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.

Diagram of a hiatal herniaShare on Pinterest
Illustration by Sophia Smith

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

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.

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.

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

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.