Hiatal Hernia

The diaphragm is a muscle separating the chest from the abdomen, and the esophagus passes through an opening in it. When this opening widens, part of the stomach slides into the chest, the valve weakens and reflux worsens. Not every hernia needs an operation: a small, symptom-free hernia is simply monitored, while a large hernia or one with treatment-resistant symptoms is repaired surgically.

Common symptoms

• Heartburn and reflux that respond poorly to medication
• Fullness or pain in the upper abdomen or lower chest after eating
• Persistent bad breath despite good dental care
• Shortness of breath or palpitations after large meals with large hernias
• Unexplained anaemia from slow bleeding in the trapped stomach

When is surgery an option?

Repair is advised when symptoms persist despite treatment, when the hernia is large (para-esophageal) because of the risk of trapping or twisting, or when complications such as esophagitis or anaemia develop. The type of operation is decided after measuring esophageal function and motility — a weak esophagus needs a partial wrap, a strong one tolerates a full wrap.

Treatment options

• Upper endoscopy and a barium swallow to define the hernia's size and type
• Returning the stomach to the abdomen and tightening the diaphragm opening robotically or laparoscopically
• A fundoplication to prevent reflux in the same operation
• A short hospital stay and a return to activity within days in most cases

Frequently asked questions