Dr Balalis performs hiatus hernia repair surgery in hospital under a general anaesthetic. The operation is performed laparoscopically or via ‘keyhole’.

The surgery involves stitching your diaphragm closed, after reducing the hernia (making sure your stomach is back in your abdomen).

If the tissue is weak, an absorbable mesh will sometimes be placed in front of the repair and behind your stomach. Also, a fundoplication (wrapping of the fundus around the stomach) can be performed, and Dr Balalis will discuss this with you when you meet.

Surgeries take between one and two hours, and in most instances, patients will be able to go home after one to two nights in hospital.

Provided surgery goes well, patients should experience significant improvement of symptoms and eliminate the need for any ongoing medication.

Dr Balalis performs hiatus hernia repairs for patients whose symptoms are impacting on their quality of life. This can be due to chest pain, difficulty with swallowing or eating, or continuing reflux symptoms.

Hiatus hernia surgery can be beneficial if symptoms are severe or interfere with quality of life, and there has been no response to other non-surgical treatments.

Also, a large hiatus hernia can be at risk of strangulation which can be fatal, however this is usually a low risk and needs to be discussed further with Dr Balalis during your consultation.

As with all surgical procedures, there are risks, and some complications are severe and, in rare cases, can cause death. Your surgeon will discuss risks with you in detail in your appointment.

Risks and side effects may include:

• General complications (as with any surgery) such as bleeding, surgical site infection, allergic reactions to medications, materials, or equipment; serious kidney injury, a hernia of the scar, blood clotting (to a leg or lung), and chest infection.
• The area around the hiatus hernia has large blood vessels, such as the aorta and vena cava, as well as nerves that help the oesophagus and stomach drain. Injuries are rare but can occur.
• Recurrence of the hernia can occur, and this risk depends on the size of the hernia and quality of the tissue. Note that the recurrence is usually not as large as the original hernia.
  Recurrence of reflux can also occur, and this depends on several factors, such as operation factors and patient factors. Again, the return of reflux is usually not as severe as previously.

• If a Fundoplication surgery is performed at the time, some people find that they have more wind as the valve between the stomach and oesophagus is tighter. This can cause gas bloating, belching or increased flatulence. This is less of an issue with Anterior Fundoplication, compared to a Nissen’s Fundoplication.
• Complications specific to keyhole surgery include surgical emphysema (a crackling sensation in your skin caused by trapped carbon dioxide), damage to structures such as your bowel, bladder, or blood vessels, and developing a hernia near one of the cuts used to insert the ports and gas embolisms.
• Complications specific to hiatus hernia surgery include pneumothorax (where air escapes into the space around your lung), a hole in your oesophagus or stomach, a stitched tear, damage to your liver, damage to your spleen and difficulty swallowing for a few months.
• Additional long-term (but rare) consequences may include ongoing difficulty swallowing, inability to control reflux symptoms, weight loss, abdominal discomfort, diarrhoea, an abnormal valve, a faulty valve, abnormal merging of tissue join, pain and scarring.