Is Hiatal Hernia Surgery Worth It?

A hiatal hernia occurs when a portion of the stomach bulges up through the diaphragm and into the chest. While medications can often manage symptoms, surgery may be necessary for severe cases. This article explores whether the surgery to repair a hiatal hernia is worth it by delving into its effectiveness, preparation, and recovery process.

Understanding Hiatal Hernia

A hiatal hernia happens when a portion of the stomach protrudes into the chest through the esophageal hiatus, a small opening in the diaphragm. Symptoms can range from mild to severe and often include acid reflux or GERD (Gastroesophageal reflux disease). However, most cases can be managed with medication, lifestyle changes, or both. Surgical intervention is typically reserved for individuals with severe symptoms that do not respond to medical treatments.

The Purpose of Hiatal Hernia Surgery

The goal of hiatal hernia surgery is to correct the protrusion of the stomach and tighten the hiatus, which helps alleviate symptoms such as heartburn, regurgitation, and chest pain. The procedure involves pulling the stomach back into the abdominal cavity and making the opening in the diaphragm smaller. In some cases, the esophageal sphincter may be reconstructed or hernial sacs may be removed to enhance the valve-like action of the lower esophageal sphincter (LES).

When Is Surgery Necessary?

Not everyone with a hiatal hernia requires surgery. However, surgery is often considered for individuals with severe symptoms that are not responding to other treatments such as medications. Indications for surgery may include:

Bleeding Scarring Ulcers Narrowing of the esophagus

Studies indicate that hiatal hernia surgery has a 90% success rate in alleviating symptoms. Nevertheless, about 30% of individuals may still experience reflux symptoms post-surgery, highlighting the importance of adherence to post-operative care and lifestyle adjustments.

Preparing for Hiatal Hernia Surgery

Preparation for hiatal hernia surgery is crucial to ensure optimal outcomes. Your surgeon will provide detailed instructions, but typically, the preparation involves:

Engaging in mild exercise like walking 2-3 miles per day Performing breathing exercises multiple times daily Avoiding smoking for at least 4 weeks before surgery Refusing to take clopidogrel (Plavix) for at least one week before surgery Not taking nonsteroidal anti-inflammatory drugs (NSAIDs) for one week before surgery

Although a clear liquid diet is not typically required, you are instructed to fast for at least 12 hours prior to the procedure. This helps prevent complications like aspiration or stomach bloating during surgery.

Types of Hiatal Hernia Surgeries

There are several types of hiatal hernia surgeries, each with its own complexities and benefits:

Open Repair: This procedure involves a large incision in the abdomen. The surgeon pulls the stomach back into position and manually wraps it around the esophagus. A tube may need to be inserted temporarily to hold the stomach in place. Laparoscopic Repair: This minimally invasive surgery involves making several small incisions in the abdomen and using a laparoscope to guide the placement of surgical instruments. This method results in fewer complications and a quicker recovery. Endoluminal Fundoplication: A newer procedure that requires no abdominal incisions. An endoscope with a lighted camera is inserted through the mouth to perform the surgery. Small clips are placed at the point where the stomach meets the esophagus, preventing acid reflux.

Recovery Process

Post-surgery, pain management is key. Medications are usually prescribed that should be taken with food to alleviate discomfort. A restrictive diet is recommended to prevent the stomach from stretching, involving smaller, more frequent meals and avoiding certain foods for several weeks.

Following the surgery, it's important to:

Wash the incision area gently with soap and water daily Avoid baths, pools, or hot tubs and stick to showers only Adhere to a low-fiber diet, including soft foods like mashed potatoes and scrambled eggs Avoid drinking through a straw, gas-producing foods, carbonated drinks, alcohol, and citrus products

Your doctor may also recommend breathing and coughing exercises to strengthen the diaphragm. Regular walking is encouraged to prevent blood clots, and you can resume normal activities gradually based on the severity of your job or physical condition.

On average, a full recovery takes 10-12 weeks. Some individuals can return to driving once off narcotic pain medication and to work in about 6-8 weeks for sedentary jobs, with more physically demanding jobs possibly taking up to three months.

Outlook for Hiatal Hernia Surgery

Once the recovery period is over, symptoms of heartburn and nausea should subside. However, your doctor may continue to recommend lifestyle changes to avoid triggering GERD symptoms, such as avoiding acidic foods and beverages.

In conclusion, hiatal hernia surgery is often worth it for individuals with severe symptoms unresponsive to medical treatment. The high success rate and potential for long-term relief make it a viable option for those suffering from chronic acid reflux or GERD. If you are considering this surgery, consult with a gastroenterologist or surgeon to discuss the best approach tailored to your specific condition.