What a hiatal hernia is
The oesophagus passes from the chest into the abdomen through an opening in the diaphragm called the hiatus. Normally this opening grips the oesophagus like a collar and forms part of the barrier that keeps stomach contents from travelling upwards. When the hiatus widens, the top of the stomach slides up into the chest. That is a hiatal hernia — known in Turkish simply as mide fıtığı.
The common form is the sliding hernia, in which the junction between the oesophagus and the stomach moves upward. The less common paraoesophageal type leaves that junction in place while part of the stomach herniates alongside the oesophagus; this type deserves closer attention because of the risk of the stomach becoming trapped. Loosening of tissue with age, excess weight, pregnancy, chronic cough, heavy lifting and repeated straining all raise pressure inside the abdomen and contribute to widening of the hiatus.
Symptoms and the link with reflux
Many small hiatal hernias cause no symptoms at all and are found incidentally during an endoscopy performed for another reason. When symptoms do appear, they are usually those of reflux: burning behind the breastbone, a bitter or sour taste rising into the throat, symptoms that worsen on bending forward or lying down, night-time cough, hoarseness, and a sensation of something caught in the throat. Some patients present mainly with chest pain, which can be mistaken for cardiac pain — so heart-related causes need to be excluded first.
With larger hernias, the stomach takes up space in the chest and patients may notice early fullness after small meals, breathlessness after eating, difficulty belching, or trouble swallowing. Reflux that goes untreated for years can inflame the lining of the oesophagus and, over time, lead to narrowing or to cellular changes known as Barrett's oesophagus. That is why persistent reflux is worth investigating and following properly rather than living with indefinitely.
How the diagnosis is made
Assessment begins with a detailed history and examination. When the symptoms started, what makes them worse, which medications you take and what tests you have already had all shape the plan. Endoscopy is the central investigation for most patients: it shows whether a hernia is present and how large it is, and it reveals inflammation, narrowing or other changes in the oesophagus.
A barium swallow can define the type and size of the hernia more clearly. When surgery is being considered, manometry — which measures the strength of the oesophageal muscle — and 24-hour pH monitoring, which quantifies acid exposure, may be requested. These tests guide both the decision to operate and the choice of technique. Which of them you actually need is decided case by case rather than as a fixed protocol.
When surgery is considered
A hiatal hernia is not in itself a reason to operate. The first line of treatment is usually a combination of lifestyle change and acid-suppressing medication: smaller portions, not lying down soon after eating, moving the evening meal earlier, raising the head of the bed, losing weight and stopping smoking. For a great many patients these measures, together with regular medication, keep symptoms under reasonable control.
Surgery enters the discussion when symptoms persist despite proper medical treatment, when they return immediately as soon as medication is stopped, when a patient cannot tolerate or does not wish to take long-term medication, when there is progressive damage to the oesophagus, and particularly with large paraoesophageal hernias. That assessment follows examination and investigation, and the conclusion is always specific to the individual patient.
How the operation is done, and where mesh fits in
Repair is usually performed laparoscopically, through several small incisions in the abdominal wall. There are two main steps. First, the portion of stomach that has moved into the chest is brought back down into the abdomen and the widened opening in the diaphragm is narrowed with sutures. Second, to restore the anti-reflux barrier, the upper part of the stomach is wrapped like a collar around the lower oesophagus — a fundoplication. Whether that wrap is complete or partial depends on how well the oesophagus is contracting.
Unlike groin or abdominal wall hernias, mesh is not routinely used here. The repair relies primarily on suturing the diaphragmatic opening. In selected cases where the opening is very large and sutures alone would not hold well, mesh may be added to reinforce the repair. That decision is often made during the operation itself based on what is found, and the possibility is discussed with you beforehand.
Recovery, eating, and urgent warning signs
After laparoscopic repair most patients go home after a short hospital stay, though this varies from patient to patient. Eating is reintroduced in stages: liquids and soft foods at first, moving back towards a normal diet over the following weeks. In the early weeks it is common to feel food catching when you swallow and to find belching difficult; this generally settles as swelling around the repair subsides. Taking small mouthfuls, chewing thoroughly and avoiding fizzy drinks for a period all make this phase easier.
With paraoesophageal hernias there is an uncommon but serious possibility that the herniated part of the stomach twists and becomes obstructed. Sudden severe chest or upper abdominal pain, retching without being able to vomit, an abrupt inability to swallow, and breathlessness all require immediate assessment — go to the nearest emergency department rather than waiting for an appointment. For appointments and information you can reach us on 0538 508 3872.
Frequently asked questions
Can a hiatal hernia go away without surgery?
The widened opening in the diaphragm does not close by itself. However, with a small hernia the symptoms can often be controlled for years with lifestyle changes and medication. Surgery is considered when symptoms persist despite treatment or when the hernia is large, and that decision follows examination and testing.
Does every hiatal hernia cause reflux?
No. Many small hiatal hernias cause no symptoms and are found by chance during endoscopy done for another reason. Reflux develops when the barrier at the lower end of the oesophagus stops working properly. The presence of a hernia alone is not a reason to operate.
Will I be able to stop my reflux medication after surgery?
Many patients need less acid-suppressing medication after repair, and some are able to stop it. This differs from person to person and cannot be promised in advance. Any reduction is planned at your follow-up visits, based on how your symptoms respond.
Is difficulty swallowing normal after the operation?
A sensation of food catching is common in the first weeks and is caused by swelling around the repair; it usually eases with time. Small mouthfuls, thorough chewing and following the staged diet you are given all help. If it does not improve, you should be reviewed in clinic.
Is mesh used in hiatal hernia repair?
Not routinely, unlike in groin or umbilical hernia surgery. The repair is based on narrowing the diaphragmatic opening with sutures. Mesh reinforcement is reserved for selected cases where the opening is unusually large, and the decision is guided by the findings at operation.
When should I seek emergency care?
Sudden severe chest or upper abdominal pain, retching without producing anything, an inability to swallow, or new breathlessness may indicate that the herniated stomach has become twisted or obstructed. This needs urgent assessment at an emergency department.