Hiatal Hernia Surgery

Surgery can repair a hiatal hernia by pulling your stomach back into the abdomen and making the opening in the diaphragm smaller. The procedure may also involve surgically reconstructing the esophageal sphincter or removing hernial sacs.

However, not everyone who has a hiatal hernia needs surgery. Surgery is typically reserved for people with severe cases that haven’t responded well to other treatments.

If you have dangerous symptoms as a result of the hernia, then surgery may be your only option. These symptoms may include:

• bleeding
• scarring
• ulcers
• narrowing of the esophagus

This surgery has an estimated 90 percent success rate. Still, about 30 percent of people will have reflux symptoms return.

Your doctor will give you all the information you need about how to prepare for your surgery. Preparation generally includes:

• walking 2 to 3 miles per day
• doing several breathing exercises multiple times per day
• not smoking for 4 weeks before the surgery
• not taking clopidogrel (Plavix) for at least one week before surgery
• not taking nonsteroidal anti-inflammatories (NSAIDs) one week before surgery

Typically, a clear liquid diet is not needed for this surgery. However, you can’t eat or drink for at least 12 hours before the surgery.

Hiatal surgeries can be done with open repairs, laparoscopic repairs, and endoluminal fundoplication. They are all done under general anesthesia and take 2 to 3 hours to complete.

Open repair

This surgery is more invasive than the laparoscopic repair. During this procedure, your surgeon will make one large surgical incision in the abdomen. Then, they’ll pull the stomach back into place and manually wrap it around the lower portion of the esophagus to create a tighter sphincter. Your doctor may need to insert a tube into your stomach to keep it in place. If so, the tube will need to be removed in 2 to 4 weeks.

Laparoscopic repair

In a laparoscopic repair, recovery is quicker and there’s less risk of infection because the procedure is less invasive. Your surgeon will make 3 to 5 tiny incisions in the abdomen. They’ll insert the surgical instruments through these incisions. Guided by the laparoscope, which transmits images of the internal organs to a monitor, your doctor will pull the stomach back into the abdominal cavity where it belongs. Then they will wrap the upper part of the stomach around the lower portion of the esophagus, which creates a tighter sphincter to keep reflux from occurring.

Endoluminal fundoplication

Endoluminal fundoplication is a newer procedure, and it’s the least invasive option. No incisions will be made. Instead, your surgeon will insert an endoscope, which has a lighted camera, through your mouth and down into the esophagus. Then they’ll place small clips at the point where the stomach meets the esophagus. These clips can help prevent stomach acid and food from backing up into the esophagus.

During your recovery, you’re given medication that you should only take with food. Many people experience tingling or burning pain near the site of the incision, but this feeling is temporary. It can be treated with NSAIDs, including over-the-counter options like ibuprofen (Motrin).

After surgery, you need to wash the incision area gently with soap and water daily. Avoid baths, pools, or hot tubs, and stick to the shower only. You’ll also have a restricted diet meant to prevent the stomach from extending. It involves eating 4 to 6 small meals per day instead of 3 large ones. You typically start on a liquid diet, and then gradually move to soft foods like mashed potatoes and scrambled eggs.

You’ll need to avoid:

• drinking through a straw
• foods that can cause gas, such as corn, beans, cabbage, and cauliflower
• carbonated drinks
• alcohol
• citrus
• tomato products

You doctor will likely give you breathing and coughing exercises to help strengthen the diaphragm. You should perform these daily, or according to your doctor’s instruction.

As soon as you’re able, you should walk regularly to prevent blood clots from forming in your legs.

Timing

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. As long as your job isn’t physically strenuous, you can resume work in about 6 to 8 weeks. For more physically demanding jobs that require a lot of hard labor, it may be closer to three months before you can return.

Once the recovery period is over, your heartburn and nausea symptoms should subside. Your doctor may still recommend that you avoid foods and beverages that could trigger GERD symptoms, such as acidic foods, carbonated beverages, or alcohol.