Hiatal Hernias From Diagnosis to Surgery

What Is a Hiatal Hernia?

Young woman hit with sudden heartburn after drinking coffee Young woman hit with sudden heartburn after drinking coffee outdoors with her friends. She reacts with a painful expression.
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A hiatal hernia happens when the diaphragm, the muscle that divides the chest from the abdomen, has a weakness or defect. This weakness allows the stomach, and potentially other organs and tissue, to bulge into the chest cavity. Normally the esophagus, or food tube, passes through a small hole in the diaphragm where it connects with the stomach.​

You will not be able to see a hiatal hernia, unlike many other types of hernias. Small ​hiatal hernias that do not cause symptoms may only be discovered when testing is being done for another purpose. If a hiatal hernia is suspected, testing must be done to determine the type and severity, as the doctor will not be able to visualize the hernia until surgery begins otherwise.

Many patients who have a hiatal hernia do not realize that it is present, as the symptoms can be vague and are often dismissed as an upset stomach or heartburn.

Diagnosing a Hiatal Hernia – Common Tests

Barium Swallow (Barium X-ray)—This test requires the patient to drink a chalky liquid that contains a small amount of barium. The barium shows up clearly on an x-ray, allowing the radiologist to clearly see if a portion of the stomach is out of place in the chest cavity.

Endoscopy (EGD)—This procedure is done by a physician. A thin tube with a light and camera built in, called an endoscope, is inserted into the mouth and down the throat. It is gently pushed down the esophagus where the doctor can see the inside of both the esophagus and the stomach. This test is often performed to look for damage caused by gastric reflux, commonly known as heartburn.

Common Tests Before and After Surgery

Symptoms of a Hiatal Hernia

Most hiatal hernias are asymptomatic. Each patient can experience a different set of symptoms when they have a hiatal hernia. In some cases, there may be no notable symptom except heartburn, in other cases,​ a patient can have problems eating, sleeping and feel chest pain on a regular basis.

  • Chronic heartburn (reflux)
  • Frog in the throat sensation
  • Chest pain, especially after eating
  • Nausea, especially after eating
  • A feeling of fullness without eating
  • Inability to swallow (rare)

The Causes and Risk Factors for a Hiatal Hernia

  • A weakness in the diaphragm that is present at birth.​
  • Repetitive straining to have a bowel movement or to urinate​
  • Chronic coughing​
  • Obesity. Losing weight may prevent a hernia from forming or growing in size.​
  • Heavy lifting with poor body mechanics

Who Is At Risk for a Hiatal Hernia?

The chances of developing a hiatal hernia increase during pregnancy, in obese people and in people who have a family history of developing hernias. The risk of developing a hernia is increased as you age. Patients who have had surgery for a hiatal hernia may find that their hernia worsens over the years following surgery and the procedure may need to be repeated.

Hiatal Hernia Treatments

Most hiatal hernias do not require management. Your hiatal hernia may not require surgery if it is small in size. For patients whose only symptom is heartburn, medication may be prescribed to control the pain and reduce acid production. There are many types of antacids that are available, your physician may prescribe one or more to control your symptoms.

You may also benefit from changes in your diet, such as limiting acidic foods (tomato, citrus fruits) and by refraining from eating immediately before bedtime. If you experience severe heartburn at night, you may also benefit from elevating the head of your bed 30 degrees.

When Is a Hiatal Hernia an Emergency?

In rare circumstances, this type of hernia can become an emergency situation if the esophagus becomes “kinked” making it impossible for food to travel from the mouth into the stomach. This complication is rare but is considered an emergency, requiring surgery to be performed quickly.

Hiatal Hernia Surgery - Nissen Fundoplication Surgery

Hiatal hernia surgery is typically performed using general anesthesia and can be done on an inpatient or outpatient basis. The surgery is typically performed by a general surgeon.

Once anesthesia is given, surgery begins with an incision on either side of the hernia. A laparoscope is inserted through one incision, and the other incision is used for additional surgical instruments. The surgeon then locates the stomach and the defect in the diaphragm. If necessary, the stomach is pulled down through the diaphragm, out of the chest cavity and into the abdominal cavity.

The top part of the stomach is then “wrapped” around the end of the esophagus, and stitched or stapled in place. If the defect in the diaphragm is very large, it may be stitched closed or a mesh graft may be put in place, but this is not necessary in most cases.

The small laparoscopic incisions can be closed in one of several ways: with sutures that are removed at a follow-up visit with the surgeon, with a special form of glue that is used to hold the incision closed without sutures or with small sticky bandages called "steri-strips."

Hiatal Hernia Surgery Recovery

Most hernia patients are able to return to their normal activity within two to four weeks. The area will be tender, especially for the first week. During this time, the incision should be protected during activity that increases abdominal pressure by applying firm but gentle pressure on the incision line.

Activities during which your incision should be protected include:

  • Moving from a lying position to a seated position or from a seated position to standing
  • Sneezing
  • Coughing
  • Crying
  • Bearing down during a bowel movement
  • Vomiting

Caring For a Surgical Incision


Hernia. National Institutes of Health.