Table of ContentsView AllTable of ContentsPurposeHow to PrepareDay of SurgeryRecoveryLong-Term CareNext in Hiatal Hernia Surgery GuideHiatal Hernia Surgery: How to Prepare
Table of ContentsView All
View All
Table of Contents
Purpose
How to Prepare
Day of Surgery
Recovery
Long-Term Care
Next in Hiatal Hernia Surgery Guide
Hiatal herniasurgery (also known as “hiatal hernia repair”) is a procedure that treatshiatal hernia, a condition in which the stomach pushes into the chest cavity.This occurs due to weakness in thediaphragm, a thin band of muscle that keeps the abdomen and chest cavity separate.
While this type of hernia is usually asymptomatic, it’s a common cause of chronicgastroesophageal reflux disease (GERD)and can lead to other issues. The surgery takes on a range of symptoms, including heartburn and acid regurgitation, pain in the chest, difficulty swallowing, shortness of breath, dry cough, nausea, vomiting, bad breath, and fainting, among others.
If less-invasive treatments don’t alleviate these issues, hiatal hernia surgery will be considered to physically repair the diaphragm and reposition the stomach and esophagus.
This procedure is performed using minimally-invasive techniques that require smaller incisions, so not only is it successful in alleviating symptoms, recovery is well-tolerated and relatively quick.If you’re considering this surgery, it’s essential to understand as much as you can about it.
What Is Hiatal Hernia Surgery?
The primary aim of hiatal hernia surgery is to restore proper anatomy of the stomach and esophagus.During surgery, doctors locate the tear in the diaphragm and use various techniques to repair and reinforce the area, after moving the stomach back into place.
Though open surgery may be required in the most severe cases, hiatal hernia is usually repaired usinglaparoscopicor endoscopic techniques, which require smaller incisions.The latter two rely on using specialized surgical tools as well as laparoscopes and endoscopes, which are cameras that can access the problem area and provide real-time video imagery for the surgeon.
Approaches have come a long way with this treatment, and nowadays some hiatal hernia surgeries are performed using robotic assistance.
Various Surgery Techniques
There are several types of hiatal hernia surgery, and the choice of procedure depends on the severity and specific location of the hernia. How do these work? Here’s a quick breakdown:
Contraindications
By nature of being minimally-invasive, hiatal hernia surgery is tolerable and acceptable for most people. Except in special circumstances, healthcare providers will first try other methods—such as lifestyle changes and medications—before calling for this operation.
There are, however, some who may not be good candidates and for whom this treatment is contraindicated, including:
Notably, hiatal hernia surgery is considered safe for people of all ages, though extra considerations are taken with pediatric and older populations.Of course, a standard aspect of this care will be thorough clinical evaluation and screening to ensure safety and success.
Potential Risks
While hiatal hernia surgery is safe and has a high success rate—recurrence of the problem is expected to occur in only 5 to 10% of cases—there is always a significant chance of complications.In the case of this treatment, most of these are more easily managed and don’t require additional surgery. The risks of undergoing this surgery include:
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Purpose of Hiatal Hernia Surgery
There are two kinds of hernia taken on with this surgery: sliding hiatal hernia and paraesophageal hernia.The former of these refers to cases where the stomach is able to slide in and out of position, whereas the latter, more severe type, it’s moved permanently into the chest cavity. What diagnoses prompt consideration of this procedure? Here’s a quick breakdown:
It’s important to note that surgery is rarely a first-line treatment, it is only considered after non-invasive treatments have been attempted.Healthcare providers will try nutrition counseling, as well as stomach acid managing medications first.
A number of tests are done for diagnosing these conditions:
Hiatal Hernia Surgery: Overview
While hiatal hernia surgery is a minimally-invasive procedure, and you’ll often need to recover in the hospital for two nights.Preparation for this surgerymeans understanding what will occur, where treatment takes place, what you need to have with you, and what to expect.
Location
What to Wear
As your healthcare provider will tell you, plan on wearing the same, comfortable clothes home, as you did to the hospital. What should you keep in mind in terms of wardrobe? Here are some quick tips:
Food and Drink
Dietary guidelines are often needed in hiatal hernia cases, and some pre-operative dietary guidelines will need to be kept in mind. Most notably, you should not eat or drink anything for at least eight hours prior to your procedure.
On top of that, your healthcare provider may be put you on a low-sugar, liquid-based pre-operative diet for two to 10 days before surgery. They’ll tell you more about it, but this typically entails featuring:
Why You Can’t Eat or Drink Before Surgery
1:26Click Play to Learn About Hiatal Hernia Diets
1:26
Click Play to Learn About Hiatal Hernia Diets
Medications
Before hiatal hernia surgery, you typically won’t be on any specific medications, though the healthcare provider may give you something to help with heartburn. Notably, some drugs and vitamin supplements should be avoided before surgery because they can affect the blood’s ability to clot:
It’s absolutely essential that you let your healthcare provider know exactly what prescribed and over-the-counter drugs you’re taking, as well as any other vitamins or herbal supplements you’re taking.
