Hiatal Hernia Repair in Melbourne
A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm, the muscular sheet separating the chest and abdominal cavities, into the chest. The most common type is the sliding hiatal hernia, in which the stomach-oesophageal junction moves above the diaphragm and is closely associated with gastro-oesophageal reflux disease (GORD).
Paraesophageal hernias, in which a portion of the stomach herniates into the chest alongside the oesophagus and becomes fixed in position, are less common but carry a higher risk of serious complications, including incarceration, strangulation, and gastric volvulus [1].
At Specialist Surgical Group, our Melbourne-based upper gastrointestinal surgeons perform laparoscopic hiatal hernia repair for patients in whom conservative management has not adequately controlled symptoms, or for whom hernia anatomy or complications require surgical correction. Repair is most commonly combined with a fundoplication to reinforce the lower oesophageal sphincter and provide durable reflux control.
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We consult from our Essendon and Bundoora clinics, with procedures performed at accredited hospitals in Melbourne.
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When surgery may be considered
Surgical repair is generally considered for patients who:
- Have a large hiatal hernia (typically greater than 5 cm) causing significant symptoms, regardless of their response to medication
- Have a paraesophageal hernia, particularly one that is symptomatic, enlarging, or involves more than 30% of the stomach in the chest
- Have persistent GORD symptoms despite at least 3 months of optimised proton pump inhibitor (PPI) therapy, where a hiatal hernia is identified as a contributing anatomical cause
- Have developed complications of chronic reflux such as Barrett’s oesophagus, peptic stricture, or oesophagitis that have not resolved with medical management
- Experience respiratory symptoms related to reflux or aspiration, including chronic cough, hoarseness, or recurrent aspiration pneumonia
- Prefer a surgical solution to long-term daily medication use
Surgery is not required for most small, incidentally found hiatal hernias. Your surgeon will review your symptoms, imaging, and oesophageal function tests before recommending any intervention.
Patients with impaired oesophageal motility may require a partial rather than complete fundoplication to reduce the risk of post-operative swallowing difficulty [1].
Potential benefits
- Sustained relief from reflux symptoms. Combined laparoscopic hiatal hernia repair and fundoplication achieves significant symptom improvement in approximately 85-90% of appropriately selected patients, with outcomes maintained at 5-10 year follow-up [2].
- Reduction or elimination of acid-suppressing medication. Most patients can reduce or discontinue proton pump inhibitor therapy after successful repair, thereby eliminating the cost and inconvenience of long-term daily medication [3].
- Prevention of serious complications in paraesophageal hernia. Elective repair prevents the risk of acute incarceration or gastric volvulus, both of which can require emergency surgery and carry significantly higher operative risk than planned repair [1].
- Structural correction of the underlying anatomical defect. Unlike medication, which manages acid production without correcting the physical problem, surgical repair closes the diaphragmatic opening and reinforces the lower oesophageal sphincter to address the root cause of reflux [2].
- Improved quality of life. Studies demonstrate meaningful improvements in health-related quality of life following surgical repair, including relief from heartburn, regurgitation, dietary limitation, and sleep disruption associated with chronic GORD [4].
Potential risks
- Dysphagia (difficulty swallowing). Some degree of swallowing difficulty is common in the first 4-6 weeks following surgery as post-operative oedema resolves. Persistent dysphagia beyond 3 months occurs in a smaller subset of patients and may require endoscopic dilation [2].
- Gas-bloat syndrome. Difficulty belching, increased bloating, and upper abdominal discomfort are recognised side effects of fundoplication, particularly following a complete Nissen wrap. This risk is lower with a partial Toupet fundoplication and is an important consideration in selecting the technique [5].
- Hernia recurrence. Anatomic recurrence on imaging is reported in up to 10-25% of patients with large hernias at 5 years, though symptomatic or clinically significant recurrence requiring further surgery is less common [6]. Mesh reinforcement of the hiatal closure reduces anatomic recurrence rates in large repairs, though it carries a small risk of erosion or migration.
- Wrap failure and symptom recurrence. Fundoplication can fail over time, particularly in patients with large hernias or poor diaphragmatic tissue quality, resulting in recurrent GORD symptoms. Management options include returning to PPI therapy or revisional surgery [2].
- Conversion to open surgery. Significant inflammation, adhesions, or complex anatomy may occasionally require conversion from laparoscopic to open surgery, resulting in a longer hospital stay and recovery period.
