How does a hiatus hernia develop?
The food pipe (oesophagus) passes into the abdomen through a natural opening in the diaphragm called the hiatus. If this opening widens, or the tissues around it weaken, part of the stomach can slide up into the chest.
Risk factors include ageing and extra pressure inside the abdomen. This pressure can come from obesity, pregnancy, a long-standing cough or heavy lifting. Sometimes an earlier injury or operation plays a part. In some people, the valve muscle at the lower end of the food pipe also weakens, so stomach acid flows back up.
Types of hiatus hernia
There are two main types:
- Sliding hiatus hernia: the most common type. The point where the food pipe joins the stomach slides up into the chest and back down. It is closely linked to acid reflux.
- Para-oesophageal hiatus hernia: part of the stomach pushes up beside the food pipe, while the joining point stays in place. It is less common but carries a higher risk of the stomach getting trapped.
Some people have a mix of both types. The type of hernia helps your doctor choose the right hiatal hernia treatment.
Hiatus hernia symptoms
Most people with a small hiatus hernia have no symptoms. When symptoms appear, they can include:
- Heartburn
- Acid reflux, or sour fluid coming up into the throat
- A burning feeling or discomfort in the chest
- Difficulty swallowing
- Burping, or feeling full soon after eating
- Food coming back up into the mouth
Read more about the signs of a hiatus hernia you should not ignore.
Chest pain can also be a sign of a heart problem. If you have severe chest pain, breathlessness, vomiting or cannot swallow, get emergency care at once.
Hiatus hernia treatment without surgery
Not every hiatus hernia needs surgery. Many people control their symptoms with medicines and a few simple changes:
- Eat smaller meals, and do not lie down for 2 to 3 hours after eating
- Raise the head end of your bed
- Lose extra weight and stop smoking
- Cut down on foods that trigger heartburn, such as spicy, fried or fatty food
- Take acid-reducing medicines as your doctor prescribes
If symptoms continue despite these steps, or if complications develop, surgery may be the better option.
When is hiatus hernia surgery needed?
Surgery is considered when symptoms continue despite medicines and lifestyle changes, or when there are complications. It is often advised for large or para-oesophageal hernias. The operation puts the stomach back in place, tightens the opening in the diaphragm and strengthens the barrier against reflux.
Common surgical approaches include:
- Laparoscopic hiatus hernia repair with fundoplication: the most common keyhole operation. The surgeon works through small cuts in the abdomen, moves the stomach back into place and tightens the opening. Then the top of the stomach is wrapped around the lower food pipe (fundoplication). This helps control reflux, and recovery is faster than after open surgery.
- Open hiatus hernia repair: less common today, but it may be needed for some complex or emergency cases.
Your surgeon decides whether the wrap is partial or complete, and whether mesh is used, based on the size of the hernia. For other types of hernia, see our hernia treatment in Chennai.
Hiatus hernia care at Unittas Hospital
Our laparoscopic surgeons and gastroenterology team work together. They confirm the diagnosis, try the right medicines first and offer keyhole repair when it is needed. We explain each option clearly, so you can choose with confidence. Speak to our team today to find the right approach for you.
Our laparoscopic surgeons
Dr. A.M. Kaliraj
MBBS, MS, FIAGES, CCDM
General and Laparoscopic Surgeon
Dr. Giridharan
MS, DNB, FMAS, FIAGES
General and Laparoscopic Surgeon
Frequently asked questions
Is hiatus hernia surgery always needed?
No. Many people manage well with medicines and lifestyle changes. Surgery is considered when symptoms continue or the risk of complications is higher.
How long does laparoscopic hiatus hernia surgery take?
Usually about 1.5 to 3 hours, depending on the size of the hernia and how complex the repair is.
How long is the hospital stay after surgery?
Most patients stay 1 to 3 days after keyhole repair, if recovery goes smoothly.
When can I return to normal activities?
Light activities usually resume within 1 to 2 weeks. Avoid heavy lifting and hard exercise for 4 to 6 weeks.
Will I still need medicines after surgery?
Many people need fewer or no acid-reducing medicines after a successful repair. Your doctor will advise you based on your recovery.
Can a hiatus hernia come back after surgery?
It can, and the chance is higher after repair of a large hernia. Following your post-surgery advice lowers the risk.
Is fundoplication the same as hiatus hernia repair?
Fundoplication is often done along with the repair. The upper stomach is wrapped around the lower food pipe to reduce reflux.
What diet is advised after hiatus hernia surgery?
You will have liquids and soft food for a short time, then slowly return to normal food, as your care team advises.
Are there risks with hiatus hernia surgery?
Like any surgery, it has risks. These include infection, short-term difficulty swallowing, gas bloating or the hernia coming back over time. Your surgeon will discuss these with you before the operation.
How is a hiatus hernia confirmed before surgery?
Usually with an endoscopy, and sometimes a barium swallow test or other scans, along with a review of your symptoms.