Hiatus hernia surgery

What is hiatus hernia surgery?

Hiatus hernia surgery is an operation to repair a weak or widened opening in the diaphragm, the muscle sheet between the chest and abdomen, where the stomach has pushed up into the chest. The surgeon returns the stomach to its proper place and tightens the opening with stitches, usually also wrapping the top of the stomach around the lower food pipe to stop acid reflux, and this is normally done by keyhole surgery.

What is a hiatus hernia?

A hiatus hernia happens when part of the stomach pushes up through the diaphragm into the chest. The diaphragm has a small opening called the hiatus, where the oesophagus (food pipe) passes through. If this opening becomes wider or weaker, the top of the stomach can slide or roll upward.

Some adults (and children) never notice symptoms. Others may experience heartburn, chest discomfort, difficulty swallowing or a feeling of food “sticking.”

How serious is a hiatus hernia?

Most hiatus hernias aren’t dangerous, but they can cause troublesome symptoms, especially acid reflux, otherwise known as gastro-oesophageal reflux disease (GORD). A small number of patients can develop complications such as severe reflux, inflammation of the oesophagus, or, in rarer cases, twisting or trapping of the stomach.

What are the different types of hiatus hernia?

Hiatus hernias can be classified into four main types:

Type 1: Sliding hiatus hernia

This is the most common type. The junction between the oesophagus and stomach slides up into the chest. It’s strongly linked with acid reflux.

Type 2: Rolling hiatus hernia (paraoesophageal)

Part of the stomach rolls up alongside the oesophagus while the junction between the oesophagus and stomach stays in place. These hernias are less common but more likely to cause complications because the stomach can become trapped.

Type 3: Mixed paraoesophageal hernia

A combination of sliding and rolling hernias. Both the junction and part of the stomach move into the chest.

Type 4: Complex paraoesophageal hernia

A larger hernia where other organs, such as the bowel or spleen, also move into the chest. These are rare and usually require surgery.

How is a hiatus hernia diagnosed?

Diagnosis often starts with a discussion of symptoms and a physical examination. Your consultant may recommend:

• Endoscopy: A camera test is used to look at your oesophagus and stomach




• Barium swallow X-ray: This is where you drink a contrast liquid so the hernia shows clearly on X-ray




• Oesophageal manometry: Measures how well the oesophagus muscles work and is often used before surgery.

What causes a hiatus hernia?

Hiatus hernias can develop for several reasons, including:

• Age-related weakening of the diaphragm
• Increased pressure in the abdomen (from lifting, straining, pregnancy or coughing)
• Being overweight
• Genetics – some people naturally have a wider hiatus
• Injury or previous surgery.

Can a hiatus hernia go away on its own?

No, the hernia itself doesn’t shrink or disappear. However, symptoms can often be managed with lifestyle changes or medication.

What happens if a hiatus hernia is left untreated?

Many adults live comfortably with a hiatus hernia. But if symptoms are severe or the hernia is large, complications can include:

• Worsening acid reflux (GORD)
• Inflammation or ulceration of the oesophagus
• Iron-deficiency anaemia. This occurs due to slow, chronic blood loss from tissue friction or ulcerations in the hernia sac
• Trapping or twisting of the stomach (rare but serious).

Surgery is usually recommended when symptoms are persistent, severe or linked to complications.

What are the symptoms of a hiatus hernia?

Common symptoms can include:

• Heartburn or acid reflux
• Chest discomfort or pressure
• Difficulty swallowing
• A feeling of food “sticking”
• Regurgitation of food or acid
• Bloating or belching
• Shortness of breath (in larger hernias).

Where is hiatal hernia pain located?

Pain is usually felt behind the breastbone or in the upper abdomen. Some patients may describe it as a burning sensation or tightness.

Can a hiatus hernia cause chest pain?

Yes, acid reflux and irritation of the oesophagus can cause chest pain. Because chest pain can have many causes, it’s important to seek medical advice if the pain is new, severe or worrying.

What is the link between a hiatus hernia and acid reflux (GORD)?

A hiatus hernia can weaken the valve between the oesophagus and stomach, allowing acid to flow upward. This is why sliding hernias are strongly associated with reflux symptoms.

What surgical options are there for repairing a hiatus hernia?

Open hiatus hernia repair
A larger incision is made in the abdomen or chest. The stomach is moved back into place, the hiatus is tightened, and the top of the stomach may be wrapped around the oesophagus to reduce reflux.

Laparoscopic (keyhole) hiatus hernia repair
Small incisions are used to repair the hernia with a camera and instruments. This is the most common approach and usually results in less pain and quicker recovery.

