“What is the best surgery for a hiatal hernia?”

In my opinion, hiatal hernias are best addressed by surgical reduction of the hernia, cruroplasty, followed by a fundoplication procedure. Before any surgery, you should undergo esophageal manometry, upper GI contrast study or esophagram, 24 hr pH probe study, and upper endoscopy. This will inform surgical technique.

This is an excellent question. There is no “best surgery“. If there were a “best” surgery then we would only offer that one procedure. The decision to fix a hiatal hernia actually starts with what type of symptoms you’re actually experiencing and what the findings from your endoscopy showed. There is a work up required beyond the endoscopy in order to determine which procedure is best suited for you. These decisions aren’t just based on the fact that you have a hiatal hernia, but also on your Health status as well as the function of your esophagus, stomach, and even the medication as you might be on. I would highly recommend discussing this further with your primary care physician and to the surgeon that your primary care physician might refer you to. I hope this answers your question, but feel free to reach out and ask a follow-up question if this did not address your concerns. Good luck!

The broad simplified answer will be “robotic (or laparoscopic) hiatal hernia repair with gastric fundoplication.” However we need to break down that named surgery to its component parts to fully explain the options available to accomplish each part. Ultimately the “best” surgery for YOUR hiatal hernia will be need to determined by your surgeon by assessing size of the hernia itself, degree and severity of associated reflux disease and whether or not you have a normal functioning esophagus. As for the component parts: I’m equally skilled in laparoscopic and robotic techniques but can attest that the robot has an advantage for larger hernias. So if you have two surgeons and one does robotic and one doesn’t, I’d personally go with the robot. The hiatal hernia repair is pretty standard but whether or not mesh is used can be discussed. I rarely use mesh but when I do it’s for larger ones. The gastric fundoplication part is probably the most variable thing to discuss. I won’t go into detail. From my point of view there’s three options. Something called a Nissen fundoplication, using the top of the stomach to wrap the esophagus to prevent reflux. This is a full wrap. It has great reflux treatment success but can cause bloating and inability to vomit. There’s a Toupet fundoplication. It’s a partial wrap. Some data says it’s as good at curing the reflux but allows better belching and vomiting. It can have a slight recurrence rate or propensity to fall apart in the wrong hands. Lastly the newest option is the LINX device which is a string of magnets to help with the reflux while allowing belching and vomiting. There’s excellent outcomes and if it fails in the long run for some reason can do the traditional stuff. You can Google and see videos on the LINX and others now that you know all the terms. Good luck!!

Thanks,
Vishu Danthuluri, M.D.

Laparoscopic surgery is best. You need to find a surgeon that does this particular type of surgery.

Minimally invasive hiatal hernia repair with wrap.

Not everybody that has a hiatal hernia needs to have it repaired. It depends more of the symptoms than of the existence of the hernia or its size. You need to have a talk to a surgeon that does hiatal hernia repairs, like I do. A surgeon, not a gastroenterologist. I fix the hernias laparoscopically and then, if needed, repair the valve there, mainly with one of 2 minimally invasive procedures.

This depends on the size of the hiatal hernia. Also, the surgery has to be tailored if you have GERD as well. A hiatal hernia is an actual defect in your diaphragm or breathing muscle where the esophagus exits the thoracic cavity or chest cavity to connect to the stomach in the abdominal cavity. Some hiatal hernias if they are small can be repaired with just suture. If the hernia is bigger a mesh may have to be used. The mesh can either be synthetic or biologic. I prefer to use a biological mesh.

Hello there! That would be a Nissen Fundoplication. It is minimally invasive and only requires the surgeon to make a few tiny incisions in your abdomen. Hope this helps. Good luck with your procedure.

The best fix is a minimally invasive (laparoscopic or robotic) hiatal hernia repair with fundoplication (wrap).

With mesh.

Hiatal hernia repair consists of three components:
1. Returning the stomach from the chest back into the abdomen.
2. Repair of the diaphragm. This can be done with or without mesh.
3. Anti-reflux component. The traditional method of repair is a fundoplication but a newer technique involves magnetic sphincter augmentation.

Different types of repair depend on your symptoms, how large your hernia is, and if you have any motility problems with your esophagus. Your surgeon should evaluate all of these prior to surgery and detail the best plan for you. What is best for someone else may not be best for you.