Purpose of Hiatal Hernia Surgery

Hiatal hernia surgery, sometimes called hiatal hernia repair, is a procedure that takes on tougher cases of hiatal hernia, in which the stomach moves out of position and penetrates the chest cavity due to weakness or a tear in the diaphragm. The primary aim of treatment is to repair the tear or weak area and reinforce the affected muscular walls.

While hiatal hernia is often asymptomatic, surgery is indicated when it leads to difficult cases of gastrointestinal reflux disease (GERD), in which stomach acids are caught in the esophagus (the tube connecting the throat to the stomach).

Though it’s not usually the first approach taken, hiatal hernia surgery is highly successful in correcting symptoms and will be considered when medications or lifestyle changes have not yielded results.

If you’re considering this option, it’s important to have a clear understanding of what it takes on, what kind of patients it treats, as well as the tests and labs that need to be performed.

Diagnosis Related to Hiatal Hernia Surgery

Most hiatal hernia surgeries treat GERD and other symptoms caused by the hernia. Typically, before surgery is attempted, surgeons may prescribe medications neutralizing the acids flooding the esophagus, called proton pump inhibitors, or recommend over-the-counter antacids and lifestyle changes.

If these fail to provide relief, then surgery is a highly successful option.

What are the signs of GERD and hiatal hernia? Here’s a quick breakdown:

• Persistent heartburn
• Nausea
• Vomiting
• Pain/discomfort in stomach, chest, and/or esophagus
• Chest pains while eating
• Difficulty swallowing
• Anemia
• Fatigue
• Hoarseness
• Persistent belching
• Scarring, bleeding, and/or inflammation of the esophagus

Diagnosis of hiatal hernia relies on a scale of severity that goes from grade one, the mildest type, to grade four, the most severe. Grade one cases are less likely to be taken on with surgery, though some circumstances warrant it. Primarily, there are two types of hiatal hernia you may be diagnosed with:

• Sliding hiatal hernia tends to be milder (grade one) and refers to a case in which the stomach freely moves in and out of the chest cavity. The most commonly seen form of hiatal hernia, it may or may not be symptomatic.
• Paraesophageal hernia results from the stomach moving permanently out of position next to the esophagus. These are typically more dangerous because they can lead to disruptions in blood supply to the stomach, as well as ulcers.

Criteria

As seen with other treatments, hiatal hernia surgery may not be the best fit for every patient. So who are good candidates for hiatal hernia surgery? Before treatment is considered, patients must meet the following benchmarks:

• Persistent symptoms: As noted above, this surgery is not a first-line treatment, and healthcare providers treating less severe cases of GERD are encouraged to explore other options. Surgery will be considered when previous treatments fail or when symptoms return when medications are stopped.
• Disrupted blood supply: Hiatal hernia surgery is called for in cases where the misalignment of the stomach is cutting of its blood supply or impacting that of the esophagus. Untreated, this can become a very serious condition.
• Healthy enough heart and lungs: General anesthesia—putting the patient to sleep—is required for this surgery, which depresses heart rate and breathing. Those with a prior history of heart disease or lung problems may not be the best candidates.
• Weight status: Typically, obesity increases the risks associated with surgery and can impact successful recovery. Surgeons, therefore, have to consider this factor and may call for weight loss before the operation.
• Abdominal health: A previous history of abdominal surgery or injury may sometimes make hiatal hernia surgery riskier, so the surgeon will need to use their discretion.

Tests and Labs

Proper diagnosis and testing is an essential component of surgery, and you’ll need to undergo a good deal of evaluation before hiatal hernia surgery is called for. Not only do healthcare providers need to know as much as possible of the hernia, itself, they also need to ensure that your body is able to handle surgery.

What does this course of assessment look like? Along with physical evaluation, several tests may be performed:

• Barium swallow/upper GI X-ray: This test helps practitioners assess the size and scale of the hernia. Patients swallow a special liquid, which enhances X-ray imaging.
• 24 hour pH test: To assess acidity levels and damage in the esophagus, a catheter is run to this organ and connected to a computer for monitoring. To get the full picture, patients need to be monitored continuously for 24 hours.  
• Endoscopy: Healthcare providers may employ a specialized tube with a camera at the end, called an endoscope, that provides real-time video of the hernia.
• Esophageal manometry: The health of the esophagus can be further checked by assessing how well muscles are working while swallowing. This also involves a small, thin catheter, to measure activity in the esophagus.

A Word From Verywell

If your healthcare provider has recommended hiatal hernia surgery, know that this procedure is safe and very effective. While there may always be complications, the minimally-invasive techniques used today reduce the impact and risk of the treatment.

Not only that, according to the UK’s National Health Service, 85 to 90% of patients are completely satisfied with this surgery. For those with GERD or other gastrointestinal symptoms, this procedure could make a huge difference; it could be the key to better, healthier days.