What Is a Hiatal Hernia?

A hiatal hernia occurs when part of the stomach pushes up through the diaphragm into the chest cavity. The diaphragm is the muscle that separates the chest from the abdomen and helps keep stomach contents in place. A hiatal hernia can contribute to acid reflux, heartburn, and other symptoms of gastroesophageal reflux disease (GERD), and in some cases may require surgical repair when conservative treatments are not effective.

Why Surgery Is Performed

Hiatal hernia repair is recommended when:

  • Symptoms of acid reflux (heartburn, regurgitation) are severe or persistent despite medication
  • There is damage to the esophagus (such as esophagitis)
  • Complications develop, such as strictures or Barrett’s esophagus
  • The hernia is large and causing pain, difficulty swallowing, or breathing issues

Surgical repair aims to reposition the stomach, tighten the opening in the diaphragm, and restore normal anatomy to reduce symptoms and prevent complications.

How Hiatal Hernia Repair Works

Hiatal hernia repair is typically performed laparoscopically using small incisions and specialized instruments. The surgeon pulls the stomach back into the abdomen and reinforces the hiatus (the opening in the diaphragm). In many cases, the procedure also includes a fundoplication, where the top of the stomach (fundus) is wrapped around the lower esophagus to strengthen the lower esophageal valve and reduce acid reflux.

Laparoscopic vs. Open Repair

Laparoscopic repair is the most common approach and uses several small incisions and a camera (laparoscope) to guide the surgery. Benefits include less pain, smaller scars, shorter hospital stays, and faster recovery compared with open surgery. In rare cases, when anatomy or previous surgery makes minimally invasive access difficult, an open repair with a larger incision may be necessary.

What to Expect During Surgery

Hiatal hernia repair is done under general anesthesia in a hospital or surgical center. The surgeon will carefully reduce the hernia, tighten the diaphragmatic opening, and perform a fundoplication if indicated. The exact technique and extent of repair are tailored to your anatomy, symptoms, and the presence of reflux or esophageal damage.

Recovery and Aftercare

After surgery, patients are monitored as anesthesia wears off and are typically allowed to start with clear liquids before advancing to a soft diet as tolerated. Key elements of recovery include:

  • Pain management and incision care
  • Gradual diet progression over several weeks
  • Avoiding heavy lifting and strenuous activity during early healing
  • Walking and light activity to promote circulation and healing

Most patients stay in the hospital one to two nights and can return to light daily activities within a week or two, with full recovery over several weeks.

Benefits of Hiatal Hernia Repair

  • Reduction or elimination of acid reflux symptoms
  • Improved quality of life and comfort
  • Prevention of esophageal complications from chronic reflux
  • Long‑term relief for hernia‑related symptoms

Risks and Considerations

As with any surgical procedure, hiatal hernia repair carries potential risks including bleeding, infection, reaction to anesthesia, difficulty swallowing (dysphagia), gas‑bloat syndrome, or recurrence of the hernia. Your surgeon will discuss your individual risk profile and how surgical planning and technique aim to minimize complications.

Divisions Involved in Your Care

Diagnoses We Treat

Frequently Asked Questions

Symptoms can include heartburn, acid reflux, chest pain, difficulty swallowing, regurgitation of food or liquid, and sometimes shortness of breath, especially after meals.

Diagnosis typically involves imaging such as upper GI series (barium swallow), endoscopy, or esophageal manometry to confirm the hernia and assess reflux or esophageal function.

No. Many small hiatal hernias are managed with lifestyle changes and medications for acid reflux. Surgery is usually considered when symptoms are severe, persistent, or when complications develop.

Fundoplication is a surgical technique often performed with hiatal hernia repair where the upper part of the stomach is wrapped around the lower esophagus to strengthen the valve and help prevent acid reflux.

Most patients gradually progress from liquids to soft foods and then to a regular diet as advised by their surgeon. Some may need to avoid certain foods that trigger discomfort during the healing period.

Most patients return to light activities within 1–2 weeks after laparoscopic repair. Full recovery and diet progression may take several weeks, individualized based on surgical findings and overall health.

Recurrence is possible but uncommon. Proper surgical repair technique and adherence to postoperative care instructions help reduce the risk.