Hiatal hernia repair can cause uncomfortable symptoms and disrupt your daily life. Fortunately, modern surgical techniques offer effective treatment for this condition. If you or a loved one has been diagnosed with a hiatal hernia, understanding the various types of hiatal hernia repair can help you make an informed decision about your treatment.

Hiatal hernias are more common than most people realize, particularly in individuals over the age of 50 or those with risk factors such as obesity, pregnancy, or chronic coughing. In most cases, these hernias may go unnoticed for years until symptoms worsen or complications arise. When conservative treatments fail or the hernia becomes too large or complex, surgical intervention becomes necessary to restore normal anatomy and function.

What Is Hiatal Hernia Repair?

A hiatal hernia occurs when a portion of the stomach pushes up through the diaphragm into the chest cavity. The diaphragm is a muscle that separates the chest from the abdomen and helps with breathing. There’s a small opening in the diaphragm called the hiatus, through which the esophagus passes before connecting to the stomach. When the stomach bulges through this opening, it results in a hiatal hernia.

Hiatal hernias are commonly associated with symptoms such as acid reflux, heartburn, chest pain, difficulty swallowing, and sometimes shortness of breath. While many people manage symptoms with medication and lifestyle changes, others may require surgery, especially if the hernia is large or causing complications.

When Is Hiatal Hernia Repair Surgery Needed?

Surgical repair is typically recommended in cases where :-

The hernia is large or paraesophageal (where part of the stomach pushes up next to the esophagus)
Symptoms persist despite medications
There are complications like ulceration, bleeding, or strangulation of the stomach
There’s risk of obstruction or loss of blood supply to the stomach

The goal of surgery is to reposition the stomach into the abdominal cavity, repair the opening in the diaphragm, and sometimes strengthen the lower esophageal sphincter to prevent acid reflux.

Types of Hiatal Hernia Repair Surgery

There are several types of hiatal hernia repair surgeries, and the best approach depends on the type and severity of the hernia, patient health, and the surgeon’s recommendation. Here are the main surgical options :

Open Hiatal Hernia Repair Surgery :- This is the traditional surgical approach and involves making a large incision in the abdomen or chest to access the hernia. The surgeon pulls the stomach back into the abdominal cavity, tightens the hiatus (diaphragmatic opening), and may perform fundoplication (wrapping the top of the stomach around the lower esophagus to reduce reflux).

Open surgery is usually reserved for complex or recurrent hernias, or when minimally invasive surgery is not possible. Recovery time is longer compared to laparoscopic procedures, and there may be more postoperative pain and scarring.
Laparoscopic Hiatal Hernia Repair :- Laparoscopic surgery is the most commonly used technique for hiatal hernia repair today. It is minimally invasive, involving several small incisions in the abdomen through which a laparoscope (a thin tube with a camera) and surgical instruments are inserted.

The surgeon visualizes the internal structures on a screen and performs the repair with precision. The stomach is repositioned, and the diaphragmatic opening is tightened with sutures. Often, a Nissen fundoplication is performed during the procedure to prevent acid reflux.

Laparoscopic surgery typically results in less pain, smaller scars, shorter hospital stays, and quicker recovery times.
Robotic Assisted Hiatal Hernia Repair :- This is an advanced form of laparoscopic surgery that uses a robotic surgical system for enhanced precision and flexibility. The surgeon controls robotic arms from a console, allowing for finer movements and better visualization, especially in tight spaces.

Robotic-assisted repair offers benefits such as reduced blood loss, lower risk of complications, and faster recovery. It’s particularly useful in complex or recurrent hiatal hernia cases where more precision is needed.
Paraesophageal Hernia Repair :- A paraesophageal hernia is a type of hiatal hernia in which part of the stomach herniates beside the esophagus. Though less common, this condition can be dangerous if the stomach becomes strangulated or obstructed.

Surgical repair of a paraesophageal hernia involves returning the stomach to the abdomen, repairing the hiatus, and sometimes placing a mesh to reinforce the area. Fundoplication may also be performed. Both laparoscopic and open methods can be used depending on the hernia’s complexity.
Transoral Incisionless Fundoplication (TIF) :- While not a hernia repair in the traditional sense, TIF is a newer, incisionless procedure used in some patients with small hiatal hernias and significant gastroesophageal reflux disease (GERD).

Using an endoscope inserted through the mouth, the surgeon reshapes the valve between the esophagus and stomach to reduce acid reflux. This procedure is less invasive and typically performed on an outpatient basis. However, it is only suitable for selected cases with minimal anatomical disruption.

Mesh Reinforcement in Hiatal Hernia Repair

In some hiatal hernia surgeries, especially those involving large or recurrent hernias, surgeons may use a mesh to reinforce the hiatus. This helps prevent the hernia from coming back.

The mesh can be synthetic or biological and is placed over the diaphragmatic repair to provide additional support. While mesh can reduce recurrence rates, its use is carefully considered due to potential risks such as infection or mesh erosion.

Recovery After Hiatal Hernia Surgery

Recovery depends on the type of procedure performed. Most patients undergoing laparoscopic or robotic surgery can go home within 1–2 days and return to normal activities within a few weeks. Open surgery usually requires a longer hospital stay and recovery period.

Patients are generally advised to follow a soft or liquid diet initially and avoid strenuous activity until healing is complete. Long-term lifestyle changes, such as eating smaller meals, avoiding late-night snacks, and maintaining a healthy weight, can help prevent recurrence.

Choosing the Right Type of Surgery

The choice of hiatal hernia repair depends on multiple factors, including :-

Type and size of hernia
Presence of GERD or other complications
Patient age and overall health
Surgeon’s expertise and experience
Availability of technology (robotic systems, etc.)

Consulting a skilled gastrointestinal or thoracic surgeon is essential to determine the best treatment approach for your individual condition.

Conclusion

Hiatal hernia repair has come a long way with the advancement of minimally invasive techniques. From traditional open surgery to robotic assisted procedures, there are multiple effective options for correcting this condition and relieving symptoms. Understanding the types of hiatal hernia repair helps patients have informed conversations with their surgeons and feel confident in their treatment decisions.