Hiatal hernia surgery: Procedure, recovery, and outlook (2022)

A hiatal hernia occurs when part of the stomach moves upward into the chest. A person may need hiatal hernia surgery if the hernia causes severe symptoms or is likely to cause complications.

Not everyone with a hiatal hernia requires surgery. Many people may be able to treat the condition with medication or lifestyle changes. However, there is a range of procedures available for those who need surgery, the most common being the Nissen fundoplication.

This article discusses hiatal hernia surgery procedures, expected recovery times, complications, and risks.

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Most hiatal hernias do not cause symptoms, and therefore, treatment is not usually necessary. Those who have more mild symptoms, such as heartburn, acid reflux, or gastroesophageal reflux disorder (GERD), may be able to treat their condition with medications or lifestyle changes.

However, a doctor may recommend surgery if the:

  • symptoms are severe and interfere with quality of life
  • symptoms do not respond to other treatments
  • hernia is at risk of strangulation, which is when the herniated tissue’s blood supply gets cut off — a situation that can be fatal
  • symptoms include bleeding, ulcers, or narrowing of the food pipe or esophagus, which is known as an esophageal stricture

What types of surgery are there?

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There are three types of surgery for a hiatal hernia: Nissen fundoplication, open repairs, and endoluminal fundoplication. All three procedures require a general anesthetic.

Nissen fundoplication

A Nissen fundoplication is a common surgery for a hiatal hernia. This procedure involves laparoscopic repair or keyhole surgery. This surgery is minimally invasive and only requires the surgeon to make a few tiny incisions in the abdomen.

The surgeon inserts a laparoscope, which is a thin tube with a light and a camera, into the abdomen to repair the hernia. The surgeon may also tighten the stomach opening to prevent the hernia from returning.

Laparoscopic repair has some advantages over other types of hiatal hernia surgeries. These include less:

  • risk of infection
  • pain
  • scarring
  • time in the hospital
  • recovery time, usually

Open surgery

Open surgery involves making a larger incision in the abdomen so that the surgeon can fix the hernia. This procedure usually carries more risks than laparoscopic repair.

A surgeon pulls the stomach back up into the abdominal cavity and wraps the upper portion, called the fundus, around the lower part of the food pipe. This creates a tight sphincter that stops the stomach acid from leaking up into the food pipe.

Sometimes, the surgeon may need to insert a tube to keep the stomach in place. The doctor will remove the tube after several weeks.

Endoluminal fundoplication (ELF)

This procedure is even less invasive than laparoscopic repair, though it is uncommon. The surgeon does not need to make any incisions. Instead, they place an endoscope, a tube with a light and camera, down the throat and into the food pipe.

The surgeon tightens the area where the stomach and esophagus join to prevent reflux.

However, this treatment may have its limitations. According to a 2015 interview, the endoluminal devices available to date are not entirely reliable, and many people experience their symptoms returning.

Transoral incisionless fundoplication (TIF)

The TIF procedure is another nonsurgical alternative to address a hiatal hernia and reflux.

The most recent version of this procedure, TIF 2.0, includes no incisions, but rather involves placing an endoscope in the esophagus to tighten it. This procedure involves a rotational wrap of the cardia and fundus of the stomach around the esophagus, secured with polypropylene fasteners.

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A 2020 research review of the history of the procedure noted that the TIF 2.0 is often one of the most popular treatments, and as of July 2019, its rate of serious adverse events is lower than in laparoscopic fundoplication at 0.41%.

Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE)

Another type of endoscopic fundoplication is the MUSE procedure. This involves using surgical staples to attach the fundus to the esophagus, creating a necessary partial fundoplication.

A small 2014 study of the procedure involving 66 people with GERD demonstrated the safety and effectiveness of the device 6 months after the procedure.

After laparoscopic surgery, most people usually do not experience much pain, but they may feel discomfort in their abdomen and chest and have difficulty swallowing for a short time.

After a laparoscopy, a person may go home the same day if they recover from the anesthetic. Otherwise, they may spend a night in the hospital and typically can walk around the day after the surgery.

A person may soon feel well again, but may find that they tire easily.

In the days after surgery, doctors usually advise the person to do the following:

  • Wash the incision area daily with plain soap and water.
  • Shower instead of bathing, and avoid the use of pools and hot tubs.
  • Walk around when possible to stop blood clots from forming in the leg.
  • Avoid drinking through a straw.
  • Practice specific breathing and coughing exercises to strengthen the diaphragm.