What to Bring
Make sure to have:
Pre-Op Lifestyle Changes
Prior to surgery, your healthcare provider may also recommend several important lifestyle changes:
What to Expect on the Day of Surgery
From start to finish, hiatal hernia surgery typically takes three to four hours.However,on the day of surgery, there’s much more that happens: healthcare providers have to ensure you’re ready for the procedure, perform it, and then ensure that early recovery is going smoothly.
Before the Surgery
Performed in the pre-op room, you’ll first undergo an initial evaluation. Here’s a quick breakdown:
During the Surgery
A couple of different techniques may be used to perform this surgery. In severe cases, an open surgery may be employed—this requires larger incisions—but in most cases, laparoscopic Nissen fundoplication is used.There may be variations, but here’s a rundown of how it works:
After the Surgery
In the post-operative recovery period—which entails at least one night in the hospital—the medical staff will be monitoring your progress carefully and keeping an eye out for complications. What does in-hospital recovery look like? Here’s what happens:
Prior to discharge, healthcare providers want to ensure that there are no complications with the surgery, that you are in stable conditions, and are able to digest foods.
Completerecovery from hiatal hernia surgerytakes at least three to four weeks. Whether a person needs physical therapy depends on a variety of factors, including their age, co-morbidities, and functional status.
Many lifestyle adjustments may need to be made in this time, and you’ll need to be open and communicative with your healthcare provider. In addition, you’ll have to come back in for a follow-up appointment in two weeks.
Recovery Timeline
Keep this in mind for how recovery may progress:
Healing
Successful recovery from hiatal hernia requires careful attention to how your feeling, as well as a number of other important factors. You’ll feel some tightness in your throat due to swelling following surgery and fatigue for one to two weeks following surgery. Furthermore, some people may develop constipation or diarrhea during the first week following the procedure.
Care for the incisions is particularly important; here’s what you should keep in mind:
How to Care For a Surgical Incision
Since hiatal hernia surgery treats the stomach and esophagus, you’ll need to be on a very restrictive, liquid-based diet during recovery. Your healthcare provider will tell you more about it, but here are the basics:
Once you have clearance from your healthcare provider, usually after three weeks, you’ll be able to resume a more normal diet.
Coping With Recovery
The most immediate concern following hiatal hernia surgery is pain, and you will be prescribed strong opioid medications to manage it. Be very careful about using these and follow the prescription exactly, and keep in mind that these can significantly affect motor function.
In most cases, hiatal hernia surgery will effectively correct GERD or other gastrointestinal symptoms, reducing the need for medications. But ensuring symptoms come back should also be a life-long project, and it may take some significant lifestyle changes. Here’s what may be recommended:
A Word From Verywell
Even though the procedure is routine and well-tolerate, there’s no doubt that the prospect of undergoing hiatal hernia surgery can be intimidating. Uncertainty and anxiety are not uncommon in those considering treatments of this scale.
However, it’s important to remember that not only does this operation significantly reduce symptoms, but the way it’s performed today makes it safer and more effective than ever before. With a dedicated surgeon and hospital staff— alongside your family and support-network—the pain and discomfort associated with hiatal hernia will surely become a thing of the past.
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic.Hiatal hernia.Columbia University Department of Surgery.Hiatal hernia.UC Davis Health Department of Health D.Robotic surgery.Keck Medicine-University of Southern California.Hiatal hernia.Kunio N, Dolan J, Hunter J.Short esophagus.Surg Clin North Am. 2015;95(3):641-652. doi:10.1016/j.suc.2015.02.015Yang X, Hua R, He K, Shen Q, Yao Q.Laparoscopic hernioplasty of hiatal hernia.Ann Transl Med. 2016;4(18):343-343. doi:10.21037/atm.2016.09.03Kohn G, Price R, Demeester S et al.Guidelines for the management of hiatal hernia. SAGES.Chang C, Thackeray L.Laparoscopic hiatal hernia repair in 221 patients: outcomes and experience.JSLS. 2016;20(1):e2015.00104. doi:10.4293/jsls.2015.00104Tatum R.Properative esophageal evaluation of patients being considered for antireflux surgery.Gastroenterol Hepatol; 9(4):249-251.Saint Luke’s Health System.Hiatal hernia repair.Bell R, Freeman K.Pre-op diet. SOFI Center for Esophageal Wellness.National Institutes of Health.Anti-reflux surgery.Larowe E, Reddy R.Preparing for your transthoracic hiatal hernia repair pre and post-operative information. Michigan Medicine.University of Washington Medicine, Center for Esophageal and Gastric Surgery.Paraesophageal hernia what it is and how it is treated.Seeras K, Bittar K, Siccardi M.Nissen fundoplication (anti-reflux procedure). StatPearls. Updated 2020.University Hospitals.Hiatal hernia surgery recovery: Nissen fundoplication & paraesophageal hernias.National Institutes of Health.Anti-reflux surgery - discharge.
