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Hiatal Hernia Surgery / Nissen Fundoplication Surgery

DrGanesh DP 2
Dr Ganesh Ramalingam

Specialist in General Surgery

Procedure

What Is A Hiatal Hernia?

A hiatal hernia refers to a condition where the upper part of the stomach and oesophagus protrude past the opening (also known as hiatus) in the diaphragm into the chest cavity. This results in the stomach bulging through the diaphragm, which may lead to reflux symptoms, lung complications, and pain. 

This condition is observed to occur more frequently in patients over the age of 50.

Table of Contents

Laparoscopic Hiatal Hernia Surgery / Nissen Fundoplication

What Causes A Hiatal Hernia?

While there are no known causes for hiatal hernia, studies have shown that people who experience injuries to the abdomen or chest may be prone to experiencing this condition. 

This could potentially be due to the damage leading to weakness in the muscle tissue, allowing the stomach to push through the diaphragm when pressure is exerted. 

Other causes of Hiatal hernias may be linked to forceful coughing, heaving from vomiting, straining during bowel movements and carrying of heavy objects.

Hiatal hernias have also been linked to risk factors such as obesity, ageing, and smoking.

Are There Different Types Of Hiatal Hernias?

Types of Hiatal Hernia 1

There are two types of Hiatal hernias:

  • Sliding Hiatal Hernia
  • Fixed (Paraesophageal) Hiatal Hernia

Sliding Hiatal Hernia

Sliding Hiatal Hernias are the most common type of Hiatal hernias. The condition occurs when the bottom of the oesophagus, also known as the gullet, and the top of the stomach protrude through the hole (hiatus) in the diaphragm. The diaphragm is a muscle that separates the lungs from the abdomen. This results in the hernia sliding into and out of the chest through the hiatus.

Fixed Hiatal Hernia 

Fixed Hiatal Hernia, also known as a paraesophageal hernia, is a different type of hiatal hernia that is less common. 

A portion of the stomach pushes past the diaphragm in a fixed hernia and remains fixed in the location, resulting in a bulge. In such cases, the fixed hiatal hernia may obstruct the blood flow to the stomach, causing a possible risk or medical emergency.

HerniaBeforeAfter img scaled

What Are The Symptoms Of A Hiatal Hernia?

Patients with hiatal hernia may not immediately present any symptoms. For those that do, common symptoms may include:

  • Heartburn, which is a burning sensation felt in the chest
  • Feelings of nausea
  • Difficulty swallowing
  • Chest pain

An obstructed hernia may lead to a blockage in the blood flow to the stomach, which can be a serious issue. You are advised to seek medical attention if you experience long periods of vomiting, pain or observe blood in your stools or black stools.

While it may seem that the symptoms of hiatal hernia are similar to that of other gastrointestinal diseases, it is difficult to diagnose the condition without further investigations. 

If you are experiencing frequent bouts of the symptoms mentioned above, consider scheduling an appointment with a medical professional for a proper diagnosis.

Do I Need Surgery for My Hiatal Hernia?

Nissen Fundoplication img2 scaled

Not every hiatal hernia requires surgery. If a hiatal hernia does not cause significant symptoms, treatment may not be necessary beyond monitoring and managing associated risk factors.

For patients with symptoms such as acid reflux or heartburn, initial treatment may include lifestyle changes and medication. These may include:

  • Antacids
  • H2-receptor blockers
  • Proton pump inhibitors (PPIs)
  • Weight management where appropriate
  • Dietary and lifestyle modifications

Hiatal hernia surgery may be considered when:

  • Symptoms remain troublesome despite medication and lifestyle changes
  • GERD symptoms are persistent or severe
  • Long-term medication is not adequately controlling symptoms
  • There are complications associated with the hernia
  • A large paraesophageal hernia is causing symptoms or has a significant risk of complications
  • Investigations suggest that surgical treatment is appropriate

The decision to proceed with surgery depends on the type and size of the hernia, severity of symptoms, results of investigations and the patient’s overall health.

 

Dr Ganesh: “Laparoscopic Nissen Fundoplication is one of the recommended treatments that we suggest to patients who have experienced long and severe bouts with GERD or Hiatal hernias. It is minimally invasive so patients can generally expect a quicker recovery time and with a lower risk of complications.”