In the weeks after surgery, the National Health Service (NHS) in the United Kingdom recommends:

  • avoiding any heavy lifting for 2–3 weeks
  • avoiding driving for 7–10 days
  • returning to work within 2–3 weeks, or whenever a person feels well enough
  • taking pain relief medications for several days after surgery to minimize discomfort

Doctors advise that people follow a specific diet after surgery. They also advise people to drink clear liquids immediately after surgery and move on to soft or liquefied foods, including mashed potatoes, smoothies, and soups, the following day. Also, it is important to avoid foods that cause gas and bloating.

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During recovery, it might be a good idea to eat several smaller meals throughout the day instead of three large ones.

Most people can return to their regular diet between 3–6 weeks after surgery.

However, even after a person makes a full recovery, their doctor may recommend they continue to limit or avoid foods that contribute to gas, bloating, and acid reflux symptoms, such as:

  • acidic foods, including citrus fruits and tomato products
  • alcohol
  • beans and lentils
  • carbonated beverages
  • corn
  • cruciferous vegetables, including broccoli, cabbage, and cauliflower
  • fried foods
  • caffeine

Open surgery will usually require a lengthier stay in the hospital and a longer recovery time.

A Nissen fundoplication is usually very effective at relieving symptoms of GERD. An older study estimated that this surgery achieves a success rate of 90%–95%. The same study also suggested that even when healthcare professionals must perform the surgery again to control reflux symptoms further, the success rate is 86%.

A 2019 study involving 122 people with symptomatic hiatal hernias found that those treated with laparoscopic Nissen fundoplication showed significantly lower reflux syndrome frequency-intensity scores and a higher percentage of satisfaction postsurgery than those who only received a hiatal hernia repair.

The NHS estimates that 80%–85% of people will continue to have relief from symptoms 10 years after surgery.

All surgeries carry risks, including the risk of:

  • bleeding
  • infection
  • injury to internal organs

However, the risk with laparoscopic procedures is lower than with open surgery.

Complications associated with hiatal hernia surgery include:

  • abdominal bloating
  • diarrhea
  • difficulty belching or vomiting
  • difficulty swallowing
  • nausea
  • recurrence of the hernia or reflux

While surgery can often be an effective treatment for a hiatal hernia that causes severe symptoms, people with mild symptoms may find relief using medications or home treatments.

Medication

People may be able to treat heartburn and acid reflux with:

  • Antacids: Antacid medications typically neutralize stomach acid. Avoid overusing these as they can cause diarrhea or kidney problems. These medications are available over the counter, by prescription, or to buy online.
  • H2 receptor blockers: These medications usually limit stomach acid production. Medications may contain cimetidine and famotidine. Stronger H2 receptor blockers are available by prescription.
  • Proton pump inhibitors (PPIs): These drugs tend to block acid production for longer than H2 receptor blockers, giving the esophagus tissue more time to heal. People can buy PPIs at a pharmacy, or a doctor may prescribe them.

Home treatments

Some people can experience relief from reflux by making the following lifestyle changes:

  • maintaining a moderate weight
  • eating five to six small meals daily rather than three large ones
  • avoiding foods that cause acid reflux, including fried foods, acidic foods, alcohol, and caffeine
  • eating the last meal of the day at least 3 hours before bedtime
  • quitting smoking
  • raising the head of the bed by 6 inches to prevent acid rising during sleep
  • wearing loose-fitting clothing to prevent pressure on the abdomen

Takeaway

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Hiatal hernias usually do not cause symptoms. If they do, people may be able to treat their symptoms with medications or lifestyle changes, though if these do not work, surgery may give long-term relief from acid reflux and GERD.

Even when hiatal hernia surgery is necessary, the procedure is usually minimally invasive and has a high success rate. Most people might make a full recovery in just a few weeks.

FAQs

How painful is recovery from hiatal hernia surgery? ›

There is usually minimal pain associated with this operation. The abdomen will be sore as well as the small incision sites, and some patients have shoulder pain for the first day or two. The shoulder pain is caused by gas left in your abdomen during the operation. It will disappear on its own.

What is life like after hiatal hernia surgery? ›

Recovery from hiatal hernia surgery takes some time and requires many lifestyle changes; however, most can return more or less to normal within six weeks, with complete return to activity expected at three months. 1 Critical to the success of hiatal hernia surgery is careful attention to long-term care.

What is the success rate of hiatal hernia surgery? ›

How effective is hiatal hernia surgery? A Nissen fundoplication is usually very effective at relieving symptoms of GERD. An older study estimated that this surgery achieves a success rate of 90%–95%.