Open vs laparoscopic repair – which is right for me?

Most adults are suitable for laparoscopic surgery. Open surgery may be recommended for very large or complex hernias, or if you’ve had previous abdominal surgery. Your consultant will discuss the safest option for you.

How do I know if I need hiatus hernia surgery?

Surgery is usually considered when:

• Symptoms don’t improve with medication
• Reflux is severe or causing complications
• The hernia is large or paraoesophageal
• There is a risk of the stomach becoming trapped.

At what size does a hiatal hernia require surgery?

There is no strict size threshold. Decisions are based on symptoms, complications and the type of hernia rather than size alone.

Who is suitable for hiatus hernia surgery?

You may be suitable if you suffer from persistent symptoms. Your consultant will assess your overall health, weight and any underlying conditions.

Who is not suitable for hiatus hernia surgery?

Surgery may be delayed or avoided if you have uncontrolled medical conditions, severe heart or lung disease or a high anaesthetic risk.

Can I have hiatus hernia surgery if I am overweight?

Yes, you can, but weight loss may be recommended first. Excess abdominal pressure can increase the risk of recurrence after surgery.

What are the alternatives to hiatus hernia surgery?

Alternatives include:

• PPIs (proton pump inhibitors): These can reduce stomach acid
• H2 blockers: Can reduce how much acid your stomach makes
• Antacids: Medicines that neutralise the acid that’s already in your stomach
• Lifestyle changes: For example, weight loss, avoiding trigger foods, raising the head of the bed.

These options may help to manage your symptoms but do not repair the hernia.

What is a Nissen fundoplication?

A Nissen fundoplication is a procedure where the top of the stomach is wrapped around the lower oesophagus to strengthen the valve and reduce reflux. It is often performed at the same time as a hiatus hernia repair.

What is the LINX procedure?

The LINX device is a small ring of magnetic beads placed around the lower oesophagus to help prevent reflux. It’s not the same as a hernia repair but may be used alongside it in selected patients.

Hiatus hernia repair vs. long-term medication (PPIs)

Medication can control symptoms but doesn’t fix the hernia. Surgery repairs the underlying problem and may reduce or eliminate the need for long-term medication.

How can I prepare for hiatus hernia surgery?

Your surgeon may advise you to:

• Stop smoking
• Maintain a healthy weight
• Avoid heavy lifting
• Follow fasting instructions
• Tell your team about all medications, including supplements
• Shower the day before or on the day of surgery.

What happens at the pre-operative assessment?

You’ll meet the healthcare team to review your medical history, discuss anaesthetic options and plan your recovery. You may have blood tests, an ECG or imaging if needed.

What happens during hiatus hernia surgery?

Hiatus hernia repair usually takes 1–2 hours. It’s performed under general anaesthetic. The stomach is moved back into the abdomen, the hiatus is tightened and, if needed, a fundoplication is performed to reduce reflux.

How long does it take to recover from hiatus hernia surgery?

Pain and recovery timeline
Most patients experience mild to moderate discomfort for a few days. Laparoscopic surgery usually allows a quicker recovery than open surgery.

Going home
Many patients go home on the same day or the next morning.

Diet after surgery
You’ll be advised to start off with liquids, then slowly introduce soft foods for 2–6 weeks. Foods to avoid early on include:

• Bread
• Tough meats
• Fizzy drinks
• Spicy or acidic foods
• Chocolate (it relaxes the valve and can worsen reflux).

Difficulty swallowing (dysphagia)
It’s common to feel tightness or difficulty swallowing for a few weeks. This usually settles as swelling reduces.

Driving and work
You can drive once you can safely control your vehicle. You must be able to perform an emergency stop comfortably. Please check with your motor insurer first.

Many patients return to work after 2–4 weeks – depending on the type of job you do, this can vary.

Exercise
Walking is encouraged immediately. Avoid heavy lifting for at least 6 weeks.

Will I need to take acid reflux medication afterwards?

Many patients reduce or stop medication after surgery, but some may still need PPIs occasionally. Your consultant will guide you on what’s best.

What are the risks and complications of hiatus hernia surgery?

Every surgical procedure has a risk of complications. Be sure to discuss any concerns you might have about these risks with your surgeon.

General risks can include:

• Pain
• Bleeding during or after the operation
• Infection of the surgical site
• Scarring
• Blood clots or DVT (deep-vein thrombosis).

Specific risks can include:

• Difficulty swallowing
• Gas bloating
• Recurrence of the hernia
• Injury to nearby organs (rare)
• Inability to burp or vomit (common after fundoplication).

Your healthcare team will do their best to minimise any risks.

How much does hiatus hernia surgery cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.