Hiatal Hernia Repair Surgery: What You Need to Know
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What Is a Hiatal Hernia Repair?
A hiatal hernia repair is a surgical procedure to correct a hiatal hernia, a condition where part of the stomach pushes upward through the diaphragm into the chest cavity. This can cause symptoms such as heartburn, acid reflux, chest pain, and difficulty swallowing.
The goal of the surgery is to restore the stomach to its proper position in the abdomen and strengthen the opening in the diaphragm to prevent recurrence.
Why Is It Done?
Hiatal hernia repair is typically recommended for patients who have:
- Severe or persistent gastroesophageal reflux disease (GERD) not controlled by medication
- Large or paraesophageal hernias that cause pain, difficulty eating, or risk of strangulation
- Complications such as bleeding, ulcers, or narrowing of the esophagus
- A desire to reduce long-term reliance on acid-suppressing medication
Types of Hiatal Hernia Repair
Laparoscopic (Minimally Invasive) Repair
- Performed through several small (0.5–1 cm) incisions in the abdomen
- A laparoscope (camera) and small instruments are used to reposition the stomach
- The opening in the diaphragm (hiatus) is tightened with sutures
- Often combined with a fundoplication, where the upper part of the stomach is wrapped around the lower esophagus to prevent reflux
- Associated with less pain, shorter hospital stays, and faster recovery
Open Repair
- Performed through a single larger incision in the upper abdomen or chest
- Usually reserved for large hernias, complex anatomy, or recurrent hernias after prior surgery
- Involves a longer recovery and hospital stay but allows for direct visualization and repair
Preparing for Surgery
- Fasting: Do not eat or drink anything for at least 6–8 hours before surgery.
- Medications: Inform your doctor of all medications, especially blood thinners, as some may need to be stopped beforehand.
- Smoking: Avoid smoking before surgery—it can slow healing and increase risks.
- Transportation: Arrange for someone to drive you home and assist you during initial recovery.
See our page on how to prepare for surgery at the link below.
What to Expect During the Procedure
- Performed under general anesthesia
- Surgery typically lasts 1–3 hours, depending on complexity
- The herniated portion of the stomach is repositioned into the abdomen
- The diaphragmatic opening is tightened, and fundoplication may be performed
- Most laparoscopic cases require a 1-night hospital stay; open surgeries may require 3–5 days
Recovery After Surgery
- Pain and soreness are common but usually mild and controlled with medication
- Diet progression:
- Start with clear liquids after surgery
- Gradually advance to soft foods over 1–2 weeks
- Return to a normal diet after about 4–6 weeks, avoiding carbonated beverages and large meals initially
- Activity:
- Light activity within a few days
- Avoid heavy lifting for 4–6 weeks
- Most patients return to work within 2–3 weeks after laparoscopic surgery
Risks and Possible Complications
While hiatal hernia repair is generally safe, risks may include:
- Difficulty swallowing (temporary or, rarely, prolonged)
- Bloating or increased gas (gas-bloat syndrome)
- Recurrence of the hernia
- Bleeding or infection
- Injury to the esophagus, stomach, or nearby organs
- Reaction to anesthesia
Contact your doctor right away if you experience:
- Fever or chills
- Persistent vomiting
- Chest pain or shortness of breath
- Inability to swallow liquids
Frequently Asked Questions (FAQs)
Will this surgery stop my acid reflux?
In most cases, yes. The repair and fundoplication reduce reflux symptoms significantly, though some patients may still need occasional medication.
How long will I be in the hospital?
Typically one night for laparoscopic repair. Open surgery may require several days of inpatient recovery.
Will I have dietary restrictions after surgery?
Yes. You’ll start with liquids and soft foods, gradually reintroducing solid foods as your esophagus heals.
Can the hernia come back?
Recurrence is uncommon but possible, especially if you strain, gain significant weight, or return to heavy lifting too soon.
When can I return to work or normal activities?
Light activity is encouraged within a few days. Most patients return to work within 2–3 weeks, depending on their job type.
Will I be able to eat normally again?
Yes. After healing, most people return to a normal diet, though it’s best to avoid large meals and carbonated drinks early in recovery.
What is a Nissen Fundoplication?
It’s a technique often performed during hiatal hernia repair in which the upper part of the stomach (fundus) is wrapped around the lower esophagus to strengthen the valve and prevent acid reflux.
Long-Term Outlook
Most patients experience significant relief from reflux symptoms and improved quality of life. Following dietary recommendations, maintaining a healthy weight, and avoiding smoking can help prevent recurrence.
Would you like me to create a companion “Preparing for Hiatal Hernia Repair” pre-procedure checklist or dietary progression guide for post-op instructions? Those pair nicely with this page for patient handouts or websites.