What is a hiatus hernia repair?

Frequent burping can be a sign of a hiatal hernia.

Hiatal hernia repair surgery is a medical procedure performed to repair an abdominal condition called a hiatal hernia. This condition can cause severe chronic acid reflux, abdominal pain, and other symptoms. Hiatal hernia repair surgery is needed when the condition is severe enough that the symptoms cannot be controlled by medication. This medical procedure is sometimes called anti-reflux surgery because it reduces reflux symptoms caused by a hiatal hernia.

Laparoscopic surgery is generally preferred over open surgery for hiatal hernia repair.

The diaphragm is a very large, thin muscle shaped like a dome. This muscle separates the abdominal cavity from the chest cavity and lies just below the lungs. The diaphragm is important for breathing because it helps push air in and out of the lungs. In the center of the muscle is a hole known as the hiatus, which allows the esophagus to access the stomach. In a hiatal hernia, the stomach muscles around the hole in the diaphragm protrude upward, allowing the upper part of the stomach to protrude through the hiatus.

Open hiatal hernia repair requires a large incision and a longer recovery time.

A hiatal hernia can be caused by injury, muscle weakness, or intense pressure exerted on the muscles, such as when lifting heavy objects. Also, some people are born with a large hiatus, which increases their risk of a hernia. Small hernias usually do not cause symptoms. Larger hiatal hernias can cause nausea, belching, difficulty swallowing, acid reflux, and chest pain. These symptoms can get worse after eating or lying down.

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Hiatal hernia repair can help keep the esophageal sphincter closed, reducing acid reflux.

Medications to treat hiatal hernia include over-the-counter antacids and prescription drugs to reduce or block stomach acid production. This gives time for the esophagus to heal. These medications are used to treat hiatal hernia symptoms, but they cannot help repair the hole in the diaphragm. If these medications do not help relieve symptoms, hiatal hernia repair surgery may be indicated.

In a hiatal hernia, the stomach muscles around the hiatus protrude upward into the diaphragm.

In hiatal hernia repair surgery, the hernia is repaired by first returning the muscles and upper stomach to their correct locations below the diaphragm. The diaphragm hiatus is then sutured to reduce its size and prevent the hernia from recurring. If gastroesophageal reflux is severe, a procedure called fundoplication may also be performed. In this procedure, the upper part of the stomach is wrapped around the lower part of the esophagus and sutured in place. This reduces acid reflux by putting pressure on the esophageal sphincter muscle that separates the esophagus from the stomach and helps keep the muscle closed.

Hiatal hernia repair can be an open procedure where a relatively large incision is made in the abdomen to access the stomach and diaphragm, or it can be performed using laparoscopic techniques. In this last procedure, three or four very small incisions are made in the abdomen. Surgical tools and a light source are inserted into the incisions, as is a mini camera that relays images of the inside of the body to a video monitor that surgeons see during the operation.

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Laparoscopic surgery is generally preferred over open surgery because of its faster recovery time. People who undergo laparoscopic hiatal hernia surgery can leave the hospital in one to three days and return to work in just two to three weeks. If a patient undergoes the open surgery technique, they will stay up to six days in the hospital and may not return to work for four to six weeks after surgery.

Both types of surgery carry a risk of complications. The two most common are gas bloating, which causes bloating after meals and can also cause pain when burping and difficulty or pain when swallowing. Most people find that these problems improve within a few months of surgery.

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