Hiatal Hernia Surgery: How to Prepare

Hiatal hernia surgery is indicated in difficult cases of hiatal hernia, in which the stomach pushes into the chest cavity due to weakness in the diaphragm. Typically a minimally-invasive procedure, the surgery is performed under general anesthesia and usually takes between two to four hours. It requires a hospital stay.

Proper preparation is critical to a successful outcome. Not only must the medical team be ready, but the patient also needs a clear understanding of what they need to do—and of what will actually happen—in the run-up to hiatal hernia surgery. If you’re considering this treatment, learn how to prepare.

Location

Hiatal hernia surgery is primarily performed in the operating room of a hospital; even though less-invasive techniques are usually used, it’s a significant procedure that takes about two days of recovery while still admitted.

The operating theater will be set up to ensure that the surgery team can work efficiently and safety; this means everything from careful monitoring of vital signs while you’re under anesthesia, to the use of specialized tools and technologies to guide the work.

What can you expect in an operating room prepared for hiatal hernia surgery? There are always some variations based on the specific approach, but here’s a quick overview:

• Operating table: After anesthesia has been administered, you’ll be taken to the operating room and placed on a special adjustable table.
• Operating lights: Critical to all surgeries is proper and adequate lighting, so special lights will be positioned around the operating table.
• Laparoscope: Most hiatal hernia surgeries are laparoscopic procedures, meaning they employ a specialized and adjustable tube with a camera at the end of it. This is then inserted into the body via a small incision and provides real-time imagery of the hernia.
• Endoscope: Some hiatal hernia surgeries—as well as some pre-operative assessments—require the use of an endoscope. This device is similar to a laparoscope in that it’s an adjustable tube with a camera at the end, but it’s inserted down the throat rather than through an incision.
• Video screens: The video imagery from the endoscope and/r laparoscope is transmitted to a monitor, allowing the surgery team to view the problem area in real-time as they work.  
• Tables with tools: Surgical tools, such as a liver retractor, and a bougie—a plastic cylinder used to widen passages during surgery—will be at ready. 
• Catheter: You’ll be connected to a catheter to help you urinate.
• Monitoring: Since you’ll be under general anesthesia (in most cases), you’ll also be hooked up to machines that monitor breathing and heart rate, strength of pulse, and other vital signs.
• Ventilator: One of the effects of anesthesia is that it can severely slow down breathing. Ventilators are machines that, when you’re attached, help you breathe.
• Robotic assistance: Sometimes, hiatal hernia repair surgery is performed with robotic assistance. In these cases, the surgeon uses specialized controls to repair the hernia using robotic arms.

What to Wear

Prior to surgery, you’ll get a good deal of consultation from your healthcare providers about preparation. As they’ll tell you, it’s important to dress practically and for comfort on the day of your treatment, and to prepare for a couple of nights in the hospital. What should you keep in mind? Here’s a quick rundown:

• Wear loose-fitting clothing to make sure incisions aren’t constricted after surgery.
• Change into a hospital gown to prepare for surgery.
• No need for a change of clothes while you’re recovering; you’ll be given a hospital gown. It’s often a good idea to wear the same clothes to and from the hospital.
• Leave home jewelry, watches, or other valuables.
• Don’t wear perfume, scents, cologne, or deodorant.
• Bring slippers and a robe to keep you snug while you are recovering.

Food and Drink

Given that hiatal hernia surgery involves operating upon the diaphragm and manipulating the stomach, you may have to follow some dietary guidelines before treatment.

In all cases, your healthcare provider will ask you not to eat or drink anything for at least eight hours before the operation. This is because it’s dangerous to have anything in your stomach while you’re on anesthesia.

In addition, your healthcare provider may want to place you on a low-sugar, liquid-based, pre-op diet for two to 10 days before surgery. Specific recommendations will vary, but here’s what you’ll have to keep in mind:

• Juices: Moderate consumption of juices, such as orange, grapefruit, or apple, is encouraged during this time.
• Milk: A cup of milk or 8 ounces of yogurt should be taken a day.
• Protein shakes: The primary source of energy will be protein shakes; your healthcare provider will let you know specific types that are acceptable.
• Jello: For snacking, it’s acceptable to eat three or fewer servings of Jello, other gelatin products, popsicles, or sugar-free fudgesicles.   
• Broth: A good source of nutrition, chicken, beef, or seafood broths are a liquid diet staple.

Not every case requires this diet, so be sure to take careful note of any instructions you get from your healthcare provider.

Medications

In most cases, you won’t need to take any medications specifically to prepare for surgery, though your healthcare provider may advise you to take anti-acid drugs. What’s essential, however, is that you give your healthcare provider a full accounting of what you’re taking, including any prescriptions, over-the-counter pills, or herbal supplements.

You may be asked to steer clear of drugs or vitamins that can affect the body’s ability to clot. These include:

• Coumadin (warfarin) 
• Plavix (clopidogrel)
• Excedrin, Anacin (aspirin)
• Advil, Motrin (ibuprofen)
• Aleve, Naprosyn (naproxen)
• Vitamin E

Discussion of medications is a major part of the pre-operative consultation, and it’s not uncommon that adjustments to what you’re taking will need to be made. Pay close attention, and don’t be afraid to ask questions.

What to Bring

Preparing for hiatal hernia surgery also involves thinking about what you need to have along with you in the hospital. As noted above, you want to avoid bringing valuables, but what items should be on your list? There are several:

• List of medications you’re taking
• Photo-ID like a driver’s license or other ID
• Insurance and pharmacy card
• Advance healthcare directive
• Face-wash, chapstick, and other toiletries
• Toothbrush and tooth-paste
• CPAP machine
• Incentive spirometer

Pre-Op Lifestyle Changes

Essential to a good outcome will be ensuring that your body is ready for surgery. As such, you’ll have to make some adjustments to your lifestyle, including:

• Quit smoking: Smoking tobacco or using nicotine products increases the risk of complications, so you must stop for at least four weeks before surgery.
• Boost fitness: Your healthcare provider will recommend you walk 2-3 miles a day or seek other exercise to boost fitness.
• Incentive spirometer: You may be asked to use this device, which measures how deeply you inhale and helps expand your lungs, three times a day.

A Word From Verywell

There’s no doubt that preparing for hiatal hernia surgery, as with most others, is critical for a successful outcome. However, given how effective this procedure is in alleviating symptoms—approximately 90% of treatments are completely successful—this effort is worth it.

If you’re considering this surgery, it’s important to be engaged in the process and communicative. Let your healthcare providers know if anything seems awry or if you have any questions or concerns.

With the guidance of your surgeon and their medical staff—as well as the support of your loved ones—you’ll be ready to get on the path towards good health and better living.