Hiatal hernias sometimes require surgery, but most often, you can manage them without it.
A hiatal hernia occurs when part of your stomach pushes through an enlarged opening in your diaphragm into your chest. The diaphragm is a parachute-shaped muscle in your chest that helps you breathe.
Hiatal hernias are common, especially among older adults (ages 65 years and older). In a 2020 study, researchers observed the CT scans of 3,200 people with hiatal hernia from ages 53–94 years. Among those people, about 2.4% were in their 50s, and 16.6% were in their 80s.
If you are diagnosed with a hiatal hernia that isn’t causing symptoms, your doctor may recommend watchful waiting, which means monitoring the condition over time.
Doctors usually reserve surgery for large hernias causing problems or smaller hernias causing gastroesophageal reflux disease (GERD) that isn’t responding to conservative options.
Let’s take a deeper look at how surgery helps manage hiatal hernias.
When determining whether a hiatal hernia requires surgery, doctors often consider the symptoms and the type of hernia. Large hernias are generally more likely to cause symptoms.
There are four types of hiatal hernias:
- Type 1 hernias are called sliding hernias, which usually do not require surgery.
- Type 2, type 3, and type 4 hernias are called paraesophageal hernias. They are more likely to need surgical treatment.
Your doctor may recommend surgery if your hernia is large, but the definition of a large hernia is subjective.
Your doctor may recommend surgery if you have persistent GERD that doesn’t resolve with lifestyle changes or proton pump inhibitors (PPIs). Symptoms of GERD include:
- long-term (chronic) heartburn
- regurgitating food or liquids from your stomach
- chest pain that can radiate to your neck or jaw and
mimic a heart attack
You may need immediate surgery if you develop signs of obstruction like:
A 2020 study reports that 96.4% of over 17,000 hiatal hernia repairs in a registry were laparoscopic surgeries. A laparoscopic surgery involves a small incision using a tube with a light, camera, and special tools.
The standard technique for hernia repair is called hiatoplasty. This surgery involves repairing the hernia and repositioning your stomach or other organs. It’s often performed with an absorbable or nonabsorbable mesh to provide support.
Surgeons often combine surgical repair with fundoplication to relieve GERD. Fundoplication involves wrapping the upper part of your stomach around your esophagus to support your lower esophageal sphincter. Doctors use several techniques, such as:
- Nissan fundoplication: The top of your stomach is wrapped 360 degrees around the base of your esophagus.
- Partial fundoplication: The Dor and Toupet partial fundoplication procedures involve wrapping the top of your stomach
180–250 degreesaround your esophagus.
The latest Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines for hiatal hernia candidacy came out in 2013. Candidacy for hiatal hernia surgery
Candidates for hiatal hernia surgery should have the following:
- symptomatic paraesophageal hernias
- obstructive symptoms and gastric volvulus, which is the unusual rotation of the stomach
- sliding hernias and GERD symptoms, which PPIs were not able to resolve
Your doctor may also advise against surgery if you have a paraesophageal hernia that is not causing symptoms and if you’re above
It usually takes 3–6 weeks to return to work and 6 weeks before you can eat normally again. Gastrointestinal side effects like bloating might take several months to go away.
Studies report recurrence rates between
Here are some frequently asked questions people have about hiatal hernia surgery.
What size hiatal hernia is considered large?
There’s no standard definition of a large hiatal hernia. In a 2022
Is hiatal hernia surgery dangerous?
All surgical procedures pose some risk. Hiatal hernia surgery generally has a low risk of serious side effects. An estimated 30-day mortality rate associated with hiatal hernia surgery is
Is hiatal hernia surgery worth it?
Hiatal hernia surgery can help relieve long-term (chronic) GERD symptoms. It can be lifesaving for severe hernias.
What percentage of hiatal hernias need surgery?
About 55–60% of adults above the age of 50 years have a hiatal hernia, but only 9% have symptoms. And only a small percentage of those showing symptoms require surgery.
What kind of doctor performs hiatal hernia surgery?
A general surgeon or a thoracic surgeon may perform hiatal hernia surgery.
Conservative treatments like lifestyle changes and PPIs can often help treat hiatal hernias. Your doctor may recommend surgery only if your hernia is large or causing symptoms that don’t respond to these treatments.
Surgery usually involves repairing the hernia and strengthening the band of muscle at the base of your esophagus to prevent the backup of stomach fluid.