 

What Is Hiatal Hernia Surgery?

Hiatal hernia surgery involves moving the stomach back into its normal position below the diaphragm and repairing the enlarged opening, or hiatus, through which the stomach has moved. The aim is to prevent the stomach from moving back into the chest and, where appropriate, address associated acid reflux.

The procedure is commonly performed using laparoscopic surgery, also known as keyhole surgery. Several small incisions are made in the abdomen to allow a camera and surgical instruments to be inserted.

Depending on the type of hiatal hernia, the severity of reflux and findings from pre-operative investigations, surgery may involve:

  1. Returning the stomach and gastroesophageal junction to their normal position
  2. Repairing and tightening the opening in the diaphragm
  3. Performing an anti-reflux procedure, such as fundoplication, when appropriate

What Is Nissen Fundoplication?

Nissen fundoplication is an anti-reflux procedure that may be performed together with hiatal hernia repair, particularly when a patient also has significant gastroesophageal reflux disease (GERD).

During the procedure, the upper part of the stomach, known as the fundus, is wrapped around the lower oesophagus. This helps reinforce the barrier between the stomach and oesophagus and reduces the likelihood of stomach acid and contents flowing back into the oesophagus.

In simple terms:

  • Hiatal hernia repair repairs the opening in the diaphragm and returns the stomach to its normal position.
  • Nissen fundoplication reinforces the anti-reflux barrier between the stomach and oesophagus.
  • Both procedures may be performed together when appropriate for patients with a hiatal hernia and significant reflux.

Nissen fundoplication can usually be performed laparoscopically in suitable patients. However, not every patient with a hiatal hernia requires fundoplication. The decision depends on the patient’s symptoms, reflux severity, investigation results and overall health.

What To Expect With Hiatal Hernia Surgery / Nissen Fundoplication?

Before the procedure

  • Fasting is required 8 hours prior to your procedure
  • Stop any prescription of aspirin or other blood thinning medications with a doctors advice.
  • All regular medications will be stopped unless absolutely necessary under a doctors supervision.
  • Be prepared to have an average hospital stay following the procedure in between 2-3 days.

On the day of the procedure

  • This procedure is usually performed under general anaesthesia.
  • Small incisions will be made on the belly for the laparoscope.
  • The length of surgery varies from patient to patient.
  • Your surgeon will advise you on the specific details.

After the procedure

  • Allow a few days for recovery.
  • Avoid heavy lifting for at least a week.

What Happens After Hiatal Hernia Surgery?

It is normal to experience some temporary changes following hiatal hernia repair and fundoplication. These may include bloating, difficulty swallowing or feeling full more quickly, particularly during the early stages of recovery.

Your diet and activity levels may need to be gradually adjusted while the surgical site heals.

Open surgery generally involves a larger incision and may require a longer recovery period than laparoscopic surgery. Your individual recovery time will depend on the type of procedure performed, your general health and whether there are any complications.

What Are The Side Effects Of Hiatal Hernia Surgery / Nissen Fundoplication?

A Nissen Fundoplication is a relatively safe procedure when performed laparoscopically. This allows smaller incisions to be made and aids in faster recovery. However, as with most surgeries, some patients may experience rare cases of complications.

The complications may include:

  • Damage to the linings of the stomach, oesophagus or tissues around the lungs during the procedure
  • Infection from the wound
  • Pneumonia
  • Difficulty in swallowing
  • Nausea or the urge to vomit
  • Excessive gas in the stomach
  • Dumping Syndrome (a condition associated with patients who have done gastric or oesophageal surgery where food moves rapidly through the stomach to the small intestines, resulting in abdominal pain and other symptoms.)

In extremely rare cases, a Nissen Fundoplication may fail and result in the recurrence of symptoms. In such cases, the wrap around the oesophagus could have been too tight or incorrectly placed, resulting in the need to repeat the surgery to fix the failure.

How Long Does It Take To Recover From Hiatal Hernia Surgery / Nissen Fundoplication?

A patient who undergoes a fundoplication procedure can be discharged within two days after the surgery. Patients who opt for open surgery may be required to stay longer as the operation involves a bigger incision, requiring more extended periods to recover.