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic.Hiatal hernia.Columbia University Department of Surgery.Hiatal hernia.UC Davis Health Department of Health D.Robotic surgery.Keck Medicine-University of Southern California.Hiatal hernia.Kunio N, Dolan J, Hunter J.Short esophagus.Surg Clin North Am. 2015;95(3):641-652. doi:10.1016/j.suc.2015.02.015Yang X, Hua R, He K, Shen Q, Yao Q.Laparoscopic hernioplasty of hiatal hernia.Ann Transl Med. 2016;4(18):343-343. doi:10.21037/atm.2016.09.03Kohn G, Price R, Demeester S et al.Guidelines for the management of hiatal hernia. SAGES.Chang C, Thackeray L.Laparoscopic hiatal hernia repair in 221 patients: outcomes and experience.JSLS. 2016;20(1):e2015.00104. doi:10.4293/jsls.2015.00104Tatum R.Properative esophageal evaluation of patients being considered for antireflux surgery.Gastroenterol Hepatol; 9(4):249-251.Saint Luke’s Health System.Hiatal hernia repair.Bell R, Freeman K.Pre-op diet. SOFI Center for Esophageal Wellness.National Institutes of Health.Anti-reflux surgery.Larowe E, Reddy R.Preparing for your transthoracic hiatal hernia repair pre and post-operative information. Michigan Medicine.University of Washington Medicine, Center for Esophageal and Gastric Surgery.Paraesophageal hernia what it is and how it is treated.Seeras K, Bittar K, Siccardi M.Nissen fundoplication (anti-reflux procedure). StatPearls. Updated 2020.University Hospitals.Hiatal hernia surgery recovery: Nissen fundoplication & paraesophageal hernias.National Institutes of Health.Anti-reflux surgery - discharge.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cleveland Clinic.Hiatal hernia.Columbia University Department of Surgery.Hiatal hernia.UC Davis Health Department of Health D.Robotic surgery.Keck Medicine-University of Southern California.Hiatal hernia.Kunio N, Dolan J, Hunter J.Short esophagus.Surg Clin North Am. 2015;95(3):641-652. doi:10.1016/j.suc.2015.02.015Yang X, Hua R, He K, Shen Q, Yao Q.Laparoscopic hernioplasty of hiatal hernia.Ann Transl Med. 2016;4(18):343-343. doi:10.21037/atm.2016.09.03Kohn G, Price R, Demeester S et al.Guidelines for the management of hiatal hernia. SAGES.Chang C, Thackeray L.Laparoscopic hiatal hernia repair in 221 patients: outcomes and experience.JSLS. 2016;20(1):e2015.00104. doi:10.4293/jsls.2015.00104Tatum R.Properative esophageal evaluation of patients being considered for antireflux surgery.Gastroenterol Hepatol; 9(4):249-251.Saint Luke’s Health System.Hiatal hernia repair.Bell R, Freeman K.Pre-op diet. SOFI Center for Esophageal Wellness.National Institutes of Health.Anti-reflux surgery.Larowe E, Reddy R.Preparing for your transthoracic hiatal hernia repair pre and post-operative information. Michigan Medicine.University of Washington Medicine, Center for Esophageal and Gastric Surgery.Paraesophageal hernia what it is and how it is treated.Seeras K, Bittar K, Siccardi M.Nissen fundoplication (anti-reflux procedure). StatPearls. Updated 2020.University Hospitals.Hiatal hernia surgery recovery: Nissen fundoplication & paraesophageal hernias.National Institutes of Health.Anti-reflux surgery - discharge.
Cleveland Clinic.Hiatal hernia.
Columbia University Department of Surgery.Hiatal hernia.
UC Davis Health Department of Health D.Robotic surgery.
Keck Medicine-University of Southern California.Hiatal hernia.
Kunio N, Dolan J, Hunter J.Short esophagus.Surg Clin North Am. 2015;95(3):641-652. doi:10.1016/j.suc.2015.02.015
Yang X, Hua R, He K, Shen Q, Yao Q.Laparoscopic hernioplasty of hiatal hernia.Ann Transl Med. 2016;4(18):343-343. doi:10.21037/atm.2016.09.03
Kohn G, Price R, Demeester S et al.Guidelines for the management of hiatal hernia. SAGES.
Chang C, Thackeray L.Laparoscopic hiatal hernia repair in 221 patients: outcomes and experience.JSLS. 2016;20(1):e2015.00104. doi:10.4293/jsls.2015.00104
Tatum R.Properative esophageal evaluation of patients being considered for antireflux surgery.Gastroenterol Hepatol; 9(4):249-251.
Saint Luke’s Health System.Hiatal hernia repair.
Bell R, Freeman K.Pre-op diet. SOFI Center for Esophageal Wellness.
National Institutes of Health.Anti-reflux surgery.
Larowe E, Reddy R.Preparing for your transthoracic hiatal hernia repair pre and post-operative information. Michigan Medicine.
University of Washington Medicine, Center for Esophageal and Gastric Surgery.Paraesophageal hernia what it is and how it is treated.
Seeras K, Bittar K, Siccardi M.Nissen fundoplication (anti-reflux procedure). StatPearls. Updated 2020.
University Hospitals.Hiatal hernia surgery recovery: Nissen fundoplication & paraesophageal hernias.
National Institutes of Health.Anti-reflux surgery - discharge.
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