequently asked questions
Will I be able to stop my reflux medication?
About 85 to 90 percent of patients are off all daily reflux medication after a well-done anti-reflux operation. A smaller group still uses occasional antacids.
What's the difference between Nissen, Toupet, and LINX?
Nissen is a full wrap — best reflux control but the most early dysphagia. Toupet is a partial wrap — slightly less reflux control but easier on swallowing, often better for patients with motility issues. LINX uses a magnetic device — preserves the ability to belch and vomit, with effectiveness comparable to a Toupet for most patients.
Will I be able to belch and vomit after LINX?
Yes — that's one of the design advantages of LINX over a fundoplication. Some patients still report decreased ability initially, but most can belch normally after a few months.
Does insurance cover LINX?
Most major insurers cover LINX when standard criteria are met (documented GERD on pH testing, partial response to PPI, hiatal hernia under 3 cm). We verify coverage before scheduling.
What if my reflux comes back?
Long-term, about 10–15% of fundoplication patients have some return of reflux at 10 years. Most are managed with as-needed medication. A small percentage need revision surgery, which we also offer.