Surgery for large hiatus hernia

Surgery should completely resolve or significantly relieve some or all of your symptoms. If acid reflux is a symptom your surgeon may be able to perform an additional procedure at the same time to improve this.

Large hiatus hernia will not get better without surgery. There are measures that you can take to limit the symptoms. These include eating smaller meals more often and, if your hiatus hernia is causing acid reflux, taking regular anti-acid medication. Medication that lowers the acid content in the stomach can control symptoms of acid reflux and heal the inflammation in the oesophagus for most people.

Surgery is not usually essential and you can continue on medication to control your symptoms.

If you have been previously admitted to hospital as an emergency with your stomach 'twisted' as a result of your hiatus hernia then you will need to discuss the risk of that happening again. It can be serious and in some cases it is life-threatening.

You can take medication to control other less serious symptoms.

It is important to follow the eating and drinking instructions that your doctor gives you and try to maintain a healthy weight. You should eat smaller meals more often. Try to eat at regular times and not in the 2 hours before you go to sleep. Sleeping with the head of your bed raised can help reduce acid reflux and vomiting.

The hernia may get larger with time. A larger hernia can be dangerous because your stomach can get trapped and have its blood supply cut off (strangulation).

Symptoms that may be caused by strangulation include:

• severe chest pain
• vomiting
• inability to keep any food down

This needs an urgent life-saving operation and is associated with a higher risk of developing serious complications.

The operation is performed under a general anaesthetic and usually takes 2 to 3 hours.

During surgery your liver will be held out of the way to give your surgeon a clear view of the hiatus hernia and hole in your diaphragm. Tissues around the hernia will be freed up and the lining of the hernia will be removed from the inside of your chest. Your surgeon will return your oesophagus, stomach and other affected organs to their normal place.They will stitch your diaphragm to reduce the size of the hiatus so it is big enough to only allow your oesophagus to pass through.

Your surgeon will usually wrap and stitch the top part of your stomach around your lower oesophagus. This strengthens the repair and, if acid reflux is a problem, it may reduce the symptoms.

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• bleeding during or after the operation
• infection of the surgical site (wound)
• developing a hernia in the scar
• allergic reaction to the equipment, materials or medication
• blood clot in your leg (deep-vein thrombosis – DVT)
• blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs
• chest infection
• irregular heartbeat
• heart attack (where part of the heart muscle dies). A heart attack can sometimes cause death
• death

Specific complications of this operation

Keyhole surgery complications

• surgical emphysema (crackling sensation in your skin caused by trapped carbon dioxide gas)
• damage to structures such as your bowel, liver or blood vessels when inserting instruments into your abdomen
• developing a hernia near one of the cuts used to insert the ports
• gas embolism. This is when gas (carbon dioxide) gets into the bloodstream and blocks a blood vessel. This is very rare but can be serious

Hiatus hernia surgery complications

• difficulty swallowing for a few months. This is normal and you should be able to swallow most foods normally by 3 months
• pneumothorax, where air escapes into the space around your lung. Sometimes the air will need to be let out by inserting a tube in your chest (chest drain)
• the stitches used for the wrap may tear if you retch or vomit in the first few weeks. Sometimes a tear can make a hole in your stomach that will need to be repaired by surgery straight away
• making a hole in your oesophagus or stomach, which needs repairing. This is serious but rare
• damage to your liver when holding it out of the way
• wrap migration, where the wrap pushes up through the gap into your chest
• mesh erosion, where the mesh erodes through the oesophagus or stomach. This is an uncommon but serious complication and you will usually need another operation

Consequences of this procedure

• pain
• scarring of your skin

Long-term problems

• continued difficulty swallowing where you cannot swallow most foods normally
• tissues can join together in an abnormal way
• weight loss during the first 2 months. It is normal to feel fuller than usual and you may be able to eat only small meals
• abdominal discomfort
• diarrhoea
• the problem coming back. If this happens it is usually much smaller than before and you may not need more treatment

If any of these problems are severe and continue for more than 3 months, let your doctor know. You may need another operation.

You should be able to go home the next day.

You will need to eat slowly and chew your food thoroughly.

You should be able to return to work after 3 to 4 weeks, depending on how much surgery you need and your type of work.

Your doctor may tell you not to do any manual work for a while. Do not lift anything heavy for a few weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

You should make a full recovery, with the symptoms of acid reflux gone or much improved. You should be able to eat and drink normally without feeling sick.

A hiatus hernia can cause heartburn or acid in your mouth. Large hernias can cause pain and problems with eating and drinking.