How is surgery performed for a hiatua hernia or reflux/GORD?

Tests that patients may need beforehand include gastroscopy (endoscopy), barium swallow (xray with swallowed dye), CT scan, and/or catheters passed down into the stomach to measure acid and assess the swallowing muscles.

Surgery to address problematic reflux and/or hiatus hernias is termed laparoscopic fundoplication or laparoscopic hiatus hernia repair. The fundoplication is where part of the stomach is wrapped around the lower oesophagus to help/reinforce the anti-reflux ‘valve’ (the valve would have been weakened over time). The hiatus hernia repair is done when a hiatus hernia is present, and requires repair of the wide diaphragm gap, and to free the stomach in the chest to allow it to be brought back to its normal position and stitched there. If the stomach is also twisted (volvulus), it is untwisted and straightened when it is brought down. These are keyhole operations that usually requires a 1-2 night hospital stay. The exact components which may make up your operation depend on these factors, in addition to individual factors as discussed with your doctor. It is important you are assessed by a specialised surgeon trained in these techniques, to determine if or how and when an operation is required.

After surgery, you are usually in hospital for 1-2 nights and commence on oral liquids under observation. You will be able to mobilise on the day of surgery and will be encouraged to walk the following day to assist your recovery. After discharge follow the dietary instructions as outlined below. Reflux medication will usually be continued for a short time until review with your doctor. After a number of weeks the expectation would be that swallowing will become easier. You may feel food passes a little slower and you may fill up sooner, which should settle with time. A small degree of weight loss can occur during this time. A noticeable improvement of reflux should be noticed and depending on your situation reflux medication should be able to be stopped after review. The expectation is that a normal diet should be able to be taken, but occasionally certain foods like white bread or steak may be more difficult. Rarely an endoscopy may be needed later on to open up the valve slightly. Occasionally, “post-fundoplication” symptoms can occur which may include a feeling of abdominal bloat, increased passage of flatus, loose bowels or difficulty belching. All things considered, multiple research studies have shown high levels of satisfaction for patients undergoing the surgery.

As the healing occurs, the stomach further settles into position within the abdominal cavity through your body’s production of scar tissue. Given the tissues have been inherently weak which led to the hiatus hernia forming in the first place, there is a possibility the hiatus hernia can come back (research studies have shown this despite various techniques being tried to prevent this from occurring). Most times, however, this will not lead to problem symptoms. Rarely, would a re-operation be required.