Surgery for Hiatal Hernia
Surgery for Hiatal Hernia
A hiatal hernia can lead to persistent discomfort and digestive symptoms. If lifestyle changes and medication are no longer effective, hernia surgery may be necessary. Understanding the procedure and what to expect can help you make an informed decision about your care.
What is Hiatal Hernia Surgery?
A hiatal hernia happens when the stomach partially pushes through the diaphragm into the chest cavity, through an opening called the hiatus. This condition can cause symptoms such as acid reflux, heartburn, difficulty swallowing, and chest discomfort.
Hiatal hernia surgery aims to restore the stomach to its correct position in the abdomen, tighten the opening in the diaphragm (hiatus), and reinforce the area to prevent recurrence. By correcting the anatomical defect, surgery can reduce symptoms and improve quality of life, especially for those with severe gastroesophageal reflux disease (GERD) or complications from a paraesophageal hernia.
What are the types of Hiatal Hernia Surgery?
Laparoscopic Nissen Fundoplication
This is the most common surgical technique for hiatal hernia. Using small incisions and a camera, the surgeon wraps the upper part of the stomach around the lower oesophagus to reinforce the valve between the stomach and the oesophagus. This minimally invasive approach offers quick recovery with minimal pain and scarring.
Open Fundoplication
In some cases with large or complex hernias, the surgeon may perform an open procedure through a larger abdominal incision. Surgeons follow similar steps to laparoscopic fundoplication but choose the open approach when laparoscopic access is not safe or feasible.
Paraesophageal Hernia Repair
For paraesophageal hernias, where the stomach moves alongside the oesophagus into the chest, the procedure involves gently reducing the stomach back into place and repairing the diaphragmatic opening. This type of hernia carries a higher risk of complications and usually requires surgery.
Use of Mesh Reinforcement
For larger hernias or weakened diaphragmatic tissue, the surgeon may use surgical mesh to reinforce the hiatus. This helps prevent recurrence and provides additional support to the repaired area.
When is Surgery for Hiatal Hernia recommended?
Surgery becomes an option when non-surgical treatments such as dietary changes, weight loss, and medications like antacids or proton pump inhibitors fail to relieve symptoms.
You may need surgery if you experience:
- Severe or persistent GERD symptoms despite medication
- Difficulty swallowing
- Chest pain not related to heart conditions
- A diagnosed strangulated or paraesophageal hernia
- Regurgitation or vomiting
Procedure for Hiatal Hernia Surgery
Before the Procedure
Your surgical team will conduct several tests to confirm the diagnosis and plan the repair. These may include:
- Endoscopy to examine the oesophagus and stomach
- 24-hour pH monitoring to measure acid levels
- Oesophageal manometry to evaluate muscle function
You’ll receive instructions on fasting before surgery, managing medications, and what to expect during anaesthesia. Your surgeon will also explain whether mesh will be used and what approach will be taken.
During the Procedure
Once under general anaesthesia, the surgeon will make several small incisions in your abdomen (or one larger incision for open surgery). They will:
- Gently pull the stomach back into the abdominal cavity
- Tighten the hiatus (the opening in the diaphragm)
- Wrap the top of the stomach around the oesophagus to create a stronger valve and prevent reflux
- Place a mesh if needed to reinforce the repair
Most procedures are performed laparoscopically and typically last between 1 to 2 hours.
After the Procedure
After the surgery, you’ll stay in the hospital for monitoring, usually for 1 to 3 days, depending on the approach and your condition. Your recovery will include:
- A gradual return to eating, starting with clear liquids, then soft foods
- Pain management with prescribed medication
- Instructions on how to move, sleep and cough safely to avoid straining the surgical area
You’ll need to avoid heavy lifting or vigorous activity for at least 4–6 weeks. Most patients return to regular routines within 2 to 4 weeks, but complete internal healing may take longer.
Risk Factors for Hiatal Hernia
Hiatal hernias can develop due to:
- Age-related muscle weakening
- Obesity, which increases intra-abdominal pressure
- Heavy lifting or straining
- Chronic coughing
- Pregnancy, which shifts abdominal organs
Risk of Enlargement or Strangulation
Small hernias may not cause symptoms, but larger or sliding hernias can worsen over time. If untreated, there’s a risk of:
- Stomach getting trapped in the chest (incarceration)
- Blockage or loss of blood flow (strangulation)
Complications If Left Untreated
A hiatal hernia can lead to:
- Persistent acid reflux and oesophageal damage
- Ulceration or bleeding
- Breathing difficulties
- Nutritional issues
Cost of Hiatal Hernia Surgery
The cost of hiatal hernia surgery in Singapore depends on several factors, including the complexity of the case and the surgical technique used. According to Singapore’s Ministry of Health historical transacted bill sizes and fee benchmarks:
- The typical surgeon’s fee ranges from S$9,300 to S$14,700 (excluding GST)
- The anaesthetist’s fee typically falls between S$2,325 and S$3,675 (excluding GST)
These figures reflect only the surgical fees. The final hospital bill will also depend on the following:
- Your choice of hospital
- Length of hospital stay and recovery needs
- Charges for anaesthesia, diagnostic tests, or other services
- Your insurance plan’s co-payment, deductible coverage, and claims limits
Procedures are Medisave-claimable, helping you cover part of the cost. Additional support may be available through your integrated shield plan or private insurance. For a cost estimate tailored to your situation, speak with your hospital’s financial counsellor or care team.
Hiatal Hernia Surgery FAQs
How do I know if I need surgery for my hiatal hernia?
If medications no longer control your symptoms or if you’ve developed complications like a strangulated hernia, your doctor may recommend surgery.
What are the risks and complications of surgery?
Risks are low but may include bleeding, infection, difficulty swallowing, or recurrence of the condition. Our surgeons will take steps to minimise these risks.
Will surgery cure my acid reflux symptoms?
In most cases, yes. Surgical repair, especially fundoplication, significantly reduces or eliminates reflux in patients with hiatal hernias.
What kind of diet should I follow after surgery?
Start with clear liquids, followed by soft foods for several days. We’ll provide detailed dietary guidance to support healing.
When can I return to work and normal activities?
Most patients return to light activities or office work within 2 to 3 weeks. Avoid strenuous activities for at least 6 weeks.
Can a hiatal hernia recur after surgery?
Recurrence is rare, especially when the repair includes mesh reinforcement. Following post-op instructions can reduce your risk.
What follow-up care is needed after the operation?
We may schedule follow-up appointments to monitor your healing, manage symptoms, and ensure the repair remains intact.
Consult Our Hernia Repair Surgeons
Living with a hiatal hernia can affect your daily comfort, diet and sleep. If you’ve been struggling with persistent reflux or discomfort, our team at Nexus Surgical is here to help.
Consult Our Doctors
Dr Jane Tan Jye Yng
Colorectal & General Surgeon
Dr Lim Khong Hee
Upper Gastrointestinal, Bariatric & General Surgeon
Cost & Financing
Nexus Surgical provides comprehensive financial services to ensure a seamless and pleasant experience.