HEARTBURN
A burning feeling behind the breastbone, often after eating or when lying down.
BACK TO SERVICESLAPAROSCOPIC FOREGUT SURGERY
HIATAL HERNIA & REFLUX
Anatomical hiatal repair and individualised reflux control, with careful preservation of swallowing function.
LAPAROSCOPICCRUROPLASTYNISSEN / TOUPET
EXPLORE THE PROCEDURESELIXIS · ADVANCED CARE
Two goals: restore anatomy and control reflux while preserving function
Endoscopy, imaging and, when needed, manometry and 24-hour pH monitoring, with or without impedance, help guide the appropriate treatment.
SYMPTOMS
Symptoms that merit assessment
A hiatal hernia is an anatomical displacement of part of the stomach into the chest and may cause no symptoms. Gastro-oesophageal reflux is a separate condition that often coexists and causes many of the typical complaints.
REGURGITATION
Food or sour, bitter fluid coming back towards the mouth.
DIFFICULT SWALLOWING
A sensation that food sticks or pain when swallowing.
CHEST DISCOMFORT
Pressure or pain behind the breastbone or in the upper abdomen that needs appropriate assessment.
EARLY FULLNESS
Bloating, belching, nausea or feeling full after a small meal.
COUGH OR HOARSENESS
Chronic cough, hoarseness or throat irritation, particularly at night.
Symptoms alone prove neither a hiatal hernia nor reflux. Depending on the case, endoscopy, imaging, pH monitoring or manometry may be needed.
PROCEDURES
Hiatal-hernia procedures
Hiatal closure and the antireflux procedure are planned as one functional reconstruction.
01TYPE I
SLIDING HIATAL HERNIA REPAIR
Return of the gastro-oesophageal junction below the diaphragm and repair of the hiatus.
- WHEN IT MAY BE CONSIDERED
- Objectively confirmed reflux with persistent troublesome symptoms despite appropriate treatment or with complications, and selected large hiatal hernias.
- WHAT IT INVOLVES
- Oesophageal mobilisation, reduction, crural closure and a selected antireflux procedure.
02TYPE II–IV
PARAOESOPHAGEAL HERNIA REPAIR
Reduction of the stomach and any organs displaced into the chest.
- WHEN IT MAY BE CONSIDERED
- Symptomatic large paraoesophageal hernia, obstruction, anaemia or concern for volvulus. A truly asymptomatic type II–IV hernia may be monitored after shared decision-making.
- WHAT IT INVOLVES
- Sac dissection, restoration of intra-abdominal oesophagus and hiatal closure, with gastropexy or an antireflux procedure only when indicated.
03CRUROPLASTY
POSTERIOR CRUROPLASTY
The diaphragmatic crura are reapproximated around the oesophagus without excessive tension.
- WHEN IT MAY BE CONSIDERED
- An enlarged hiatus during surgical repair.
- WHAT IT INVOLVES
- Calibrated posterior suture closure; mesh reinforcement is used selectively rather than routinely.
04360°
NISSEN FUNDOPLICATION
A 360° wrap around the lower oesophagus to reinforce the antireflux barrier.
- WHEN IT MAY BE CONSIDERED
- Selected reflux disease with suitable oesophageal motility.
- WHAT IT INVOLVES
- A short, tension-free wrap after complete anatomical restoration.
05270°
TOUPET FUNDOPLICATION
A 270° posterior partial wrap balancing reflux control and swallowing.
- WHEN IT MAY BE CONSIDERED
- Selected patients in whom a partial wrap is preferred based on functional assessment.
- WHAT IT INVOLVES
- The fundus is fixed posteriorly and to the sides of the oesophagus without a complete wrap.
06REDO
COMPLEX OR REDO HIATAL REPAIR
Specialist reconstruction for major recurrence or failure of a previous procedure.
- WHEN IT MAY BE CONSIDERED
- Recurrence, wrap migration, dysphagia or complex anatomy after previous surgery.
- WHAT IT INVOLVES
- Adhesiolysis, careful definition of the altered anatomy and tailored reconstruction, with gastropexy or reinforcement where appropriate.
Conceptual anatomical artwork for general information — not a patient photograph or an exact representation of an operation.
PLANNING & SAFETY
Functional assessment before the surgical decision
A hiatal hernia on a test is not by itself an indication for surgery. Symptoms must correlate with anatomy and function, while mesh or gastropexy is considered selectively.
ENDOSCOPY
Assessment of oesophagitis, stomach and anatomy.
FUNCTION
Manometry and 24-hour pH monitoring ± impedance when they affect management.
TENSION FREE
Adequate intra-abdominal oesophageal length and calibrated closure.
SWALLOWING
Wrap selection is tailored to function.
QUESTIONS
FREQUENTLY ASKED QUESTIONS
Short answers before an individualised surgical assessment.
01Is a minimally invasive approach always possible?
No. It is chosen when safe and meaningfully beneficial. Anatomy, previous surgery and complexity may require another approach or conversion.
02How long does recovery take?
Recovery varies with the procedure, disease severity and general health. The individual plan covers mobilisation, diet, work and exercise.
03Will I stop reflux medication immediately?
Not necessarily. Postoperative medication and diet are individualised and reviewed during follow-up.
CLINICAL EVIDENCE
CLINICAL EVIDENCE
The final choice is based on the clinical presentation, individual anatomy and current guidance.
01SAGES · Surgical Treatment of Hiatal HerniasOfficial clinical practice guidelineOFFICIAL SOURCE02SAGES · GERD Surgical TreatmentGuideline for surgical treatment of refluxOFFICIAL SOURCE03NHS · Hiatus HerniaSymptoms and when to seek medical assessmentOFFICIAL SOURCE04NIDDK · GER & GERD in AdultsSymptoms of gastro-oesophageal refluxOFFICIAL SOURCE
This content is educational and does not replace medical assessment. No technique is appropriate for everyone; benefits, risks and alternatives are discussed individually.
INDIVIDUALISED SURGICAL ASSESSMENT
The right operation starts with the right indication.
Symptoms, investigations and alternatives are reviewed during consultation to create a safe, individualised treatment plan.
REA MED practice & directions