Most hiatus hernia surgery is performed laparoscopically (keyhole surgery) and involves returning the contents of the hiatus hernia to the abdominal cavity and then repairing the hernia itself.
The procedure is performed under a general anaesthetic. Five small incisions are made to act as the keyholes down which the surgeon places instruments to retract the liver and perform the surgery.
A hiatus hernia usually contains some or all of the stomach, and occasionally other organs such as the liver or colon. The stomach (or other organs) that have slipped through the hernia, are sitting above the diaphragm in the chest, and they are then pulled back down along with the sac, or lining of the hernia itself.
Once the organs are back where they belong the hiatus is repaired by stitching the muscles that surround it together with a series of surgical sutures. Sometimes a piece of mesh is used to reinforce this repair and allow an appropriate amount of scar tissue to form to strengthen the hiatus itself.
After the hernia is repaired a fundoplication, or gastric wrap, is performed (see Fundoplication – Anti-Reflux Surgery topic). This is because people with hiatus hernias tend to have reflux, which may persist following repair of the hernia, unless the fundoplication component to the operation is undertaken. It is a routine part of a hiatus hernia repair.
You will usually stay in hospital for 1-2 days after your surgery. Sometimes there is a little chest pain in the first couple of days, but most people don’t need much pain relief by the time that they go home.
An x-ray test may be performed on the first or second post-operative day to ensure the repair is working and that you can swallow fluids without an issue. You will go onto a fluid diet initially. Your diet will gradually increase from fluids, to puree, soft foods and eventually normal food, over a period of a few weeks.
After keyhole surgery your stitches are usually dissolving and there are some small dressings that are removed in the first week or so.
our surgeon will see you in the office several weeks after your surgery. At this time your diet will be progressed meaning you will be able to eat more normal food and your surgeon will ask you questions about your symptoms. Usually by this time you can swallow as normal and your reflux symptoms have resolved.