Following the surgery, you will likely require tube feeding in the initial two weeks. After that, patients will resume consumption of a liquid diet for another two weeks before progressing to soft foods and finally returning to eating normally after 1 to 3 months.

Depending on whether you opt for open surgery or laparoscopic surgery for your fundoplication, the recovery of your wound would also differ.

Similarly, the recovery of the wound will differ between individuals. Most patients should recover within two weeks from the surgery if there are no serious complications or infections observed.

For a more accurate assessment of your recovery period, you may seek advice from our doctor to get a clearer picture.

Are There Any Dietary Restrictions After Hiatal Hernia Surgery / Nissen Fundoplication?

A patient who has undergone a fundoplication would be advised to make dietary changes to avoid complications after the procedure. A dietary change can also aid in preventing any long term effects of discomfort following the surgery.

Following the surgery, you will be expected to make the changes to your diet according to the different phases. This is what may be recommended:

  • Recovery Phase (2 weeks after surgery): Liquid or soft diet. You are recommended to consume only liquid for the recovery phase and avoid carbonated beverages. Food such as soup and yoghurt are recommended.
  • Acclimatisation Phase (3-4 weeks after surgery): Soft to light solid food diet. You can start introducing solid foods that are easily digestible into your diet. These can include bread, mashed potato. Your food should also not be overly spicy or oily to prevent causing discomfort.
  • Maintenance Phase (1 Month after surgery and long term): Solid food diet. You can return to your usual diet. However, you are advised to avoid eating foods that are rough and may become stuck in the oesophagus, such as chicken, steak or nuts.

Should You Opt for Hiatal Hernia / Nissen Fundoplication?

This is done for severe heartburn. This means that there is daily burning pain behind the chest bone for a few months. Surgery is recommended especially if the pain persists despite medication and lifestyle changes. These symptoms occur if the muscles between your oesophagus and stomach are not tight enough. This allows acid to flow back up to the oesophagus, causing the discomfort.

Frequently Asked Questions

If your hernia currently does not present any symptoms, our doctor may advise you just to monitor and observe the lump. However, if the hernia starts to hurt, you may be advised to undergo a hernia repair to prevent further complications.

There are several factors that can contribute to the decision of when to have hernia repair surgery. One important consideration is the size of the hernia. Hernias that are large or growing rapidly are more likely to require surgery sooner than smaller ones. Hernias causing pain or interfering with daily activities are also generally candidates for repair. 

If you are considering hernia surgery, talk to our doctor about your specific situation to determine the best course of treatment.

While selecting your hernia surgeon, it might be ideal if you consider their experience and training in the field. Additionally, you’ll want to get recommendations from friends or family who have had hernia surgery. Finally, once you have the information you need, schedule a consultation with the surgeon of choice to see if they are the right fit for you.   

It is important that you feel comfortable and secure in your choice of hernia surgeon.

Hernia surgery is considered major surgery, but it is usually safe and effective with advances in surgical techniques and anaesthesia. Recovery time varies depending on the type of hernia and the individual but is typically short, with most people returning to their regular activities within a few weeks.

The incisions will be made above the belly button where the laparoscope will be inserted.

In general, the surgery can take between 2-3 hours, depending on the complexity of the case. Patients may be expected to stay 1-2 nights for observation.

In most cases, patients will be expected to stay in the hospital for 1-2 days following the procedure, depending on their individual recovery needs. During this time, patients may experience some mild discomfort and may need to take pain medication as needed. After being discharged, you should also expect a full recovery from your hernia repair within 3-6 weeks.

Why Choose Us For Your Hiatal Hernia Treatments In Singapore?

Dr Ganesh at G & L Surgical Clinic strives to prioritise his patients’ recovery and comfort. Having had adequate experience in performing hiatal hernia surgeries for numerous patients for many years in Singapore.

Furthermore, the staff at G & L Surgical Clinic have been thoroughly and adequately trained to make your experience a comfortable and hassle-free one. Whether you intend to undergo our hernia treatments, procedures or other medical services in Singapore, you can rest assured that you will be properly and sufficiently cared for by trained professionals.

Organise a consultation with our surgeons for further assistance on hiatal hernia treatments in Singapore.