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When Should I Consider Hiatal Hernia Surgery?

Aug 01, 2023
When Should I Consider Hiatal Hernia Surgery?
Hiatal hernias occur when your stomach or other tissue pushes into your chest through a hiatus in your diaphragm. A hiatal hernia may not cause symptoms, or you could develop heartburn and serious complications. Would surgery help? Find out here.

Up to 60% of women and men in the United States over age 50 develop a hiatal hernia. A hiatal hernia is a condition in which the hiatal portion of your diaphragm weakens, which allows your stomach or other tissue to push through the muscle wall into your chest area.

About 91% of the time, hiatal hernias don’t create any symptoms. In fact, you may not even know you have one. If you’re among the other 9%, however, your lower esophageal sphincter (LES) is weak enough to allow stomach contents to push upward into the esophagus, leading to symptoms and complications, such as:

  • Gastroesophageal reflux disease (GERD)
  • Regurgitation
  • Burping
  • Trouble swallowing
  • Nausea
  • Vomiting
  • Chronic cough
  • Asthma

At Slim Vegas Bariatric & General Surgery in Las Vegas, Nevada, our fellowship-trained surgeon, Jon Williams, MD, repairs hiatal hernias to relieve symptoms and reduce complications. He uses minimally invasive, robotic, and traditional open surgery to repair your hernia and tighten your LES. 

Do you have a hiatal hernia? Here’s when you should consider hernia surgery to repair it.

Your heartburn doesn’t respond to medications

GERD, known colloquially as heartburn, occurs when your stomach acid pushes up into your esophagus, causing pain and irritation. Proton pump inhibitors (PPIs), a type of medication that reduces acid production, can be helpful in reducing the severity of GERD symptoms. 

However, if you still experience GERD despite PPIs and lifestyle adjustments — such as sleeping with your head elevated and eliminating foods such as tomatoes and onions — you may benefit from surgical hiatal hernia repair. Chronic GERD puts you at a risk of complications, such as:

  • Esophagitis and esophageal stricture
  • Barrett’s esophagus
  • Asthma
  • Chronic cough
  • Hoarseness

The harshness of acid rising up into your esophagus and your mouth can also affect your teeth. Continuous exposure to acid reflux can wear away your teeth’s enamel, putting you at risk for decay and tooth loss. 

You already have complications

Untreated or poorly managed GERD may cause complications that lead to further symptoms and difficulties. The hernia itself can also create serious problems. You need hiatal hernia surgery when you have complications such as:

Strangulated hernia

In some cases, the hiatal hernia cuts off blood supply to your stomach or intestines. Without treatment, that tissue could die. A strangulated hernia is considered a medical emergency.

Lung problems

When you have GERD due to a hiatal hernia, stomach acid can travel through your esophagus and into your windpipe to affect one or both lungs. You may have trouble breathing and even develop asthma.

Barrett’s esophagus

The constant exposure to the erosive acid of GERD can irritate the lining of the lower esophagus, leading to changes on a cellular level known as Barrett’s esophagus. Barrett’s esophagus puts you at increased risk for esophageal cancer. In addition to hiatal surgery, you should undergo cancer screening to be sure no cells have become cancerous.


When your hiatal hernia bleeds or causes bleeding in the tissues it affects, you may develop iron-deficiency anemia. Anemia is a condition in which your body no longer produces sufficient red blood cells. Because red blood cells carry oxygen throughout your body, anemia robs your organs of oxygen.

Your hernia is growing

Even if you don’t yet have intolerable symptoms or complications, if you notice that your hernia is growing larger, we may recommend surgery. A large hernia increases your risk for serious, even life-threatening complications, such as strangulation. 

You’re uncomfortable

You don’t have to wait until you develop complications to qualify for surgical hiatal hernia repair. Whether you’re not getting relief from PPIs or other medications, or you simply don’t want to take such medications long-term, surgery could be the right solution.

To find out whether you should consider hiatal hernia surgery, contact Slim Vegas today to consult with our knowledgeable team.