Acid Reflux and Hiatus Hernia

Anti-reflux or hiatus hernia surgery can help selected patients when tests confirm the cause of troublesome symptoms. Careful assessment is essential before choosing an operation.

What are acid reflux and hiatus hernia?

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.

What are the symptoms of acid reflux and hiatus hernia?

Common symptoms are:

Heartburn, a burning feeling behind the breastbone
Acid or food coming back into the throat or mouth (regurgitation)
A cough at night or a hoarse voice
Difficulty or pain when swallowing
With a large hiatus hernia: chest pressure, feeling full early, or breathlessness

Difficulty swallowing, vomiting blood, black stools or weight loss need prompt assessment. Severe chest pain must first be checked for heart and lung causes.

How are acid reflux and hiatus hernia tested?

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.

Comparison of normal stomach position and a sliding hiatus hernia — A hiatus hernia occurs when part of the stomach moves through the diaphragm into the chest.

When is reflux or hiatus hernia surgery needed?

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. For people living with obesity, a gastric bypass treats reflux as well as weight and may suit them better than a fundoplication; see bariatric surgery.

How is a hiatus hernia repaired, and what are the risks?

Laparoscopic 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 after reflux surgery

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.

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.

Clinical snapshot

Approach: Laparoscopic / Robotic
Stay: 24–48 hours
Back to desk work: 7–10 days
Anaesthesia: General

Reflux occurs when the valve between the oesophagus and stomach does not prevent stomach contents moving upwards.

When to seek evaluation

Heartburn unresolved by medication
Difficulty or pain when swallowing
Nocturnal cough or hoarseness
Persistent acid regurgitation

Sources and guidelines

When is surgery advised for acid reflux?

When tests confirm reflux and symptoms continue despite medicines, or you cannot take them long term. A large hiatus hernia may also need repair.

Which tests are needed?

Endoscopy, a barium swallow, a reflux test and manometry. They confirm the cause and guide the right operation.

When does a hiatus hernia need an operation?

When it causes troublesome reflux, pressure, swallowing difficulty, anaemia or blockage. A large hiatus hernia should be assessed early.

Will surgery help my cough or throat symptoms?

Only if tests clearly link them to reflux. Otherwise surgery is less likely to help.

Is the operation laparoscopic or robotic?

Laparoscopic, with robotic assistance in selected cases. Most patients stay in hospital for one to two days.

Can I stop antacid medicines after surgery?

Many patients stop daily antacids after successful surgery. Some still need them occasionally.

What should I eat in the first weeks?

Liquids for the first 3 to 5 days, followed by soft foods (khichdi, soups, curd rice) for 2 to 3 weeks, before returning to normal solid meals. Eating slowly and chewing well prevents swallowing discomfort.

Are there side effects?

Some people have difficulty swallowing, early fullness or bloating for a few weeks. Contact us if you cannot swallow liquids.

How do I prepare for surgery?

Bring all your reports and a list of your medicines. Do not eat for 6 hours before a general or spinal anaesthetic; sips of water are usually allowed until 2 hours before, unless you are told otherwise. Blood thinners and diabetes medicines may need a change, which is planned with you. Do not stop them yourself.

Are long-term antacid tablets safe?

For most people, yes, when they are needed and taken at the lowest dose that controls symptoms. Long-term use should be reviewed with your doctor from time to time. Do not stop them suddenly, as symptoms can bounce back. Surgery is an option if you cannot or do not wish to take them for years.

What can I do at home to ease reflux?

Raise the head end of your bed by 15 to 20 cm. Finish dinner at least 3 hours before lying down and eat smaller meals. Lose weight if you are overweight and stop smoking. Cut down on foods that trigger your symptoms, such as tea, coffee, spicy or fried food, chocolate, citrus fruit and alcohol.

Discuss reflux or hiatus hernia surgery

Review your symptoms and test findings to determine whether surgery is likely to improve them.

Please bring: endoscopy report and photographs; contrast swallow, reflux study and manometry reports; a list of medicines and the symptoms they do or do not control.

Why we see you in person: scans and reports can miss what an examination finds. That is why opinions are given in clinic, not on WhatsApp. Bring all your reports and they will be gone through with you.

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