UPPER GI / HERNIA · CONDITION GUIDE

Hiatal Hernia

Q: Does every hiatal hernia need surgery?

Small sliding hiatal hernias are very common and do not always require surgery. They are managed with proton pump inhibitors and lifestyle modification. Surgery is recommended for large symptomatic hernias, paraoeósophageal hernias at risk of volvulus, reflux failing medical therapy, and hernias causing respiratory symptoms or anaemia.

Q: What is a paraoeósophageal hernia and why is it more serious?

In a paraoeósophageal hernia, part of the stomach rolls up alongside the oesophagus into the chest without the gastro-oeósophageal junction moving. This creates a risk of acute gastric volvulus — twisting of the stomach in the chest — which is a surgical emergency causing severe pain, inability to swallow, and gastric ischaemia.

Q: What diet restrictions apply after hiatal hernia surgery?

A liquid diet is commenced on day one, progressing to soft foods over 4–6 weeks to allow post-operative swelling at the repair site to resolve. Gradual reintroduction of normal foods is advised. Long-term dietary habits — smaller meals, avoiding eating immediately before lying down, weight management — reduce recurrence risk.

Protrusion of the stomach through the oesophageal hiatus in the diaphragm — causing acid reflux, chest discomfort, and respiratory symptoms, treated laparoscopically when symptomatic.

Book on WhatsApp Call Clinic

Laparoscopic Hiatal Hernia Surgery for Acid Reflux by Dr. Tagore

Upper GI LOCATION

60–90 Min PROCEDURE DURATION

1–2 Days HOSPITAL STAY

ABOUT THIS CONDITION

What is Hiatal Hernia?

A hiatal hernia occurs when the stomach herniates through the oesophageal hiatus in the diaphragm into the chest cavity. Type I (sliding) is the most common and is typically associated with GERD. Type II–IV (paraoeósophageal) hernias are larger, may contain other abdominal organs, and carry a risk of acute gastric volvulus — a surgical emergency. Symptoms include heartburn, regurgitation, chest pain, dysphagia, and in large hernias, respiratory compromise. Dr. Tagore Mohan Grandhi performs laparoscopic hiatal hernia repair with fundoplication at Lux Hospitals, Hyderabad. The herniated stomach is reduced into the abdomen, the hiatal defect is repaired with sutures and mesh reinforcement in large defects, and a fundoplication is added to restore the anti-reflux mechanism and anchor the stomach below the diaphragm.

SIGNS TO WATCH

Common Symptoms

⚠️

Symptoms that need attention

Heartburn, regurgitation, and acid taste — typical sliding hernia symptoms Chest pain or discomfort, sometimes mimicking cardiac pain Dysphagia — difficulty swallowing with large paraoeósophageal hernias Respiratory symptoms — shortness of breath or recurrent aspiration pneumonia Early satiety and postprandial fullness from gastric compression Acute severe chest pain and inability to swallow in gastric volvulus — an emergency

WHY IT HAPPENS

Causes & Risk Factors

Age-related weakening and widening of the oesophageal hiatus
Obesity increasing intra-abdominal pressure
Chronic cough, COPD, and repeated Valsalva manoeuvres
Congenitally short oesophagus or wide hiatus
Previous upper abdominal surgery altering hiatal anatomy
Pregnancy and multiple childbirths increasing diaphragmatic strain

CLINICAL DETAILS

KeyFacts

Types

Type I (sliding) most common; Type II–IV (paraoeósophageal)

Surgical Option

Laparoscopic repair with fundoplication

Emergency

Gastric volvulus requires urgent surgery

Mesh Use

Mesh hiatal repair for large defects to reduce recurrence

Recovery

Discharge in 1–2 days; soft diet for 4–6 weeks

Hospital

Available at Lux Hospitals, Hitech City, Hyderabad

HOW WE TREAT IT

Treatment Approach

✦

Laparoscopic Hiatal Repair with Fundoplication

Laparoscopic repair reduces the herniated stomach, repairs the hiatal defect, and wraps the gastric fundus around the lower oesophagus to restore the anti-reflux valve and secure the stomach below the diaphragm. Dr. Grandhi performs this procedure as a minimally invasive operation with a short hospital stay and excellent long-term relief from reflux and hernia symptoms.

Available at Lux Hospitals, Hitech City, Hyderabad

1

Investigation & Symptom Assessment

Endoscopy confirms the hernia type and excludes oesophagitis or Barrett’s oesophagus. Barium swallow assesses hernia size. Manometry and pH monitoring evaluate oesophageal function and reflux.
2

Surgical Indication

Large symptomatic hernias, paraoeósophageal hernias with volvulus risk, GERD failing medical therapy, and anaemia from Cameron lesions are indications for laparoscopic repair.
3

Laparoscopic Hiatal Repair

The stomach is reduced into the abdomen and the hiatal crura approximated with sutures. Mesh reinforcement is placed for large defects. Nissen or Toupet fundoplication is added to restore the anti-reflux mechanism.
4

Dietary Progression & Follow-up

Soft diet maintained for 4–6 weeks post-operatively as swelling settles. Endoscopy at 3 months confirms satisfactory healing. Long-term reflux symptoms resolve in the majority of patients.

AVAILABLE TREATMENTS

TreatmentOptions

Laparoscopic Fundoplication

Laparoscopic hiatal repair with gastric fundus wrap restoring the anti-reflux mechanism. Preferred approach for sliding and paraoeósophageal hiatal hernias.

Fundoplication (Open)

Open hiatal repair and fundoplication for complex cases or where laparoscopic access is not appropriate.

View All Treatments ↓

COMMON QUESTIONS

Frequently Asked Questions

Does every hiatal hernia need surgery?+

What is a paraoeósophageal hernia and why is it more serious?+

What diet restrictions apply after hiatal hernia surgery?+

Not sure about your condition?

Compassionate, confidential consultations — Book your appointment today.

WhatsApp Us ← ← All Conditions