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 Surgery May Be Needed

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

Before the Procedure

Acute Hiatal Hernia Repair (Urgent Emergency)

If an emergency hiatal hernia repair surgery is needed:

Evaluation/diagnosis: Blood tests, urine tests, and imaging (such as ultrasound or CT scan) are performed.
Surgical timing: Once diagnosed, surgery is typically scheduled immediately as an emergency procedure.
Hospital stay: You may stay multiple days in the hospital for observation depending on your condition.
Pre-op treatment: IV fluids and antibiotics may be given before surgery.

Elective Hiatal Hernia Repair

If a hiatal hernia is identified but emergency surgery is not needed, you will likely be referred to a general surgeon who can discuss treatment options, but an elective hiatal hernia surgery is most commonly recommended to prevent future episodes. Preparing for an elective hiatal hernia surgery includes:

Initial Consultation: Where you meet with the surgeon who will be performing the surgery and discuss treatment options.
Pre-Op Tests: Some but not all patients may require blood tests and an EKG before surgery. Please complete all blood tests and EKGs within 30 days of surgery, and no later than two weeks before, to allow time for any needed repeats.
Imaging: CT/CAT scans, ultrasounds, or an MRI may be performed to determine the best and most safe surgical approach.
Medications: Inform your doctor about all medications and supplements, especially blood thinners.
Smoking: Stop smoking before surgery to promote better healing. Some insurances may require this step in order to authorize surgery. Check with your healthcare provider if you have questions about this.
Prep the Night Before:
- Use the provided soap to wash the area the night before and morning of the surgery. This excludes hemorrhoid procedures.
- Clean clothes and clean sheets gets you prepared for surgery.
Fasting: Do not eat or drink anything for at least 6–8 hours before surgery.
Transportation: It is required that you arrange for someone to drive you home after the procedure.

It is very important that you properly prepare yourself for surgery as it allows for your doctor to perform the surgery safely and effectively. If you’re preparing for a hiatal hernia repair, please visit the link below to view more detailed instructions on how to prepare for surgery.

Visit our Preparing for Surgery Page

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

There are two main surgical methods to repair a hiatal hernia:

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

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 over 100.4°F (38°C) or chills
Persistent nausea and/or vomiting
Chest pain or shortness of breath
Increasing pain or swelling
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.

Will I need to stay on acid reflux medication after surgery?
Many patients are able to stop or significantly reduce reflux medications, but some may still need them occasionally.

Will I have difficulty swallowing after surgery?
Temporary difficulty swallowing is common in the early recovery period as swelling improves and the esophagus adjusts.

When can I drive after surgery?
You can usually resume driving once you are off prescription pain medication and able to move comfortably, often within 1–2 weeks.

What can I do to help recovery go smoothly?
Eating slowly, taking small bites, avoiding heavy lifting, and following your post-op diet plan are important for healing.

Is gas or bloating normal after surgery?
Yes, temporary bloating and difficulty burping or passing gas is common after fundoplication and usually improves over time.

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.

Need Support or Have Questions?

Your care team is here to help. If you’ve been diagnosed with a hiatal hernia or are recovering from a hiatal hernia surgery, don’t hesitate to contact us with questions about your treatment or recovery.