How long is the hospital stay after hiatal hernia surgery? ›

Expect stay in the hospital one to two days after this procedure. On the morning after your procedure you will get a swallowing study to make sure everything is in the proper place. After that, you will start on a liquid diet.

Is it worth getting hiatal hernia surgery? ›

Treatment of giant hiatal hernias is important because of their potentially complications such as gastric volvulus, anemia, obstruction, strangulation or perforation. Therefore, surgical treatment is recommended in all cases although some authors advocate for a conservative management in selected cases [4].

How much weight do you lose after hiatal hernia surgery? ›

Patients are counseled that they will likely lose 10–15 pounds during the first 4–6 weeks after surgery before the nadir of weight loss (2). Our post-esophageal surgery dietary instruction also includes methods for boosting protein and caloric intake if needed.

How hard is recovery from hiatal hernia surgery? ›

Because this is a major surgery, a full recovery can take 10 to 12 weeks. That being said, you can resume normal activities sooner than 10 to 12 weeks. For example, you can start driving again as soon as you're off narcotic pain medication.

What can you not do after hiatal hernia surgery? ›

It is important to follow the doctor's instructions after hiatal hernia surgery. Some things you should do include avoiding hard or crunchy foods, caffeine, alcohol, fatty foods, and spicy food. You should also drink plenty of fluids and eat soft foods that are easy to swallow.

Can you eat normally after hiatal hernia surgery? ›

You can start eating a soft sloppy diet from the day after your operation. Sloppy food is any food that is moist, can be broken into pieces with a fork, and does not require a lot of chewing. Examples include cereals that have been softened in milk, smooth soup (no lumps) and pureed foods.

Can you throw up after hiatal hernia repair? ›

The most common complications are difficulty swallowing, abdominal bloating, diarrhea, and nausea. Most patients can't belch as well as they could before surgery, although the inability to belch is distinctly uncommon. About 25% of patients can't vomit after surgery.

How often does hiatal hernia surgery fail? ›

There is an ongoing worldwide discussion regarding the high rate of recurrence after laparoscopic hiatal hernia repair, which can reach up to 66%, ranging from 1.2% to 66%, according to the vast available data.

Does your stomach get smaller after hiatal hernia surgery? ›

The cramping and bloating usually go away in 2 to 3 months, but you may continue to pass more gas for a long time. Because the surgery makes your stomach a little smaller, you may get full more quickly when you eat. In 2 to 3 months, the stomach adjusts. You will be able to eat your usual amounts of food.

What should you not do before hernia surgery? ›

Before surgery, make sure to follow any pre-appointment restrictions set by your hernia team such as avoiding nonsteroidal anti-inflammatory medications (NSAIDs) like aspirin and ibuprofen for a week before surgery and not eating the day of surgery.

What size hiatal hernia is considered large? ›

Hiatal hernias were classified as small if their size ranged from 2 to 4 cm and large if > or = 5 cm.

Will hiatal hernia surgery stop acid reflux? ›

Hiatal hernia surgery can be a long-term cure for persistent heartburn, acid reflux, difficulty swallowing and many other upper gastrointestinal symptoms. Our surgeons perform almost all hiatal hernia repair surgeries using advanced minimally invasive laparoscopic and robotic techniques.

What size hiatal hernia needs surgery? ›

In fact, hiatal hernia problems typically only present in hernias larger than 6 cm or 2.5 inches. So long as your hernia is smaller than 6 cm or 2.5 inches, it should be manageable with self-care and medication.

How long will I be off work after a hernia operation? ›

Most people are able to return to work within 1 to 2 weeks after surgery. But if your job requires that you do heavy lifting or strenuous activity, you may need to take 4 to 6 weeks off from work.

What is the main cause of hiatal hernia? ›

The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the: Lower part of the esophagus and stomach. Small intestine, colon and rectum.

Do you need to lose weight before hiatal hernia surgery? ›

With an incisional hernia repair, for example, the surgery is best done when you've lost enough weight that your body mass index (BMI) is less than 40. And your doctor might say you're not ready for a hiatal hernia repair surgery unless your BMI is less than 35.

Can I drink coffee after hernia surgery? ›

Hernia Repair | Hernia Surgery Recovery. You may begin eating and drinking as soon as you get home from surgery. Start with a bland liquid diet such as Gatorade, tea, coffee, water, soup and crackers, or jell-o. You can increase your diet slowly to a regular diet as tolerated.

Will a hiatal hernia make your stomach big? ›

Answer: Hernia

Hiatal hernia does not increase the size of stomach. A general surgeon will repair the hiatal hernia. Unless you have a large umbilical hernia, it will not decrease your stomach (abdominal) size.

