Hiatal hernia surgery is a surgical procedure designed to return the portion of the stomach that has protruded through the diaphragm to its normal position below the diaphragm, followed by repairing the opening through which the hernia passed, when necessary. The procedure may also include an additional step to reduce the backflow of stomach acid into the esophagus, depending on the patient's condition and the surgeon's assessment.
Not everyone with a hiatal hernia needs surgery. Some mild cases do not cause noticeable symptoms and can be managed with medication and lifestyle modifications. However, cases involving severe symptoms, a large hernia, or complications may require surgical intervention. The choice of treatment depends on the type and size of the hernia, the symptoms, and the results of medical examinations.
Medical Disclaimer: This article has been medically reviewed and approved for publication by Dr. Ahmed Abu Kheima, Consultant in General Surgery, Gastrointestinal Surgery, and Surgical Oncology.
What Symptoms of a Hiatal Hernia May Require Surgery?
A hiatal hernia may not cause any symptoms, particularly when it is small. However, some patients experience symptoms associated with gastroesophageal reflux or a larger hernia. Experiencing these symptoms does not necessarily mean that surgery is required. Instead, they should be evaluated alongside the results of medical examinations.
Symptoms may include frequent heartburn, regurgitation of food or fluids into the mouth, difficulty swallowing, feeling full after eating a small amount of food, and occasional chest or upper abdominal pain. If symptoms persist despite appropriate treatment or interfere with daily life, the doctor may recommend further tests to determine the most suitable treatment.
When Does a Patient Need Hiatal Hernia Surgery?
The surgeon determines whether hiatal hernia surgery is necessary after evaluating the type and size of the hernia, the severity of symptoms, and the response to medication. In cases of a sliding hiatal hernia associated with gastroesophageal reflux, surgery may be considered when medications and lifestyle changes do not provide sufficient relief or when reflux-related complications develop.
A paraesophageal hernia accompanied by noticeable symptoms may require surgical repair to reduce the risk of obstruction or stomach twisting. Surgery is not automatically recommended for every asymptomatic case. The decision also takes into account the patient's age, general health, and the risks associated with anesthesia and surgery. The potential benefits and complications should be discussed before a decision is made.
How Is a Hiatal Hernia Diagnosed Before Surgery?
Diagnosis begins with discussing the symptoms and medical history and performing an appropriate examination. The doctor then selects tests that help identify the type of hernia and assess the esophagus and stomach.
These tests may include an upper gastrointestinal endoscopy to examine the esophagus and stomach or a barium swallow study to visualize the movement of the esophagus and the position of the stomach.
In certain cases, the patient may need esophageal motility testing or additional tests to evaluate reflux. A CT scan may also be used when specific complications are suspected.
Not every patient needs all these tests. Their selection depends on the symptoms, initial findings, and proposed treatment plan. An accurate diagnosis helps determine whether surgery is necessary and which procedure is most appropriate.
How Is Laparoscopic Hiatal Hernia Surgery Performed?
Laparoscopic hiatal hernia surgery is usually performed under general anesthesia through small incisions in the abdomen. These incisions allow the surgeon to insert a camera and surgical instruments.
The surgeon returns the stomach to its normal position and then narrows the opening in the diaphragm with surgical sutures, as appropriate for the patient's condition. An anti-reflux procedure may also be performed, such as wrapping the upper part of the stomach around the lower esophagus, when medically appropriate.
Laparoscopic surgery generally involves smaller incisions and a shorter hospital stay compared with open surgery. However, the final choice depends on the size and complexity of the hernia and the patient's overall health. Open surgery may be necessary in some cases. Laparoscopy does not eliminate the possibility of complications or future hernia recurrence.
What Are the Risks and Complications of Hiatal Hernia Surgery?
Hiatal hernia surgery may provide significant improvement for appropriately selected patients. However, like any surgical procedure, it carries risks that should be discussed with the surgeon and anesthesiologist beforehand.
Potential complications include bleeding, infection, or injury to nearby organs. Temporary difficulty swallowing, bloating, a feeling of fullness, and difficulty belching may also occur after surgery.
