Hiatal Hernia Surgery: What to Expect on the Day of Surgery

In This Article

Hiatal hernia surgery treats a common form of hernia, in which the stomach pushes into the chest cavity through a hole or area of weakness in the diaphragm, near the esophagus. This surgery is usually performed while you’re under general anesthesia, and, all-told, the procedure takes between three and four hours.

If you’re considering hiatal hernia surgery, it’s essential to get a sense of what happens the day of this procedure and how it works.

Operation using laparoscopic equipment - stock photo
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Before the Surgery

Before surgery can begin, the doctors and medical staff need to ensure that your body is ready for the procedure. Though a couple different hiatal hernia surgery techniques may be employed, all require initial consultation and medical evaluation, which is performed in a pre-op or pre-anesthesia room.

What does this pre-operative assessment look like? Here’s a quick breakdown:

  • Testing: A standard practice prior to surgery is to perform a final evaluation of important health benchmarks, such as heart rate and blood pressure. Once in the pre-op area, medical staff will also provide you with a heated blanket; warming up the body can help prevent infection.
  • Medications: In the pre-operative room, you will also be fitted with an intravenous (IV) line, which will be used to deliver anesthesia, and be given medications to prevent blood clots. About 30 minutes prior to work, you’ll also be given a dose of antibiotics.
  • Anesthesia: Another important pre-operative procedure is consultation with the anesthesiologist, who will be in charge of putting you under or preventing pain during the procedure. They’ll assess how much they should give you, and explain how everything will work.

Once the doctors are certain that you’re ready to go, you’ll be taken to the operating room.

During the Surgery

Generally speaking, there are two major approaches to hiatal hernia surgery—open fundoplication and a minimally-invasive approach called laparoscopic Nissen fundoplication.

Nowadays, the open surgery is only indicated in certain, severe cases of hiatal hernia, and the vast majority of procedures are performed laparoscopically, meaning they employ a specialized camera and tools using multiple smaller incisions.

The goals of this treatment are three-fold—to move the stomach back into position, create a new valve between stomach the and esophagus by wrapping the former around the latter, and to repair and reinforce the weakened or broken diaphragm walls.

Though there may be some variation, laparoscopic Nissen fundoplication tends to follow a consistent order of operations. Here’s a brief overview of what the procedure looks like.

Anesthesia

In the operating room, the first step will be to ensure that you won’t feel pain during the procedure. In most cases, hiatal hernia surgery is performed while you’re asleep under general anesthesia.

Visualizing the Hernia

Once you’re asleep, doctors will need to insert the laparoscope into the body through a small incision near your navel; this is essentially an adjustable tube with a camera that can provide real-time video of the affected area. Doctors will use this to guide their work.

Carbon Gas

Typically, the doctors will need to fill the abdomen and stomach with carbon gas to inflate it, a procedure called insufflation. This allows doctors more room to operate.

Accessing the Affected Area

Once the surgeon is able to visualize the hernia, four other incisions are made around the abdomen to allow surgical tools to access the area. Depending on the case, a draining catheter may also be placed near the esophagus (behind the throat).

The first order of the business, once the hernia is reached, will be to divide the blood supply and gently move nerves and other structures out of the way to allow room to operate.

Wrapping the Stomach

As noted, one of the central aims of Nissen fundoplication technique is to wrap the upper portion of the stomach—the fundus—around the esophagus to reinforce the area, and help prevent stomach acids from flooding the area.

Surgeons use a special tube, called a bougie, to guide the process; this is placed into the stomach via the esophagus. Surgical stitches will be used to keep everything in place.

Repairing the Hernia

Once the esophagus is mobilized and stomach is in place, doctors will need to repair the hiatal hernia—the hole or weakness in the muscular walls of the diaphragm.

There are many different methods to do so, with some doctors employing a surgical mesh to add extra strength to the area, while others use stitches or sutures.

Closure

Once the work is done, the laparoscope, any catheters, and other tools are taken out, the incisions in the body are closed and allowed to heal.

After the Surgery

The period following hiatal hernia surgery is one of careful evaluation and monitoring; the surgeons need to know that everything has worked well and there are no complications. In most cases, patients will require at least one night of recovery in the hospital, though some cases may call for longer stays.

What happens before you go home? There are several important steps.

In the Recovery Room

After surgery’s complete, you’ll be taken to a post-op recovery room. When you wake up, you’ll still have on a mask for oxygen and be connected to several tubes, including a Foley catheter attached to your bladder and a nasogastric tube, running through the nose to the stomach. These may be in place throughout in-hospital recovery.

Recovery Monitoring

Medical staff monitors vital signs, especially pulse, breathing, and blood pressure, as these can be affected by the anesthesia. Once these are stable, and you’re alert—usually about three hours—you’ll be taken to your hospital room.

Recovery in the Hospital

As you’re recovering from surgery in the hospital, you’ll be given medications to manage pain. Some patients feel pain or discomfort due to the insufflation, but this can be managed and subsides within a few days.

During this time, patients are encouraged to get up and walk a little, which may take some assistance at first. This helps prevent blood clots from forming.

Breathing Exercises

An important aspect following surgery is ensuring your lungs are getting exercise. To help with this, you’ll be given a special device called an incentive spirometer, which encourages you to take deeper, fuller breaths.

Liquid Diet

It takes approximately three weeks after surgery before you’re able to tolerate solid foods following hiatal hernia. As you’ll be counseled, you’ll start off on an all-liquid diet and will have to slowly introduce soft foods as you recover, while avoiding carbonated beverages throughout this time.

Discharge

Before you’re cleared to go home, doctors will ensure that you’re condition is stable, you’re digesting foods, and are able to remain hydrated. You won’t be able to drive following surgery, so make arrangements for transportation home.

In some cases, patients will continue to wear the Foley catheter for up to three days at home, before coming back in to have it removed.

Make sure you have a clear understanding of what’s expected of you during your recovery period, and let your doctor know if you’re feel feverish or sick.

A Word From Verywell

While there’s no denying that the prospect of undergoing hiatal hernia surgery may be intimidating, it’s important to remember that this treatment has come a long, long way. Advances in both techniques and technologies has made this surgery safer, more effective, and better tolerated than ever before.

With the help of the right medical staff, as well as the support of your family and friends, this surgery may well be the key to good health and better quality of life. 

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Article Sources
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