Hiatus Hernia Repair

What is Hiatus Hernia Repair?

Hiatus hernia repair, or hiatal herniorrhaphy, is an operation performed to correct a hiatus hernia when conservative treatments and lifestyle modifications have proven ineffective or when complications arise. 


The surgical procedure involves repositioning the herniated stomach and repairing the diaphragmatic opening to restore the normal anatomy. Occasionally, this can be combined with a weight loss operation to maximise anti-reflux outcomes.


Who is Suitable for Hiatus Hernia Repair?

Hiatus hernia repair is typically recommended for individuals who experience severe symptoms or complications related to their hiatus hernia. Suitable candidates for surgery may include those with recurrent acid reflux, chronic heartburn, difficulty swallowing, or complications such as Barrett's oesophagus or oesophageal ulcers.


Benefits of Hiatus Hernia Repair

Hiatus hernia surgery offers several potential benefits, including:

  • Symptom Relief: Surgery aims to alleviate symptoms associated with a hiatus hernia, such as acid reflux, heartburn, chest pain, and difficulty swallowing.
  • Improved Quality of Life: By addressing the underlying hernia, surgery can improve an individual's overall quality of life by reducing or eliminating the need for medication and providing long-term relief from symptoms.
  • Prevention of Complications: Hiatus hernias can lead to complications like oesophagitis, ulcers, bleeding, strictures and oesophageal cancer. Surgery helps prevent these complications and their associated risks.


Types of Hiatus Hernia Repair

There are different types of hiatus hernia repair procedures available. The choice of procedure depends on factors such as the size and type of hernia, the patient's overall health, and the surgeon's expertise. Common types of hiatus hernia surgery include:

  • Nissen Fundoplication: This is a common surgical procedure for hiatus hernia repair. It involves wrapping the upper part of the stomach (fundus) around the lower oesophagus to strengthen the lower oesophageal sphincter and prevent acid reflux.
  • Toupet Fundoplication: A partial wrap procedure that addresses the hernia while preserving the ability to swallow effectively. It involves wrapping only a portion of the stomach around the ¾ of the lower oesophagus.
  • Dor Fundoplication: A partial wrap procedure that addresses the hernia while preserving the ability to swallow effectively. It involves wrapping only a portion of the stomach around ½ of the lower oesophagus.


Laparoscopic Hiatus Hernia Repair

Normally, surgery to repair a hiatus hernia is done laparoscopically. This involves five small cuts in the abdomen, using the operating telescope (laparoscope) to return the stomach to the abdomen and reduce the size of the defect in the diaphragm.


Laparoscopic Hiatus Hernia Repair Risks

All operations share some risks of laparoscopic hernia repair, but these risks rarely occur. They include heart attack, stroke, a clot in the lungs (pulmonary embolism), significant bleeding, infection and injury to the bowel.  Some risks are specific to laparoscopic hiatus hernia repair, which include:

  • About 1-3% of hernia repair patients will require revision surgery for a recurrent hernia
  • There can be an injury to the spleen injury. 
  • Sometimes, the hernia cannot be repaired laparoscopically, and an open repair is necessary. 
  • Occasionally, patients have difficulty swallowing after the operation. 
  • Bloating and discomfort from gas buildup may occur because the person cannot burp.
  • Excess gas.


Preparation Before Hiatus Hernia Repair

Before undergoing hiatus hernia surgery, certain steps need to be taken:

  • Consultation and Evaluation: Consult a healthcare professional specialising in hernia surgery. They will evaluate your symptoms, perform diagnostic tests, and determine if surgery is appropriate.
  • Medical Preparation: Your healthcare provider may provide specific instructions regarding medications to take or avoid leading up to the surgery. It's important to follow these instructions diligently.
  • Preoperative Testing: Depending on your medical history and the severity of your hernia, your healthcare provider may request preoperative tests such as an upper endoscopy or imaging studies to gather more information.


Hiatus Hernia Repair Procedure

The surgical procedure for hiatus hernia repair typically involves the following steps:

  • Anaesthesia: You will be given anaesthesia to ensure you are comfortable and pain-free during the surgery. Your surgeon will determine the type of anaesthesia (general or local).
  • Surgical Approach: Hiatus hernia surgery can be performed using open or minimally invasive techniques such as laparoscopy. The surgeon will choose the most suitable approach based on individual factors.
  • Hernia Repair: The surgeon will reposition the herniated stomach back into the abdominal cavity and repair the opening in the diaphragm. This may involve sutures or the use of surgical mesh to reinforce the repair.


What to Expect After Hiatus Hernia Repair?

After hiatus hernia surgery, several aspects need to be considered:

  • Hospital Stay: The length of the hospital stay varies, but is typically short. You will be monitored for a brief period to ensure a smooth recovery. You can go home a few days after the operation and take a puree diet once you are comfortable. 
  • Recovery Diet: Your healthcare provider will provide specific dietary guidelines for recovery. This may include initially consuming a soft or liquid diet and gradually reintroducing solid foods.
  • Pain Management: You may experience some post-operative discomfort, which can be managed with prescribed pain medications as your surgeon recommends.
  • Activity Restrictions: Your surgeon will provide instructions regarding activity restrictions, including lifting limitations and restrictions on strenuous activities. It's crucial to follow these guidelines to facilitate proper healing.


Hiatus Hernia Repair Care Plan

  • Try not to drink too much for the first 24 hours. 
  • Stay away from driving for at least five days. 
  • Do not do heavy lifting (anything heavier than 3-4 kg) or strenuous exercise for six weeks.   
  • After one week, you can remove your dressings.
  • After 2 weeks,, you should be able to return to work. 
  • Schedule a postoperative appointment six to eight weeks after the operation. 


Hiatus Hernia Repair Prognosis

Most people experience a significant improvement in symptoms and quality of life. However, individual outcomes may vary, and adherence to post-operative care instructions and lifestyle modifications are crucial for long-term success.


Hiatus Hernia Repair Risks

As with any surgical procedure, hiatus hernia surgery carries risks and potential complications, including infection, bleeding, adverse reactions to anaesthesia, injury to surrounding structures, or hernia recurrence.


What if Hiatus Hernia Repair is Delayed?

Delaying hiatus hernia repair may allow symptoms to worsen over time and may increase the risk of complications. Ongoing reflux can lead to inflammation of the oesophagus (oesophagitis), difficulty swallowing, and damage to the oesophageal lining.


Long-term acid reflux may also lead to conditions such as Barrett’s oesophagus, which increases the risk of oesophageal cancer.


In larger hiatal hernias, particularly para-oesophageal hernias, the stomach can move further into the chest. This may lead to obstruction, twisting of the stomach (gastric volvulus), or loss of blood supply to the stomach, which can become a surgical emergency.


Early assessment and treatment may help prevent these complications and improve long-term symptom control.

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