How serious is a hiatal hernia? ›

It's rare for a hiatus hernia to cause complications, but long-term damage to the oesophagus caused by leaking stomach acid can lead to ulcers, scarring and changes to the cells of the oesophagus, which can increase your risk of oesophageal cancer.

Is hernia surgery a major surgery? ›

Comparing surgical repair options

Open hernia repair is a major surgery that's performed with the aid of general anesthesia or local anesthesia and sedation. It's done through one or two standard-sized incisions (three to six inches in length) that allow the surgeon to fully visualize and access the problematic area.

Can you drink coffee after hiatal hernia surgery? ›

Fluids and semi-fluid items only - these should be smooth with no lumps • water, juice, cordial (not soft drinks) • milk – plain, flavoured (not milkshake) • tea, coffee (not too hot) • soups (strained or finely pureed) • ice-cream, custard, jelly Page 2 GI SURGERY • yoghurt (plain, vanilla or honey – not with seeds or ...

Can you eat salad with a hiatal hernia? ›

There are some exceptions for those who have food intolerances. Elimination diets may be helpful for optimal improvement in symptoms. Safe foods to eat may include: leafy greens.

How soon can I walk after hernia surgery? ›

There are no medical or physical restrictions on activity after surgery. That means it is OK to walk, climb stairs, lift, have sexual intercourse, mow the lawn, or exercise as long as it doesn't hurt. In fact, returning to normal activity as soon as possible will most likely enhance your recovery.

What is the best position to sleep after hernia surgery? ›

Sleeping After Umbilical Hernia Surgery

The best sleeping position after umbilical hernia surgery is to sleep flat on your back with your head on a small pillow. This prevents too much pressure on the incision site and allows for comfortable breathing during sleep.

Can you still burp after hiatal hernia surgery? ›

Burping after Nissen fundoplication is not common either. Patients may have small burps results from small amount of air trapped above the wrap. However, “big burps” after Nissen fundoplication may indicate wrap failure. Gastroparesis is not common at all following Nissen fundoplication performed by expert hands.

Does a gastroenterologist do hiatal hernia surgery? ›

Mayo Clinic's hiatal hernia care team includes doctors trained in digestive diseases (gastroenterologists) and imaging (radiologists). In some cases, abdominal surgeons and chest (thoracic) surgeons are also involved.

Can hiatal hernia surgery come undone? ›

This operation can also come undone over time in about 5 to 10% of cases, leading to a return of symptoms. If these options do not relieve symptoms, surgery may be needed.

When is it time for hiatal hernia surgery? ›

Sometimes a hiatal hernia requires surgery. Surgery is generally used for people who aren't helped by medications to relieve heartburn and acid reflux, or have complications such as severe inflammation or narrowing of the esophagus.

Does hiatal hernia reduce life expectancy? ›

They found a 2.7% perioperative mortality rate in patients who underwent surgical treatment. In patients that were hospitalized for PEH but ultimately treated without surgery, the mortality rate was 16.4%.

What tests are done before hiatal hernia surgery? ›

Barium Swallow or Upper GI x-ray is performed to characterize a hiatal hernia's size and position.
...
Tests that may be necessary include:
  • Upper GI X-ray.
  • Upper GI Endoscopy.
  • 24-hour pH test.
  • Esophageal manometry.
  • Bloodwork.
  • Chest x-ray.
  • EKG.

What is the best way to prepare for hernia surgery? ›

Keep your stomach empty: Don't eat or drink anything (not even water) after midnight the night before surgery. Your surgery may be canceled if you eat or drink before surgery. If you take any regular medications and have been told to continue them, take them with small sips of water.

What pain medication is given after hernia surgery? ›

From Laparoscopic Hernia Surgery. It is not uncommon to have significant discomfort over the first 2-3 days after your operation. You will be prescribed a NARCOTIC pain medication to help control this pain (Vicodin, Norco, Hydrocodone, etc.).

What is a Type 3 hiatal hernia? ›

Type III hiatal hernias are combined hernias in which the gastroesophageal junction is herniated above the diaphragm and the stomach is herniated alongside the esophagus. The majority of paraesophageal hernias are type III.

What is a Type 4 hiatal hernia? ›

Finally, type IV hiatal hernias are massive herniations defined by the presence of the stomach and other abdominal organs into the thoracic cavity. This occurs due to a large defect in the phrenoesophageal membrane, as well as an increased laxity in the esophageal hiatus, providing more area for organ protrusion.

