If the hiatal hernia causes the stomach to become obstructed (blocked) or strangulated (blood supply cut off), surgery is needed to untwist the stomach and return it to its normal location. During surgery the stomach is brought back to its normal anatomical position below the diaphragm and the hiatus closed to a normal size.
Hiatal hernia surgery can usually be performed using minimally invasive surgery. This includes laparoscopic (using a telescope and small incisions) or robotic (using a telescope and instruments attached to a robot guided by the surgeon) techniques. Using these techniques, surgery is performed using four small (5 to 10 millimeter) incisions. The advantages of minimally invasive surgery include less pain, improved cosmesis, and a more rapid recovery and return to activities. Patients are typically discharged from the hospital the day after surgery.
The most common form of hiatal hernia repair is the Nissen Fundoplication where the hiatus is closed, the stomach returned to its appropriate position and a portion of the stomach used to form a valve and prevent the backwash of stomach contents into the esophagus. Your surgeon will choose the best hiatal hernia approach and repair for you.
With careful patient selection and meticulous surgical technique, outcomes for hiatal hernia surgery and GERD are excellent. The risk of surgery is relatively low and improvement in quality of life excellent. Recurrence (return) of a hiatal hernia despite repair can occur but is generally uncommon. Surgeons in the Baylor Scott & White Center for Thoracic Surgery are experienced in all forms of hiatal hernia repair and surgery for GERD.
Hiatal hernias can recur despite surgery. Surgery might be required for re-repair. It is important that you undergo thorough testing to determine whether a reoperation should be performed, how it should be performed and what can be done to prevent this from happening again. Re-do hiatal hernia repair should be performed by a surgeon with experience in this type of operation because it is technically more difficult given the scarring from the original surgery. Despite this, results can still be excellent and the risk of operation still low. Surgeons in the BSW Center of Thoracic Surgery have significant experience in re-operative hiatal hernia repair.