When Should I Consider Hiatal Hernia Surgery?

For most people, heartburn is a now-and-then occurrence. If your heartburn is occurring several times a week, or you’re having other unpleasant symptoms of acid reflux, a hiatal hernia may be the culprit.
You’ve taken medication, but it hasn’t helped — you might need surgery.  
Board-certified and award-winning general surgeon Dr. Buckminster Farrow specializes in hernia repair and abdominal surgery; you’re in expert hands. 



What is a hiatal hernia? 

When body tissue moves through an opening to a place it shouldn’t be, you have a hernia. You have a hiatal hernia if your stomach pushes through a small opening in your diaphragm called a hiatus. Your diaphragm is a large muscle between your abdomen and your chest. 

Small hiatal hernias usually don’t cause symptoms; more than 50% of adults have them. However, large hernias can cause health problems. 

Symptoms of a hiatal hernia

The following are common symptoms caused by a hiatal hernia: 

  • Heartburn 
  • Pain in your chest 
  • Acid reflux, when stomach acid travels up into your esophagus, throat, and/or mouth
  • Bloating
  • Nausea or vomiting
  • Difficulty swallowing 
  • Shortness of breath 

When should I consider surgery for a hiatal hernia? 

A large hiatal hernia may require surgery if your quality of life is suffering and symptoms have become severe — for instance, if you can’t enjoy dinner because your esophagus burns, you spit up food, it’s hard to swallow, and you have a sour taste in your mouth. These persistent symptoms warrant surgery for lasting relief. 

You may be on medication to control your symptoms. However, if your hernia is large, the medication may not work effectively. All medications have side effects, and you may not want to stay on medication indefinitely, so surgery may be a better option.

When is surgery required for a hiatal hernia?

If you have a large hernia causing severe symptoms, it’s important not to wait too long to decide on surgery. If you have any of these intense symptoms, you need to seek immediate emergency medical treatment. 

  • Severe pain in your chest or abdomen
  • Shortness of breath; heart palpitations 
  • Vomiting 
  • Vomiting blood
  • Black stools
  • Unable to have a bowel movement

If you’re vomiting blood or have black stools, you may have internal bleeding

Waiting too long to have surgery could also lead to the risk of an incarcerated hernia, where the herniated tissue gets trapped and is difficult to move back into place. Incarcerated hernias can lead to a bowel obstruction. 

Another serious condition called a strangulated hernia may also occur if the nearby muscles tighten around the small intestine and cut off the blood supply, which can be fatal. 

Hiatal hernia surgery performed by a specialist has a high success rate of 90%. It’s normally a laparoscopic procedure, which is less invasive than open surgery, includes fewer risks, and leads to faster recovery.

Most people can undergo hiatal hernia surgery, but if you have a severe heart or lung condition, it may disqualify you. Dr. Farrow reviews your medical history and medications and discusses treatment options with you. 

Call Buckminster Farrow, MD, or book an appointment online for expert, compassionate hernia and other abdominal care.