Hiatal Hernia Surgery: Purpose, Process, Recovery

What is hiatal hernia? This condition happens when a portion of stomach spills over to the chest through the diaphragm, which is the muscle that separates your stomach from your chest.

Hiatal hernia is quite common.  In fact, an estimate of 40 percent of people in the US alone has some form of this hiatal hernia.  However, not all need hiatal hernia surgery because symptoms range in severity among cases. Below are more details about this condition and when you should seriously consider going under the knife.

What is Hiatal Hernia?

Understanding what this condition is all about will help you make the decision whether to have hiatal hernia surgery or not.  So what is a hiatal hernia? This condition happens when a portion of stomach spills over to the chest through the diaphragm which is the muscle that separates your stomach from your chest.

The term hiatal is attributed to the hiatus, a small opening in your diaphragm where the esophagus is found. The esophagus is the tube through which food passes from the mouth down to your stomach.  When hiatal hernia occurs, a part of the stomach pushes up to the chest through the hiatus. Those who are 50 years old and older, obese, pregnant, or do work that requires lifting of heavy objects are highly at risk of developing this condition.  It is important to note that hiatal hernia is more prevalent among women and people who are overweight.


While there is no definite cause of hiatal hernia, the most probable culprit could be any of the following:

  • Weakened muscle tissue that is unable to push back the portion of the stomach that spills over to the chest area
  • Injury especially to the diaphragm area which affects the muscle that separates the stomach from the chest
  • Persistent pressure in surrounding muscles of the diaphragm area (i.e. non-stop coughing, vomiting, lifting heavy objects, and so on)


As said earlier, symptoms vary in severity.  In fact, in many cases, the situation is so mild that it would not require any hiatal hernia surgery.  However, there are other cases that do require medical attention. Here are some symptoms of relatively larger types of hiatal hernias:

  • Difficulty breathing
  • Stomach pain
  • Chest discomfort
  • Difficulty swallowing
  • Acid reflux
  • Heartburn
  • Regurgitation of whatever has been ingested
  • Vomiting of blood or passing black stool (both are signs of bleeding in the gastrointestinal area)

Once any of these manifest, it would be best to talk to your doctor immediately.  He or She can diagnose if you do have hiatal hernia and if it requires immediate hiatal hernia surgery.


There are two main types of hiatal hernia.  The first is sliding hiatal hernia. Here, a part of the stomach and esophagus slide up through the hiatus.  The second which is less common but more complicated is the paraesophageal hernia. Here, a part of the stomach bulges through the hiatus, forcing itself to situate beside the esophagus.


Most cases of hiatal hernia do not exhibit symptoms.  There are people who do not even know they have it. However, there are people who experience severe symptoms that cause doctors to require immediate hiatal hernia strategy.  This can only be determined through a combination of endoscopy which determines if there is inflammation in your esophagus or stomach; esophageal manometry which measures the rhythmic contractions of your esophagus; and employing a barium swallow, a process of getting x-ray pictures of the esophagus, stomach, and duodenum.


For simpler cases that do not require hiatal hernia surgery, the following treatment may be prescribed by the doctor:

  • Antacids
  • Medication that drastically reduce acid build up
  • Medicines that prevent acid production
  • Medication that treats inflammation in the esophagus or stomach
  • Lifestyle changes
    • Maintaining healthy body weight
    • Having sufficient exercise but do not overstrain yourself
    • Not too much pressure on the abdomen
    • High fiber diet
    • Avoid constipation
    • Proper hydration
    • Manage heavy lifting
    • Quit smoking

When to Have Surgery

Most cases do not require hiatal hernia surgery.  In fact, by changing your lifestyle, you can prevent this condition altogether. However, if symptoms are severe, surgery may be recommended. Here are some situations that you should consult a doctor regarding the possibility of hiatal hernia surgery:

  • Gastrointestinal bleeding (vomiting of blood and passing of black stool
  • Painful ulcers
  • Non-response to medication
  • Interference with day-to-day activities
  • Danger of cut off of blood supply because the part of the stomach or esophagus that spills over to the hiatus gets strangled

Types of Hiatal Hernia Surgery

When any of these happen, your doctor will most likely suggest any of these types of hiatal hernia surgery:

  • Nissen fundoplication:  This is very common and is minimally invasive.  The surgeon does this by making tiny incision through the abdomen and with a laparoscope, repairs the herniated area.  This operation is frequently employed because recovery is easier and there is lesser risk of infection. Scarring is reduced as well and it is relatively less painful.
  • Open surgery: If the herniated area cannot be fixed through tiny incision, this might be the next option.  The surgeon will have to manually place the stomach back to its place and insert a tube to make sure that no part of the stomach will push to the hiatus again.  The upper portion of the stomach (fundus) will also have to be secured around the lower part of the food pipe which will ultimately prevent acid reflux. This is a very complicated operation so you have to make sure you are literally in good hands if this is the way you have decided to repair your condition.
  • Endoluminal fundoplication:  This is not as common than the Nissen type only because it is new.  Here, absolutely no incision is made. Repair of herniated tissue is done via endoscopy.  More studies are needed to prove if this is really an effective type of surgery so you can opt for this one but at your own risk.


After any of these types of hiatal hernia surgery, there might be a degree of pain accompanied by difficulty swallowing and overall stomach discomfort.  This might persist for 48 hours to a week. You might have to stay in the hospital for about two days after the surgery just to monitor any adverse reactions to the operation.

After the surgery, the patient will be recommended to:

  • Shower instead of bathing
  • Clean area of the incision with soap and water
  • Move from time to time to prevent blood clotting
  • Avoid heavy lifting for a month
  • Avoid driving for about two weeks
  • Complete rest (no work) for about three weeks
  • Take painkillers as needed
  • Do “coughing exercises” to strengthen the diaphragm

Hiatal hernia, while common, might be a life-threatening condition especially if the symptoms are severe.  Once you experience any of the symptoms mentioned, consult your physician immediately to get an accurate surgery.  Once that is done, you can now make a better decision whether to have a hiatal hernia surgery or not.

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