When should I have surgery for my hiatus hernia?

Being told a diagnosis of a hiatus hernia is not an uncommon experience for someone. You may be told this from a GP or a specialist, such as a gastroenterologist for Upper Gastrointestinal Surgeon. A hiatus hernia is picked up on an endoscopy/gastroscopy usually, but can also be found on imaging investigations such as CT scans, plains chest x-rays or barium swallow scans.

By far and away, being told this diagnosis should not cause alarm for you. First understand what it is. The diagnosis essentially means your stomach organ (which digests your meal plate of food and sits just on the abdomen/belly/tummy side below your chest bone) has ‘slipped’ up into your chest behind your heart. It goes through a natural gap in your diaphragm. Small ones (1-2 cm) are quite common. Large ones (sometimes the whole stomach) less common.

Depending on the circumstance, a small one that is not causing problems is usually managed by your GP. Sometimes these can cause reflux/heartburn and your GP may advise simple measures such as eating smaller simpler meals or take occasional medication. Larger size hernias can cause problems of swallowing problems, twisting of the stomach, internal bleeding or breathlessness. These require specialist input to both investigate and potentially surgically manage these.

Surgery is the only way to fix these, although that is not to say they all need to be repaired. The widened gap in the diaphragm is a ‘mechanical’ problem and so needs a mechanical solution – stitching this gap to be narrower and placing the stomach back in the abdomen. It frequently is performed by keyhole/laparoscopic or robotic surgery with an overnight hospital stay.

The real question is does surgery need to be done. This should be judged by your GP as to if any worrying symptoms exist, and if so then discussed with a surgeon experienced with managing these. Seeing a surgeon does not necessarily mean surgery will or should be done, rather your are informed of the issues and make a collective decision together.