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Hiatal Hernia Surgery

Dec 28, 2015

Hiatal hernias happen with part of your stomach pushes up through your diaphragm and into the thorax cavity. It is a very painful condition and can be the cause of severe heartburn.It is often caused by being overweight, but can also happen due toinjury to the stomach, pressure on the abdominal area from repeated episodes of vomiting or coughing, and a birth defect in the hiatus.

Symptoms include upper abdominal pain, chest pain, and heartburn. Some people mistake the pain for a heart attack and end up in the emergency room. If you have severe pain in your chest, always see a doctor right away to rule out a heart condition.

Hiatal hernia surgery is sometimes necessary to relieve the painful symptoms that can occur with a hiatal hernia. Let’s take a deeper look at who may need surgery, the recovery, and hear from others who have dealt with this.

Who Is a Candidate for Hiatal Hernia Surgery?

The usual treatment is medications and lifestyle changes in milder cases. Doctors usually prescribe acid reducing medications and suggest losing excess weight, dietary changes and elevating your head and upper body when you sleep. If these methods are ineffective you may be a candidate for hiatal hernia surgery.The good news is not every person with this condition will require surgery to treat hiatal hernia. There are two types that most likely need surgical repair:

Paraesophageal Hiatal Hernia – This type occurs when a part of the stomach pushes through the diaphragm in a separate area and can be serious with complications. The people who need surgery to correct this type are young people that have severe GERD, patients with breathing problems, and people who cannot tolerate acid reducing medications. The complications of not having surgical correction include stomach strangulation, puncture of the digestive tract, and twisting of the bowel. These can be fatal.

Type IV Hiatal Hernia – This is a rare, but very severe form of hiatal hernia. In this type, the stomach, intestines, spleen, and part of the colon can slide up into the herniation. This is extremely serious and requires surgery.

The Surgical Procedure

Hiatal hernia surgery can usually be done via laparoscope which is minimally invasive with easy recovery. The surgeon will just push the stomach and anything else that slipped through back into its proper place. They close up the opening with stitches. They can also stitch the stomach in place near the weakened area to prevent it from slipping back through. The surgeon may also do a technique called “fundoplication” to help reduce GERD symptoms. They literally wrap the top of the stomach around itself to create a tighter passage.

A laparoscope is inserted through tiny incisions to avoid making a large incision into the abdomen. The surgeon can perform necessary tasks through the scope and the patient has less healing time, less pain, and very tiny scars. 

The Results and Recovery Period

The surgery requires around a one-night hospital stay for laparoscopy and a few nights for an open surgery. The day after surgery, a nurse will get you up walking to help get things moving again inside. The usual activity restrictions are about a week and you can expect to be fully healed within two or three weeks if you had a laparoscopy. If you had open surgery, expect about a six-week recovery time frame. The prognosis is very good for patients who have surgical repair of a hiatal hernia. The surgery is most often very safe and very effective and most patients have a large reduction of symptoms.

Tips for Better Recovery

Having abdominal surgery may need a little extra TLC to help you recover. You will be surprised how much you use your stomach muscles on a daily basis so expect it to be a bit sore for a while. These tips will help you recover faster and protect your stomach:

  • Relieve pain from surgery and from gas. The pain usually isn’t excruciating with hiatal hernia surgery, but it can get uncomfortable. Use a pain reliever that your doctor recommends for the first few days. Also, if you had a laparoscopy you will have some carbon dioxide gas left in your abdomen. This can cause a pain that radiates up to your shoulders. Ask your doctor about gas relief and get up and walk.
  • Follow your prescribed diet. The usual diet for post-op is clear liquids the first day or two and then advance to a soft diet. The biggest complaint with this surgery is the inability to completely pass food through the esophagus. This is due to the tightening procedure and will eventually pass after 6 to 8 weeks. Until then, surgeons usually recommend a very soft diet.
  • Take care of your incisions. If you had a laparoscopy, you will just have some small “butterfly” bandages that will fall off on their own. Go ahead and shower with them and keep them clean. If you had open surgery, ask your post-op/recovery nurse how to care for your incision and stitches. Make sure you ask about having the stitches removed or if they dissolve.
  • Take care of constipation. The abdomen can slow down after abdominal surgery. Make sure you increase your dietary fiber, take walks a few times a day, and ask your doctor about a stool softener. Make sure you are drinking plenty of fluids to help keep things on the move.

Hiatal Hernia Surgery: Experiences of Others

“I was diagnosed in my 20’s with a hiatal hernia and they said I was born with it. I always remember being sick as a kid and couldn’t ever keep my food down. I constantly complained of stomach aches and threw up almost every meal. When they found the hernia they said I absolutely had to have surgery to fix it. The surgery took away all of my symptoms and I was finally able to keep a whole meal down. I felt like a new person.” --Kat

“I noticed around 14 years of age that I had a lot of heartburn and it was hard to swallow food all the way down. I started suffering from chest pain and my mom took me to the hospital. They found the hernia and did the lap band surgery. It took about two-weeks to recover and I don’t have any more issues at all.” --Sarah

“I had a Nissen fundoplication a few years back and my hernia actually came back. My hernia was the “rolling type” and I couldn’t breathe well. I had a car accident and it undid some of the surgical repair, so recently I had to go in for another surgery. So far, I am feeling much better.” --Mark