The likelihood of these problems varies depending on the type of procedure, the patient's condition, and the surgical team's experience. The hernia may recur in some patients over time, and a small number may require another intervention.
Follow-up care and adherence to dietary and activity instructions can support recovery, but they cannot guarantee that all complications will be prevented.
How Long Does Recovery Take After Hiatal Hernia Surgery?
Recovery time after hiatal hernia surgery varies depending on the surgical approach and the patient's health. The patient may need to stay in the hospital for one day or longer, depending on the medical team's assessment.
After discharge, recovery continues at home over the following weeks, with a gradual return to normal activities according to the surgeon's instructions.
Patients generally begin with liquids and gradually progress to soft foods before returning to their usual diet, depending on their tolerance and the doctor's guidance. Mild bloating or difficulty swallowing may persist during recovery, but severe or worsening symptoms require medical evaluation.
Heavy lifting and strenuous activities should be avoided until the doctor gives permission. Recovery times also vary from one patient to another.
Eating After Hiatal Hernia Surgery and Important Tips
Following the diet recommended by the medical team can make swallowing easier and reduce pressure and bloating during recovery. The timing of the transition from liquids to soft foods and then to regular meals depends on the type of surgery and the patient's ability to swallow.
Your doctor may recommend the following tips:
Eat small, frequent meals instead of large meals.
Chew food thoroughly and eat slowly.
Avoid foods that cause bloating or worsen reflux if you notice that they trigger your symptoms.
Drink fluids according to the medical team's instructions, especially if you experience difficulty swallowing.
Avoid lying down immediately after eating, following your doctor's guidance.
Do not follow a standardized diet without considering your surgeon's instructions. Seek medical advice if you experience increasing difficulty swallowing or are unable to keep fluids down.
Book Your Consultation with Dr. Ahmed Abu Kheima
If you experience symptoms of a hiatal hernia or want to find out whether surgery is appropriate for your condition, you can book a consultation with Dr. Ahmed Abu Kheima, Consultant in General Surgery, Gastrointestinal Surgery, and Surgical Oncology.
During the consultation, your symptoms can be evaluated, your test results reviewed, and the available treatment options discussed. A specialist assessment helps determine whether medication is sufficient or whether surgical intervention may offer greater benefits, while explaining the procedure, recovery period, and potential risks.
Address: 29 Fawzy Moaz Street, Smouha, Alexandria, next to Etisalat, Entrance 2, Safwa Businessmen Tower, Clinic 203.
Appointments: 01226222297 or 01006719949.
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Frequently Asked Questions About Hiatal Hernia Surgery
Is Hiatal Hernia Surgery Dangerous?
Like any surgical procedure, hiatal hernia surgery carries potential risks. The level of risk varies depending on the patient's condition, the type of hernia, and the surgical technique. The surgeon explains the expected benefits and possible complications before a decision is made.
Can a Hiatal Hernia Be Treated Without Surgery?
Yes. Many cases can be managed with medications that reduce stomach acid and lifestyle modifications, particularly when symptoms are related to reflux and there are no complications requiring surgery.
How Long Does Laparoscopic Hiatal Hernia Surgery Take?
The duration of the procedure varies depending on the size of the hernia, the complexity of the case, and any additional procedures required. The surgeon can estimate the expected duration after reviewing the patient's medical history and test results.
When Can I Return to Eating Normally After Surgery?
Patients gradually return to their regular diet according to their ability to swallow and the surgeon's instructions. Some patients may need several weeks before resuming their usual eating habits.
Can a Hiatal Hernia Return After Surgery?
Yes. A hiatal hernia may recur in some patients, even after successful surgical repair. The likelihood of recurrence depends on several factors, including the size of the hernia, the characteristics of the tissues, the patient's overall health, and adherence to follow-up instructions.
When Should I Seek Medical Attention After Surgery?
Seek urgent medical evaluation if you experience severe or worsening pain, repeated vomiting, an inability to drink fluids, severe difficulty swallowing, fever, or shortness of breath.
Severe chest pain or sudden difficulty breathing requires immediate emergency medical assistance.