Hiatal Hernia Surgery: When Is Surgery Needed and Is Laparoscopic Repair Better?

Hiatal Hernia Surgery: When Is Surgery Needed and Is Laparoscopic Repair Better?

A hiatal hernia occurs when the upper part of the stomach moves upward into the chest through an enlarged opening in the diaphragm. Some people may have no symptoms, while others experience heartburn, acidity, acid reflux, difficulty swallowing, or vomiting. When symptoms persist despite medical treatment, hiatal hernia surgery in Mumbai may be considered after a proper evaluation by a surgeon. The decision depends on factors such as the size of the hernia, symptoms, and response to medicines.

Understanding Hiatal Hernia and Its Symptoms

The diaphragm is a sheet of muscle separating the chest from the abdominal cavity. A weakness or enlarged opening in this area can allow part of the stomach to move upwards, resulting in a hiatal hernia.

According to MetaHeal-Laparoscopy and Bariatric Surgery Center, there are mainly two types:

• Sliding hiatal hernia: The more common type, where the stomach and food pipe slide upwards into the chest.
• Para-oesophageal hernia: A less common type in which a portion of the stomach moves through the hiatal defect while the stomach and food pipe otherwise remain in their natural positions. This type can be more concerning because of the possibility of strangulation and compromised blood supply.

Symptoms can range from no noticeable symptoms to significant acid reflux. Common complaints include heartburn, acidity, difficulty swallowing, vomiting, and reflux. Symptoms may become worse while lying down or bending and may improve when sitting or standing upright.

When Is Surgery Actually Needed?

Surgery is not automatically required for every person diagnosed with a hiatal hernia. The doctor recommends lifestyle changes, behaviour modification, and medications as the first line of treatment.

Some measures may include eating smaller, frequent meals, choosing less oily and non-spicy foods, having dinner earlier, and sleeping with the head elevated. Antacid medicines may also help some patients.

Surgery may become appropriate when conservative treatment does not provide sufficient relief. Surgery may be advised when:

• Symptoms continue despite medication for a prolonged period.
• The patient is unable to stop taking medication.
• Complications such as Barrett’s esophagus develop.
• Asthma-like symptoms are associated with severe reflux.
• Ulcer formation occurs.
• The size of the hernia and the patient’s symptoms indicate that surgery would be beneficial.

Therefore, simply having a hiatal hernia does not necessarily mean that surgery is needed. A surgeon should assess the individual case before recommending an operation.

How Is a Hiatal Hernia Diagnosed?

A proper diagnosis helps determine the size and nature of the hernia and whether surgery should be considered. The evaluation may include a detailed medical history and clinical examination.

Depending on the case, investigations can include:

• Barium swallow or oesophagogram: This imaging test can show the stomach moving upwards into the chest.
• Upper GI endoscopy: It allows the doctor to examine the upper gastrointestinal tract and assess the size and grade of the hiatal defect.
• 24-hour pH manometry: This test measures acid movement and pressure within the food pipe.

These investigations help the surgeon understand the condition before deciding on an appropriate treatment approach.

Is Laparoscopic Repair Better?

Hiatal hernia surgery is performed laparoscopically through small keyhole incisions. Around four to five small cuts, approximately 0.5 to 1 cm in size, are made in the abdomen.

The surgery involves tightening the hiatal opening and creating a wrap using the upper part of the stomach. This procedure is also known as laparoscopic Nissen fundoplication and is used for treating hiatal hernia and GERD.

Laparoscopic surgery can offer practical recovery benefits. The website highlights that laparoscopic procedures generally involve less pain, earlier mobility, shorter hospital stays, and faster return to normal activities compared with more invasive approaches. In hiatal hernia surgery specifically, most patients can start an oral diet within about six hours and may be discharged the following morning. Return to work may be possible within approximately a week, depending on the patient’s clinical condition.

This makes hiatal hernia surgery in Mumbai through a laparoscopic approach an option worth discussing with a qualified surgeon when surgery is indicated.

What Does Recovery Look Like?

Recovery after laparoscopic hiatal hernia surgery is generally structured around gradually returning to normal eating and activity.

The website advises:

• A liquid diet for the first two days.
• A soft diet for the following few days.
• Normal home-cooked food from around the fourth or fifth day, as advised.
• Avoiding heavy lifting and strenuous activity for a couple of months.
• Walking can usually begin within four to six hours after surgery.
• Hospital discharge may occur within 24 to 36 hours, depending on recovery.

Patients should follow their surgeon’s individual instructions because recovery can vary based on overall health and the complexity of the procedure.

What About Pain, Recurrence and Cost?

One common concern is whether hiatal hernia surgery is painful. Laparoscopic surgery generally causes less pain, and pain relief medication is provided during the hospital stay. Patients are also encouraged to begin moving relatively soon after surgery.

As with any surgical procedure, recurrence is possible. MetaHeal-Laparoscopy and Bariatric Surgery Center notes that recurrence is uncommon but can depend on factors such as the strength of the abdominal wall, the size of the defect, and the amount of intra-abdominal fat.

The cost of laparoscopic fundoplication or hiatal hernia surgery can vary between hospitals and according to the individual case. Health insurance coverage is also available for hiatal hernia/laparoscopic fundoplication surgery, subject to the applicable policy terms.

Making the Decision With the Right Surgical Evaluation

A hiatal hernia should not be treated based only on its diagnosis. The severity of symptoms, size of the hernia, response to medicines and presence of complications all play a role in deciding whether surgery is appropriate.

For people who need surgical treatment, hiatal hernia surgery in Mumbai using a laparoscopic approach can provide the advantages of smaller incisions, less postoperative pain, shorter hospitalisation and an earlier return to work. MetaHeal-Laparoscopy and Bariatric Surgery Center is the best option to consider for patients looking for specialised evaluation and treatment, with Dr. Aparna Govil Bhasker and her team providing laparoscopic surgical care. Patients should consult the surgeon for a personalised assessment before deciding on surgery.