Hiatus Hernia Repair

Summary:

Hiatal hernia repair is surgery to repair the bulging of stomach tissue through the muscle between the abdomen and chest
Hiatal hernia repair is performed through keyhole surgery
Price: up to $500 with adequate Private Health Insurance (uninsured options are available)

Gastro-Oesophageal Reflux Disease (GORD)

The oesophagus carries food from the mouth to the stomach. It passes through the muscle between the abdomen and chest (diaphragm) just before it meets the stomach, through an opening called the oesophageal hiatus. When the opening in the diaphragm is too large, some of the stomach can slip up into the chest cavity.

This can cause heartburn (gastro-oesophageal reflux: GORD) due to gastric acid backflowing from the stomach into the oesophagus. Hiatal hernia repair is performed by bringing the stomach back down into the abdominal cavity and tightening the diaphragm muscle around the bottom of the oesophagus. The ‘valve’ at the bottom end of the oesophagus is re-created by wrapping the top part of the stomach ‘fundus’ over it. This is called a fundoplication.

This surgery can be performed very safely in a ‘minimally invasive/keyhole’ way. In rare circumstances open surgery may be required, particularly if there has been previous surgery in the area.

Hiatus hernia and hiatal hernia are the same condition, and the repair is often searched for as laparoscopic hiatus hernia repair or keyhole hiatal hernia surgery. Because the operation usually includes a fundoplication, it overlaps with anti reflux surgery, which we cover in detail on our reflux surgery page. Our Melbourne surgeons perform both, and the right operation for you depends on your assessment.

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Laparoscopic hiatus hernia repair surgery diagram

Does Every Hiatus Hernia Need Surgery?

No. Many hiatus hernias cause few or no symptoms and are managed without an operation, often with acid lowering medication and lifestyle measures. Surgery is considered when symptoms are severe, when medication no longer controls the reflux, when complications such as oesophageal inflammation or stricture develop, or when the hernia is large.

Before recommending surgery, your surgeon may arrange tests to confirm the diagnosis and plan the repair, including gastroscopy and oesophageal manometry and pH studies, which measure how the oesophagus is working. You can read about these tests on our manometry and pH studies page, and more about reflux disease itself on our guide to the diagnosis and management of reflux disease (GORD).

Patients may need to spend 3 to 10 days in the hospital after surgery. Rarely, a tube may need to be placed into the stomach through the nose and throat (nasogastric tube) during surgery and may remain for a few days. Small, frequent meals are recommended.

In the early weeks a softer diet is usually recommended while swallowing settles, progressing back to normal foods as comfort allows. Most patients return to light activities within a couple of weeks, with heavy lifting avoided for around six weeks while the repair strengthens. Your surgeon will tailor this advice to your operation and your job.

General risks as for all surgery

Risks of general anaesthetic
Infection
Bleeding
Deep vein thrombosis

Risk specific to this Surgery

Recurrence of the hernia up to 15-20%
Difficulty swallowing for 6 weeks occasionally requiring further treatment with stretching of oesophagus
Difficulty vomiting or belching with occasional increase in flatulence, all of which are mostly temporary
Rarely, injury to the internal organs

For most patients with adequate private health insurance, out of pocket costs for hiatus hernia repair are up to $500. Without private health insurance, out of pocket costs are higher and depend on the hospital. In both cases, full informed financial consent is provided after your consultation and before you commit to surgery. The detail below explains how the costs work.

With Private Health Insurance

There is no waiting list. If you wish, your operation can usually be performed within a week or two or planned at a time of your choosing. For most patients with full private health insurance there will be some extra costs not covered by Medicare or your health fund. The cover provided by your health fund will vary according to which fund and which level of cover you have and in some cases you may have to pay an “excess”. It is your responsibility to check with your health fund prior to surgery. Full financial details will be provided to you prior to surgery. Occasionally other tests, procedures or specialist consultations may be necessary and some other costs incurred.

Hospitals used by LapSurgery Australia for this surgery are:

Mulgrave Private Hospital – Mulgrave
Knox Private Hospital – Wantirna
Peninsula Private Hospital – Frankston
St John of God Berwick Hospital – Berwick

Without Private Health Insurance

If you do not have private health insurance, you can expect to have a higher out of pocket depending on where you have your surgery. Following your consultation with our surgeon our staff will be able to give you an informed financial consent prior to going ahead with surgery.

Public hospital waiting lists are very long and the surgery is usually carried out by trainee surgeons under the supervision of one of the specialist surgeons appointed by the hospital. There is no choice of surgeon in the Public Hospital and your LapSurgery Australia surgeon cannot be involved in your operation.

The team at LapSurgery Australia are recognised for their exceptional and major contribution to the Government sponsored Bariatric Safety Registry (BSR). The BSR tracks surgical complications and provides an unbiased safety record for weight loss surgery.

Related Procedures

Reflux Surgery

Anti-reflux procedures often performed alongside hiatus hernia repair.

Learn more

Manometry and pH Studies

Diagnostic tests used to assess oesophageal function before surgery.

Learn more

Hernia Repair

Inguinal and femoral hernia repair performed laparoscopically.

Learn more

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Frequently Asked Questions

Common questions about hiatus hernia repair

For most patients with adequate private health insurance, out of pocket costs are up to $500, with health fund cover and any excess varying by fund and level of cover. Without insurance, out of pocket costs are higher and depend on the hospital. Full informed financial consent is provided after your consultation. Contact us for a written estimate.

Yes. Hiatal hernia is simply the American spelling of hiatus hernia. Both describe part of the stomach slipping through the opening in the diaphragm into the chest, commonly causing reflux and heartburn.

No. Many are managed with acid lowering medication and lifestyle measures. Surgery is considered when symptoms are severe, medication stops working, complications develop, or the hernia is large. Your surgeon will assess which applies to you.

A fundoplication recreates the valve at the bottom of the oesophagus by wrapping the top part of the stomach, the fundus, around it. It is usually performed as part of hiatus hernia repair to stop acid backflowing into the oesophagus.

Patients may need to spend 3 to 10 days in hospital after surgery, depending on the size of the repair and how recovery progresses. Your surgeon will give you a realistic expectation for your operation at your consultation.

Yes, recurrence occurs in up to 15 to 20 per cent of patients over time, which we tell you plainly because it is part of making an informed decision. Difficulty swallowing for around six weeks after surgery is also common and usually settles, occasionally needing a gentle stretch of the oesophagus.

Not privately. With private health insurance your operation can usually be performed within a week or two, or planned at a time of your choosing. Public hospital waiting lists for this surgery are very long, with no choice of surgeon.

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