Hiatus hernia can cause acid reflux, where stomach acid flows back into the oesophagus, causing symptoms such as heartburn, regurgitation (volume reflux), and chest pain. Hiatus hernia repair is often used in conjunction with another procedure called fundoplication to treat reflux symptoms. Hiatus hernia repair and fundoplication are normally performed as keyhole surgery, either laparoscopically or robotically.
The procedures aim to strengthen the lower oesophageal sphincter, a ring-like muscle that acts as a valve between the oesophagus and stomach, and to correct the anatomical abnormalities associated with a hiatus hernia.
If symptoms of heartburn and acid reflux are not subsiding with other treatments such as medication and lifestyle changes, you may be considered for surgery, particularly if you have persistent symptoms such as regurgitation or trouble swallowing. Others may respond well to antacid medication (proton pump inhibitors), but do not wish to take these over the long term.
During hiatus hernia repair, the surgeon retracts the protruding part of the stomach back down into the abdominal cavity through the opening in the diaphragm (hiatus) and then repairs the diaphragm to prevent the hernia from recurring. This step helps to reduce the risk of stomach acid flowing back into the oesophagus.
Fundoplication is performed with hiatus hernia repair to strengthen the lower oesophageal sphincter. It involves wrapping the upper part of the stomach (fundus) around the lower oesophagus and suturing it in place. This creates a valve-like effect that helps reinforce the lower oesophageal sphincter to prevent stomach acid from refluxing into the oesophagus.
In some cases, nonoperative management may better control symptoms. This may include lifestyle changes such as losing weight, reducing the consumption of alcohol, diet changes, smoking cessation, and medication.