When should I be worried about a hiatal hernia? ›

Get medical care immediately. You are being treated for heartburn or hiatal hernia, and you feel sudden chest or stomach pain, have difficulty swallowing, are vomiting, or are unable to have a bowel movement or pass gas; you may have a hernia that has become obstructed or strangulated, which are emergencies.

Does chest xray show hiatal hernia? ›

Approximately 99% of hiatal hernias are sliding, and the remaining 1% are paraesophageal. Most hiatal hernias are found incidentally, and they are usually discovered on routine chest radiographs or computed tomography (CT) scans performed for unrelated symptoms.

How long does it take to heal from hiatal hernia surgery? ›

Because this is a major surgery, a full recovery can take 10 to 12 weeks. That being said, you can resume normal activities sooner than 10 to 12 weeks. For example, you can start driving again as soon as you're off narcotic pain medication.

What can you not do after hiatal hernia surgery? ›

It is important to follow the doctor's instructions after hiatal hernia surgery. Some things you should do include avoiding hard or crunchy foods, caffeine, alcohol, fatty foods, and spicy food. You should also drink plenty of fluids and eat soft foods that are easy to swallow.

How long before you can eat after hiatal hernia surgery? ›

After about four weeks, you should be able to eat a full range of foods. However, you are advised to: continue with small meals and between-meals snack if need to satisfy your appetite rather than large meals • continue to chew all foods well.

How long does your stomach stay swollen after hiatal hernia surgery? ›

The cramping and bloating usually go away in 2 to 3 months, but you may continue to pass more gas for a long time. Because the surgery makes your stomach a little smaller, you may get full more quickly when you eat. In 2 to 3 months, the stomach adjusts. You will be able to eat your usual amounts of food.

Can you throw up after hiatal hernia repair? ›

The most common complications are difficulty swallowing, abdominal bloating, diarrhea, and nausea. Most patients can't belch as well as they could before surgery, although the inability to belch is distinctly uncommon. About 25% of patients can't vomit after surgery.

How soon can I walk after hernia surgery? ›

There are no medical or physical restrictions on activity after surgery. That means it is OK to walk, climb stairs, lift, have sexual intercourse, mow the lawn, or exercise as long as it doesn't hurt. In fact, returning to normal activity as soon as possible will most likely enhance your recovery.

How many incisions are needed for hiatal hernia surgery? ›

Traditional hiatal hernia surgery is done by a general surgeon on an inpatient basis. Once the patient undergoes general anesthesia, the surgeon makes two incisions on both sides of the hernia.

Will my stomach shrink after hernia repair? ›

This appearance will not change with hernia repair. You will do best by dropping to your long-term stable weight (if you are not there already) prior to proceeding with any type of body contouring surgery.

What is the main cause of hiatal hernia? ›

The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the: Lower part of the esophagus and stomach. Small intestine, colon and rectum.

Can you eat salad with a hiatal hernia? ›

There are some exceptions for those who have food intolerances. Elimination diets may be helpful for optimal improvement in symptoms. Safe foods to eat may include: leafy greens.

How do you sleep after hiatal hernia surgery? ›

The doctors do not recommend sleeping on the stomach after the surgery. This position can hurt your spine and can also pressurize the hip area. Try to control your sleeping habits if you are a stomach sleeper. It is best to sleep on your side or back.

What is the fastest way to recover from hernia surgery? ›

How can you care for yourself at home?
  1. Rest when you feel tired. ...
  2. Try to walk each day. ...
  3. If your doctor gives you an abdominal binder to wear, use it as directed. ...
  4. Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.

Can you eat pasta with a hiatal hernia? ›

Hiatal Hernia: Foods That Are Less Likely to Cause Symptoms

Grains, like cereals (bran and oatmeal), bread, rice, pasta, and crackers. Low-fat or skim milk and low-fat yogurt. Fat-free cheeses, cream cheese, and fat-free sour cream. Lean meat, chicken, and fish.

Can you still burp after hiatal hernia surgery? ›

Burping after Nissen fundoplication is not common either. Patients may have small burps results from small amount of air trapped above the wrap. However, “big burps” after Nissen fundoplication may indicate wrap failure. Gastroparesis is not common at all following Nissen fundoplication performed by expert hands.

How soon can you drive after hernia surgery? ›

Since you will be given general anesthesia, it is recommended that you wait 24-48 hours before driving at minimum. If your hernia is located in an area where driving may place abnormal strain on it, you may be asked to wait a couple more days before getting behind the wheel.

What size hiatal hernia is considered large? ›

Hiatal hernias were classified as small if their size ranged from 2 to 4 cm and large if > or = 5 cm.

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