When to Seek Urgent Care
Seek prompt assessment for difficulty or pain on swallowing, vomiting blood, black stools, persistent vomiting, unexplained weight loss, anaemia or sudden severe upper abdominal pain. Severe chest pain must first be assessed for heart and lung causes.
Understanding the Condition
Acid reflux occurs when stomach contents travel back into the oesophagus, causing heartburn or regurgitation. A hiatus hernia means part of the stomach has moved through the diaphragm into the chest. It may contribute to reflux but does not always cause symptoms.
A sliding hiatus hernia is the commonest type. A larger para-oesophageal hernia can cause pressure, early fullness, breathlessness, anaemia, swallowing difficulty or obstruction. Symptoms and test results matter more than scan size alone.
How It Is Assessed
Upper GI endoscopy checks for inflammation, narrowing, Barrett's oesophagus and other disease. A contrast swallow shows the shape and position of the stomach. Reflux monitoring measures acid or fluid coming into the oesophagus, while manometry checks swallowing strength. These tests help match the operation to the problem.
When Is Surgery Considered?
Surgery may suit patients with objectively confirmed reflux, troublesome regurgitation despite appropriate medicines, medicine intolerance, or a symptomatic large hiatus hernia. It is less likely to help vague throat, cough or bloating symptoms unless testing shows a clear reflux link.
Weight management, avoiding late meals and acid-suppressing medicines remain useful for many people, but they do not repair a large anatomical hernia.
Surgery and Important Risks
Keyhole surgery returns the stomach to the abdomen and narrows the enlarged opening in the diaphragm. A fundoplication usually wraps the upper stomach around the lower oesophagus to strengthen the valve. The wrap may be complete or partial according to swallowing function and the operative findings.
Risks include bleeding, infection, injury to the oesophagus, stomach, spleen or nearby nerves, difficulty swallowing, gas bloat, inability to belch or vomit, persistent reflux and hernia recurrence. A large or complex hernia may need a different repair plan.
Recovery and Follow-up
A staged soft diet is commonly needed while swelling settles. Eat slowly, take small mouthfuls and chew well. Walking starts early; heavy lifting is restricted for the period advised by the surgeon.
Seek advice for inability to swallow liquids, repeated retching, severe chest or abdominal pain, fever, breathlessness or wound problems. Barrett's oesophagus and persistent symptoms may require long-term review even after successful surgery.