What is Hiatal Hernia Surgery?

A hiatal hernia occurs when a portion of the stomach protrudes through a tear or weakness in the diaphragm and through the muscles between the abdomen and chest. In some instances, surgery is the only way to address this issue. 

Hiatal hernias are common in individuals who are over the age of 50 and in those who suffer from obesity. Often, individuals who suffer from a hiatal hernia may experience chronic heartburn or chest pain. While a small hernia may not cause any lingering medical complications, a larger hiatal hernia can lead to severe Gastroesophageal Reflux Disease (GERD). The first line of treatment for patients who have symptoms is usually medications, such as pepcid or protonix.  However, if the medications do not work, or if you have become dependent on the medications for several years, you may be a candidate for surgical repair of the hiatal hernia. 

In this article, we will tell you about hiatal hernia surgery. We will discuss how it’s performed, how you can prepare for surgery, and how long it takes to recover. 

When is Surgery Needed to Treat a Hiatal Hernia?

While surgery is the most immediate solution to correcting a hiatal hernia, that doesn’t mean it’s the only option available. Hiatal hernia surgery is typically offered to patients with inflammation of the esophagus (esophagitis), pre cancerous changes (Barrett’s esophagus), failure of medical treatment, or severe symptoms.

If patients have a large hernia, or if a hiatal hernia is at risk of becoming constricted or strangulated, surgery is often recommended to prevent further medical problems. 

Symptoms of medical complications of a hiatal hernia include: 

• Bleeding
• Scarring
• Ulcers
• Narrowing of the esophagus

If left untreated, even a small hiatal hernia can lead to chronic gastroesophageal reflux, which can cause further complications such as inflammation, esophageal ulcers, and bleeding or scarring of the esophagus.

How is Hiatal Hernia Surgery Performed?

There are three available surgeries to treat hiatal hernias, all of which are performed under general anesthesia and that take on average at Olde Del Mar Surgical an hour to complete. 

During surgery, your surgeon will repair the rupture in the diaphragm and then wrap the upper part of the stomach, called the fundus, around the lower portion of the esophagus. This creates a natural valve so that stomach contents will not reflux into the esophagus.

Let’s take a look at each surgery. 

Laparoscopic Repair

This is the most common procedure performed to repair a hiatal hernia since there is less risk of pain, scarring, and infection. In a laparoscopic repair, your surgeon will make 5 small incisions in the abdomen into which surgical instruments will be inserted to pull the stomach back into the abdominal cavity. The surgeon will repair the hernia with sutures placed laparoscopically and sometimes mesh to reinforce the sutures. The decision to use mesh is typically made during the surgery depending on the size of the hernia and the strength of the muscles that have to be repaired. 

Afterwards, your surgeon will recreate the natural valve between the stomach and esophagus by wrapping the upper part of the stomach around the lower portion of the esophagus to help reduce the episodes of reflux. 

Endoluminal Fundoplication 

The newest of the three procedures, endoluminal fundoplication is the least invasive option. Instead of making an incision, your surgeon will use an endoscope, inserted orally, to place small clips at the point where the stomach meets the esophagus to prevent stomach acid and food from building up. Although there was a lot of enthusiasm for these procedures a few years ago, they have become less popular as a result of poor outcomes and a higher complication rate when compared to the laparoscopic operations.

Open Repair

This surgery is typically only performed in patients who cannot have laparoscopic surgery as it is the most invasive of the three procedures, and requires the longest recovery time.  

In an open repair, your surgeon will make one long surgical incision in the abdomen through which they’ll manually pull the stomach back into place and wrap it around the lower portion of the esophagus to create a tighter sphincter. 

In some instances, it may be necessary to insert a tube into your stomach to keep it in place. This tube can typically be removed in 2-4 weeks.

How Can I Prepare for Hiatal Hernia Surgery?

As with every surgery at Olde Del Mar Surgical, each patient will be provided with individualized precautions by their bariatric surgeon based on their unique needs. 

In general, however, the following recommendations are typical for patients preparing for hiatal hernia surgery: 

• Walk 2-3 miles per day
• Perform a variety of different breathing exercises
• Quit smoking for at least four weeks before surgery
• Do not take clopidogrel (Plavix) or nonsteroidal anti-inflammatories (NSAIDs) for at least one week before surgery
• While a clear liquid diet is not required, patients cannot eat or drink for at least 12 hours before the surgery

 

How Long Does it Take to Recover From Hiatal Hernia Surgery?

Most patients can typically return home the same day after undergoing hiatal hernia surgery. However, you should not return to work for 2-3 weeks and you should also avoid any heavy lifting during this time. 

After 3 – 6 weeks, you can return to your normal diet. Generally, your bariatric surgeon will inform you if dietary adjustments are needed. 

The post-surgery recovery process is fairly straightforward. In addition to washing your incisions gently with soap and water daily, keeping up with breathing exercises given to you by your bariatric surgeon, and avoiding pools or hot tubs, there are only a few dietary recommendations you’ll need to follow: 

• Start on an all-liquid diet and gradually add in soft food to avoid overextending your stomach
• Eat 4-6 small meals per day instead of 3 large meals for the same reason
• Do not consume alcohol, carbonated beverages, citrus, or tomato products
• Do not consume foods that may cause gas, such as corn, beans, and cruciferous vegetables
• Avoid drinking through a straw 

Hiatal Hernia Treatment at Olde Del Mar Surgical 

Though hiatal hernia surgery is a complex procedure, it has a success rate of 90%. When choosing a surgeon, you not only want to feel confident in their surgical abilities, but also their ability to communicate openly and clearly with you throughout the entire process. 

At Olde Del Mar Surgical, we have over 20 years of performing these surgeries, have operated on several hundred patients, often with complex illness, and have authored peer reviewed papers on our techniques and outcomes. 

That’s why you can trust the bariatric surgeons at Olde Del Mar Surgical. Not only have they successfully completed hundreds of surgeries, both for revisional and treatment purposes, but they’ve also helped hundreds of patients down the path to recovery. 

If you suffer from severe obesity in addition to a hiatal hernia, we encourage you to schedule a consultation with Dr. Bhoyrul to discuss combining your hiatal hernia repair with personalized weight loss surgery to dramatically improve your health and quality of life.