How Safe Is Surgery For Hiatus Hernia Repair?

Nov 27, 2020

In today’s blog post, I’m going to be talking about this very commonly asked question that; ‘Is it safe to have surgery to get your hiatus hernia repaired?’

Now, in my previous article, I had described what is a hiatus hernia, what symptoms people can get, but predominantly, it is centred around symptoms of heartburn, reflux, regurgitation, difficulty in swallowing and one of the most dreaded complications of not addressing the hiatus hernia, could be, that it could lead to the development of this condition called as ballads esophagus which can progress to esophageal cancer. So, appropriate investigations clearly need to be done. Predominantly, they are by way of an endoscopy, which is a gastroscopy and a CT scan as the two initial investigations to find out whether the individual has got a hiatus hernia or not.

Now, when it comes to treatment, surgical treatment, the thing is the hiatus hernia itself is a mechanical problem. The valve has kind of opened up. The gap in the muscle of the diaphragm has become so wide that it cannot be fixed by medications or just diet and lifestyle measures. This is where the role of surgery comes that it fixes a mechanical problem.

hiatal hernia

What we do is it generally involves two steps. Number one, is we do it using firstly keyhole surgery which is tiny cuts on the tummy after appropriate investigations to make sure the individual is fit enough for surgery. Following that, what we do is that we define the gap during surgery which is the gap in the muscle and we repair it using stitches or we sometimes use a mesh which is called biomesh. It’s a synthetic mesh and it’s fairly safe to use in that area.

The next part of the operation is called fundoplication and the simplest way to look at fundoplication is that it is a wrap or a fold of the stomach which is put around the lower part of the esophagus in order to recreate and improve the functioning of the valve. It has often been referred to as nissen fundoplication or also referred to as partial fundoplication. In my own personal practice, I have significantly moved away from nissen fundoplication because of some of the complications associated with nissen’s by way of you know, bloating and difficulty in swallowing that can happen in the individuals a few months to few years after surgery.

surgery fundus location wrap

The important thing to understand is, friends, that sometimes the whole issue around hiatus hernia and symptoms is created by carrying a lot of fat around the middle part of the abdomen. So, if an individual’s BMI is above 35 I will discuss with them the option of the gastric bypass which is a weight loss surgery operation but it’s a very effective tool for managing reflux symptoms and also repair of the hiatus hernia is undertaken at the same time.

What we do is it generally involves two steps. Number one, is we do it using firstly keyhole surgery which is tiny cuts on the tummy after appropriate investigations to make sure the individual is fit enough for surgery. Following that, what we do is that we define the gap during surgery which is the gap in the muscle and we repair it using stitches or we sometimes use a mesh which is called biomesh. It’s a synthetic mesh and it’s fairly safe to use in that area.

Sometimes, we have also considered a gastric sleeve if the individual has got a small hiatus hernia because the gastric sleeve will allow the individual to lose some weight. However, the downside of that option is that sometimes gastric sleeve can make your reflux worse. The key things to understand as far as the safety profile of surgery is concerned is that there are always some risks associated with surgery such as those of bleeding, infection, DVT, which is deep vein thrombosis and pulmonary embolism which are associated with any general anesthetic. But, specific to surgery for repair of hiatus hernia, there’s a small risk of injury to the esophagus, injury to the stomach, injury to the liver (these are the structures in that area) and also injury to a nerve which is called as the vagus nerve. These are very unlikely things to happen but individuals still need to know about it.

As far as the recovery goes from surgery generally we say it is about two to three nights stay in the hospital and following that, individuals can go home on some anti-nausea and pain killer medications. I always recommend to my patients to have at least two weeks of a sloppy diet which is like a pureed diet: anything that goes through the blender, or things like soups which are, you know, easy to pass through. But the most important thing is even after a few weeks down the track I tell people to be very mindful that things like steaks, meats and other things might still get stuck. It might give them some symptoms so it’s important to be mindful of that. If you are having or if you’re introducing meats, introduce things like first, some chicken, some fish and chew it properly so that it doesn’t form a rubbery mass that sticks at the point where your new valve is because, if you start vomiting again or if you kind of you know regurgitating again, you can undo the repair that has been done as part of the surgical procedure.

So I hope that information is helpful for you. If you found it useful, please subscribe to my newsletter as I continue to publish articles related to our services because I firmly believe that true information leads to lasting transformation. So, do share it with any of your friends that you might find this useful. Take care and stay safe.