A hiatus hernia may require surgery. Surgery is generally reserved for emergency situations and for people who aren’t helped by medications to relieve heartburn and acid reflux. Hiatus hernia repair surgery is often combined with surgery for gastroesophageal reflux disease.

An operation for a hiatus hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac. In some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery).

This is an operative procedure using the keyhole (laparoscopic) method to fix reflux problems. During fundoplication, the top part of your stomach — called the fundus — is folded and sewn around the lower oesophageal sphincter, a muscular valve at the bottom of your oesophagus. If you have a hiatus hernia, it can be repaired at the same time. Your surgeon may also tighten the hiatus, the opening in your diaphragm through which the esophagus passes.

• • The fundoplication reinforces the lower oesophageal sphincter. The aim is to prevent acid from spilling out of the stomach into the gullet (oesophagus) by creating a valve effect at the junction of the oesophagus and stomach.
  • Most patients go home after 2-3 days after a laparoscopic anti-reflux procedure with 5 tiny incisions and skin clips which are usually removed by day 10.
  • Dysphagia (difficulty in eating) though very uncommon can be troublesome for the first few days.
  • Gas bloat syndrome (inability to vomit or belch) is common with this type of surgery.
  • Many patients note a marked increase in flatus for up to one year.
  • 10% or more weight loss is not uncommon following this type of surgery.

Indications for Laparoscopic Nissen Fundoplication

• Patients with symptoms that are not completely controlled by proton pump inhibitors
• Patients with well-controlled reflux disease who desire definitive, one-time treatment
• The presence of Barrett’s oesophagus
• The presence of extra-oesophageal manifestations
• Young patients
• Poor patient compliance with regard to medications
• Postmenopausal women with osteoporosis
• Patients with cardiac conduction defects
• Cost of medical therapy