Hiatal Hernia Surgery: Long-Term Care

Recovery from hiatal hernia surgery takes some time and requires many lifestyle changes; however, most can return more or less to normal within six weeks, with complete return to activity expected at three months. Critical to the success of hiatal hernia surgery is careful attention to long-term care.

What is the outlook after this treatment? What can you do to ensure that gastroesophageal reflux disease (GERD) symptoms stay away? Here’s what you can expect when it comes to life after this operation.

Benefits of Surgery

The symptoms of GERD can arise due to hiatal hernia, in which, due to a weakness or tear in the diaphragm, the stomach slides out of position and accesses the chest cavity.

The primary benefit of hiatal hernia surgery is to relieve GERD symptoms and/or those associated with chronic reflux, in which stomach acids flood the esophagus in the throat. These include:

• Chronic heartburn
• Vomiting
• Impaired ability to swallow food
• Pain or discomfort in the chest and abdomen when eating
• Bloating
• Persistent hiccups, belching, or coughing
• Anemia (low levels of red blood cells)

These are typically resolved with surgery; about 90% of patients are satisfied with treatment, and 70% see complete relief of symptoms. However, some measures need to be taken to maintain that outcome:

• Adherence to diet: You’ll get a great deal of counseling following surgery regarding what you can safely eat. Typically, you’ll have to transition slowly from an all-liquid back to the one you’re more accustomed to. Critical to success is your ability to keep up with the plan, and as you resume eating a regular diet, be mindful of how you’re feeling.
• Over-the-counter (OTC) antacids: If milder symptoms persist following surgery, your healthcare providermay recommend you take antacids, such as calcium carbonate (Tums, Alka-Seltzer) or magnesium hydroxide (Maalox, Mylanta). If symptoms continue despite antacid use for two weeks, alternatives will be considered.
• Prescribed medications: In some cases, surgery alone doesn’t relieve all symptoms, so you may still need to take prescribed heartburn or anti-reflux medication, such as Protonix (pantoprazole), Aciphex (rabeprazole), or others.

Stay communicative with the medical team about symptoms; especially if surgery along with medications has not resolved them. Essential to long-term outcomes for this surgery is patient communication; be sure to let your healthcare provider know if anything seems awry, or if symptoms are coming back or worsening.

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Possible Future Surgeries

Though it’s relatively low, there’s a chance that additional surgery may be needed if hiatal hernia surgery doesn’t yield results, or in response to conditions that can follow it. What sorts of procedures might be employed? Here’s a quick overview: 

Revision

In cases where an initial surgery hasn’t yielded results—and the hernia persists despite the treatment—healthcare providers may indicate surgery to correct the issue. Since this is done on parts of the body that have already been operated upon, surgeons need to work particularly carefully and carefully gauge whether patients are good candidates.

Surgery for Esophageal Stricture

Some patients experience esophageal stricture after hiatal hernia surgery, in which the esophagus narrows as a result of exposure to stomach acids. If non-surgical techniques don’t work to resolve problematic cases, then the healthcare provider may employ a minimally-invasive, laparoscopic surgery to essentially open up these areas.

Barrett’s Esophagus Treatment

Though there is some controversy about it, some healthcare providers recommend surgery for Barrett’s esophagus, which can accompany GERD or occur following surgery. This condition is characterized by inflammation and damage to the esophagus and can be pre-cancerous. Especially in the latter case, laparoscopic surgery may be employed to remove affected areas.

Lifestyle Adjustments

Anyone undergoing hiatal hernia surgery will have to undergo significant lifestyle changes. As mentioned, a specific post-operative diet will be crucial in the first six weeks; however, the work shouldn’t end there.

In fact, many pre-operative strategies you’ll have tried—such as dietary changes—will still be needed. As such, there are a number of broader changes you can make to improve prognosis and prevent relapse of GERD or other symptoms:

Exercise

It’s hard to overstate the health benefits of fitness work, and ensuring a good, regular routine will no doubt help ensure that symptoms don’t return. Of course, you have to be careful and avoid heaving lifting or abdominal strain for the first three months; however, getting light exercise will prevent complications in the earlier going.

Down the line, too, a dedicated fitness plan can also help lose weight, preventing the risk of obesity-related recurrence.

Skip Acidic Foods

Largely, it’s a good idea to cut out foods and drinks that can worsen stomach acid problems. Though it can vary from person to person, typically this means steering clear of spicier foods, fried foods, coffee, carbonated beverages, and chocolate, among others.

Diet and Weight Loss

Given the impact that obesity can have on outcomes for this surgery, you may also want to work with a dietician to devise a healthy meal plan. This would feature fresh vegetables and healthy proteins, while de-emphasizing salts and sugars. Don’t be afraid to ask your healthcare provider for input on a diet that can encourage weight loss. 

Quit Smoking

Among the numerous reasons smoking tobacco can be harmful is the fact that it can lead to complications and issues after surgery. In addition, this habit can have a negative impact on digestion and stomach acidity. There are treatments and approaches that help with cessation; talk to your healthcare provider about them.

Smaller Meals

Throughout recovery from surgery, you’ll be asked to avoid large meals, and to break eating into more numerous smaller ones. It’s a good idea to keep this up even after you’ve recovered from surgery, as this can ease distress on the stomach and prevent relapse of symptoms.

Clothing

GERD or acid reflux can be more prominent if the chest and abdomen are wrapped in tight-fitting clothes. Wearing looser fits are necessary as your incisions, and may help prevent heartburn, nausea, and other symptoms from coming back.      

Stay Upright After Eating

Another means of preventing heartburn and reflux is to avoid laying down after meals for at least two hours. This can help prevent stomach acids and digestive juices from flowing up into the esophagus.

A Word From Verywell

For most, hiatal hernia surgery will be part of a longer continuum of care for GERD, but the good news is that this treatment is not only safe but usually decisive in managing the condition. Typically, most symptoms resolve within a week of treatment; however, there’s no doubt that much needs to be done to ensure that they don’t come back.

The work doesn’t end with initial recovery; over the long term, you’ll want to make lifestyle adjustments to ensure that surgery is indeed a success. That said, with the right support networks and the guidance of dedicated staff, you’re sure to emerge from treatment healthier and with improved quality-of-life for years to come.