The Importance of Getting Your Hiatal Hernia Repaired Correctly the First Time

Hiatal hernias affect approximately 50% of adults by age 60, yet many people delay seeking treatment until their symptoms become unbearable. 

As a board-certified general surgeon who specializes in robotic hiatal hernia repair, Dr. Dina Madni understands how important it is to tailor each operation according to a patient’s specific anatomy. She has performed a large number of hiatal hernia surgeries with excellent outcomes, short hospital stays, and minimal post-operative pain. 

What is a hiatal hernia?

A hiatal hernia occurs when the opening between the chest and abdomen (called the hiatus) is widened, which allows a portion of the stomach or other abdominal organs to push upwards into the chest. This can result in a variety of different symptoms, including reflux, chest pain, shortness of breath, or the feeling that food gets “stuck” when swallowing.

Small hiatal hernias resulting in minimal symptoms can oftentimes be managed with medicine and lifestyle changes. However, patients who fail medical management or have larger hiatal hernias oftentimes require surgery to control their symptoms.

Failed repairs lead to worse outcomes

Research proves that fixing a hiatal hernia right the first time matters tremendously. Studies show that 42% of laparoscopically repaired hernias come back, requiring another surgery.

When surgeons have to operate again, they must cut through tough scar tissue from the first surgery. That makes the procedure harder, extends your recovery time, and increases your risk of developing ongoing pain problems. 

That’s why finding an experienced surgeon who specializes in hiatal hernia repair can save you from repeated surgeries and the pain that comes with them.

Signs your hiatal hernia needs surgical repair

Not everyone with a hiatal hernia needs surgery, but certain symptoms signal that an operation may be your best option:

Persistent acid reflux despite medication

If you have  tried prescription medications for months without relief, your hiatal hernia may be too large for conservative treatment. Chronic acid exposure damages your esophageal lining and increases your cancer risk over time. More specifically, chronic exposure of the esopahgus to gastric acid may lead to a diseaes called “Barrett’s esophagus”. This is a condition that requires routine surveillance, as it may progress into esophagus cancer over time. Surgically repairing a hiatal hernia does not reverse Barrett’s esophagus, but it does stop it from progressing into cancer. 

Difficulty swallowing or breathing

When your hernia grows large enough to compress your esophagus or restrict lung expansion, you may experience trouble swallowing or shortness of breath, especially after meals. These symptoms rarely improve without surgical intervention.

Severe chest pain mimicking heart problems

Hiatal hernias can cause intense chest pain that radiates to your shoulders, neck, or back. This pain often worsens when lying down and can be mistaken for cardiac issues. If cardiac testing proves negative, your hiatal hernia may be the culprit.

Food regurgitation hours after eating

When portions of your stomach become trapped above your diaphragm, food and liquid can collect there and later regurgitate into your throat. Patients often describe a sensation of “food getting stuck” in their chest, intense burning in their chest after meals or when laying down flat. Severe reflux may also result in a condition called “silent aspiration”. Signs of silent aspiration in include voice changes such as hoarseness or raspiness, and a cough that is worse at night or when laying flat.

GI bleeding

When a portion of the stomach herniates up into the chest, the constant movement of the diaphragm around teh herniated stomach can cause ulcers to develop on the inside of yoru stomach. These ulcers are called “Cameron’s ulcers” and can cause abdominal pain and bleeding. Patients with bleeding Cameron’s ulcers may notice blood in their emesis or in their bowel movements, which may appear bright red or black. Other patient’s may never discover that they are bleeding at all until they experience shortness of breath, dizziness, fatigue or chest pain. When these patients present to the doctor’s office or emergency room, a lab draw will show that their hemoglobin is very low, and oftentimes they require a blood transfusion. The only way to treat these Cameron’s ulcers is with surgery. Medicine alone will not work to heal Cameron’s ulcers. 

What workup will you need before hiatal hernia surgery

Oftentimes, one or more of these studies is necessary for a complete workup before surgery. Not all patients will have the same pre-operative workup, and which studies are ordered depend on what symptoms you are experiencing, and also on your clinical history. 

EGD - This is one of the first procedures Dr. Madni will require while working up patients with a hiatal hernia or gastric reflux. An EGD is a procedure in which a camera scope will be advanced through your mouth into your stomach in order to look at your esophagus, your stomach, and your duodenum. An EGD will allow Dr. Madni to learn if you have any esophageal or gastric masses, ulcers, or strictures. It will also reveal the size of your hiatal hernia. It is important to know if you have any masses before proceeding with surgery, as you would need a different operation completely. 

Upper GI study - this study requires you to drink contrast and various xray images are taken to delineate how your esophagus functions as it pushes food and drinks down to your stomach. This study also allows Dr. Madni to understand how severe your reflux is. In patients with esophageal dysmotility, Dr. Madni needs to tailor the fundoplication, or wrap, depending on the severity of dysmotility. It is not “one wrap fits all”, and the wrong procedure can leave patients completely unable to swallow.

Esophageal manometry - this is a study that investigates the amount of pressure in the esophagus and can be helpful in diagnosing patients with certain conditions that oftentimes mimic a hiatal hernia but are treated completely differently. 

pH testing-  is a study that delineates the timing and severity of reflux disease and can be helpful in deciding whether medical management alone can cure patients, or if surgery is necessary. Some patients believe they are having reflux but in reality they are experiencing a cardiac or lung issue insead. This study can help determine whether the symptoms you are experiencing are truly from reflux. 

CT scan- This is a radiology study that allows Dr. Madni to look at the anatomy in your chest and abdomen. While most patients will not require this, patients with massive hiatal hernias may require as they often have many organs that have herniated up into their chest. A CT scan can help Dr. Madni with her surgical planning.

Why experience matters for your procedure

Hiatal hernia surgery is a complicated operation as it requires surgeons to operate in the abdomen and in the chest. Done wrong, this operation can be catastrophic and can result in lifelong consequences that leave patients with chronic intractable diarrhea, gastroparesis, or inability to swallow. Dr. Madni is a high volume robotic hiatal hernia surgeon and has a large amount of experience with this operation. She has the technical skills, knowledge, and experience to ensure that her patients have great short-term and long-term outcomes. She provides excellent pre-operative instructions that help patients understand exactly what to expect following surgery. She also counsels patients on what drinks and foods to avoid in the immediate post-operative setting in order to reduce discomfort within the first 4-6 weeks after surgery.

Successful hiatal hernia repair depends on several technical factors:

• Thorough and complete surgical planning to ensure the correct type of “wrap” is performed during the operation
• Technical precision to avoid injury to the esophagus, lining of the lungs, vagus nerves, spleen, and stomach
• Appropriate tension on repaired tissues to reduce risk for recurrence
• Appropriate sizing of the fundoplication, or “wrap”. A wrap that is too lose will not cure reflux. A wrap that is too tight will result in difficulty swallowing after surgery. A wrap must be “just right” in order to tackle reflux while ensuring patients are still able to eat and drink without difficulty.

Surgeons who perform this procedure regularly achieve better outcomes with lower complication and recurrence rates. Choosing an experienced surgeon is absolutely essential- your life depends on it!

Get it done right, the first time!

A hiatal hernia will not resolve without intervention. If you are experiencing symptoms that are impeding your lifestyle, there is no need to wait. Schedule a consultation with Dr. Madni to learn if surgery is the right option for you. 

Call our Dallas, Texas, office today or request an appointment online to experience lasting relief from your hiatal hernia symptoms.