Should I Have Surgery If I Have A Hiatal Hernia Or Reflux?

Gastroesophageal reflux (GERD) occurs when the contents of the stomach return to the esophagus, resulting in its typical symptom: heartburn (or as the patient would call it: “burning”).

According to anti reflux surgery London experts, reflux often happens when the muscles between the esophagus and stomach become weak, do not close properly, or are disturbed.

Liver hiatal hernia happens when the stomach rises towards the thorax, through the esophageal hiatus of the diaphragm (natural orifice or passage of the esophagus from the thorax to the abdomen). Therefore, hiatal hernia alters the anti-reflux mechanisms of the esophagogastric junction and may be the cause of a worsening of GERD.

GERD symptoms

Typical (esophageal): heartburn (“burning”, “burning sensation, scratches…”), regurgitation (“return food to the mouth”), chest pain.

Atypical (extraesophageal): laryngeal symptoms (“itchy / sore throat”), respiratory, cough…

Where To Go?

Before considering the possibility of surgery, you should consult a gastroenterologist or specialist in the Digestive System, who will order tests to confirm the diagnosis

Blood Tests

Esophageal manometry: Measures the pressures for the progression of food in the esophagus. It rules out other diseases of the esophagus and assesses the alterations that the GER has been able to produce in the pressure of the esophagus to know which is the most appropriate technique in the event that the patient undergoes surgery.

pHmetry: Technique used to assess the amount of acid that passes from the stomach to the esophagus. You can quantify whether the GER is mild, moderate, or severe.

Upper digestive tract endoscopy (gastroscopy): This will be done by your endoscopist / Digestive System Specialist. It is important to know if the GER has produced lesions and ulcerations in the esophageal mucosa and to what degree. It rules out the presence of a Barret’s esophagus, which is a lesion that can lead to cancer.

All these tests are not always necessary to be performed in a consultation because most of the time they are mild cases. All of them must be performed if surgical treatment is considered because with the results it is possible to predict the degree of success of the surgery.

Medical Treatment

Medicines: like anti H2 blockers (ranitidine) or proton pump inhibitors (omeprazole, pantoprazole, esomeprazole…)

Lifestyle changes:

• Food: small and divided meals throughout the day. Avoid foods rich in fat, spicy, acidic and alcohol and coffee. Therefore, eat skimmed foods, eat lean meats (chicken, turkey, blue fish). Vegetables do not usually cause symptoms.
• Raise the head of the bed, especially if you have night-time symptoms.
• Don’t smoke, it makes reflux worse.
• Don’t drink alcohol, it increases gastric acidity and decreases the function of the lower esophageal sphincter.
• Avoid obesity and overweight, increased abdominal pressure, easier for reflux.

When To Operate?

Medical treatment decreases the amount of acid produced by the stomach, consequently less acid enters the esophagus and symptoms improve but this doesn’t solve the cause of the hiatal hernia and/or GER. For this, laparoscopic surgery is necessary.

Indications For Gastroesophageal Reflux Surgery

• Patients who do not improve their symptoms even if they take the appropriate medication. It includes not only the persistence of symptoms, but also the persistence of endoscopic lesions in asymptomatic patients. The most common situation is that medical treatment controls heartburn but not regurgitations, especially at night, accompanied by aspiration.
• Duly informed patients who do not wish to continue taking medication. They are mainly young or middle-aged patients.
• Recurrent respiratory complications (aspiration, pneumonia, laryngitis…)
• When you have a giant paraesophageal hernia and hiatal hernia, where part of the stomach is raised in the chest or presents torsion, it is solved by an anti reflux surgery.
• More serious problems in the esophagus: scarring, ulcers or bleeding, and Barret’s esophagus.

How Is Surgery Performed?

Anti-reflux surgical procedures are performed laparoscopically (minimally invasive surgery) which means small incisions, with small scars and early recovery.

In the operation, the stomach is placed back in the abdomen and the esophageal hiatus is closed to prevent the hernia from recurring. Then a “tie” is made with the upper part of the stomach around the esophagus, creating a new valve to reinforce the lower esophageal sphincter that was weak or damaged, this technique is called Nissen fundoplication.

Postoperative Surgery

• The GER disappears immediately after surgery. It is as if the backflow “tap” is turned off.
• Stop the medication immediately.
• It is a quick recovery surgery when performed laparoscopically.
• Usually, the patient is discharged on the first or second postoperative day.
• You can start eating the day after the intervention and resume normal eating after 10 days.

GER surgery performed with a correct indication by your digestive or anti reflux surgery London specialist has not only good immediate but also long-term results with a success rate of more than 90%.