- General surgical risks. Bleeding, infection, and anaesthesia-related complications apply to all laparoscopic procedures. Our minimally invasive approach and experienced surgical team help to minimise these risks [1].
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(03) 9466 7338Meet our Upper GI surgeons
Your hiatal hernia repair journey
The following steps provide a brief overview of your hiatal hernia repair journey. Individual experiences will vary based on your specific health circumstances.
1. Initial consultation and health assessment
Your surgeon will take a detailed history of your reflux symptoms, including their duration, severity, and response to prior medication. The nature of any swallowing difficulties, regurgitation, chest pain, or respiratory symptoms will also be reviewed, as these influence both the surgical recommendation and the choice of technique.
A physical examination will be performed, and any prior investigations, including endoscopy, CT scans, and barium swallow studies, will be reviewed.
If a hiatal hernia has not yet been characterised, or if oesophageal function has not been formally assessed, your surgeon will arrange the appropriate workup before recommending surgery.
2. Pre-operative investigation and preparation
A structured workup is completed before surgery to confirm the anatomy and assess oesophageal function.
This typically includes upper endoscopy to assess the oesophageal lining and confirm hernia size, oesophageal high-resolution manometry to evaluate motility and guide technique selection, and 24-hour pH monitoring where the diagnosis remains uncertain. A barium swallow study is arranged for large or paraesophageal hernias to characterise the anatomy before surgery.
Once investigations are reviewed, your surgeon will explain the planned approach and provide written pre-operative instructions covering fasting requirements, medication management, and what to expect on the day.
3. The surgical procedure
Hiatal hernia repair is performed under general anaesthesia at an accredited Melbourne hospital and typically takes 60-90 minutes using a laparoscopic approach. 5 small incisions (each under 1.5 cm) are made in the upper abdomen to insert a high-definition camera and surgical instruments.
The hernia sac is carefully dissected, and the stomach is returned to its correct position below the diaphragm.
The diaphragmatic hiatus is then closed with permanent sutures (cruroplasty), with mesh reinforcement added when the hiatal defect is large or the tissue quality is poor.
4. Hospital recovery
Most patients spend 1-2 nights in the hospital following hiatal hernia repair. Clear fluids are commenced within hours of waking from anaesthesia, progressing to free fluids and soft foods as tolerated. Pain is generally mild and can be managed effectively with oral analgesics.
Before discharge, written instructions are provided covering your diet, medications, wound care, and activity restrictions. A follow-up appointment is scheduled before you leave the hospital.
5. Dietary progression at home
A staged diet is followed during recovery at home:
- Weeks 1-2: soft or pureed foods, in small portions, eaten slowly and chewed thoroughly
- Weeks 3-4: a broader range of soft foods as swallowing comfort and wrap oedema improve
- Weeks 5-6 onward: gradual return to a normal diet, avoiding carbonated drinks and tough or fibrous textures initially
Most patients return to desk-based work within 1-2 weeks. Heavy lifting and strenuous exercise are restricted for 4-6 weeks.
Avoiding carbonated beverages long-term can help reduce gas and bloating, particularly after a complete Nissen fundoplication.
6. Long-term follow-up and monitoring
Follow-up appointments are scheduled at 2 weeks, 6 weeks, 3 months, and 12 months following surgery. At each visit, your surgeon will assess symptom control, swallowing function, and any concerns about bloating or recurrent reflux.
A post-operative gastroscopy may be arranged at 12 months to confirm the position of the repair and assess the oesophageal lining. Patients with Barrett’s oesophagus require ongoing endoscopic surveillance in accordance with current clinical guidelines, regardless of symptom resolution after surgery.
Those who develop recurrent symptoms should return for review, as the repair can fail over time and may require further management.
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(03) 9466 7338Hiatal hernia repair FAQ
The total cost includes the surgeon’s fee, anaesthetist’s fee, and hospital facility charges. Medicare provides a rebate on the surgical fee when the procedure is performed for a confirmed, clinically appropriate indication. Privately insured patients typically pay out-of-pocket costs ranging from $500 to $3,000, depending on their health fund, hospital, and policy level.
Where repair is performed at the same time as a fundoplication (which is standard practice in most cases), this is covered under the same episode of care. Your specific costs will be outlined during your consultation, and we recommend contacting your fund before your appointment to confirm your cover and any applicable waiting periods.
Small, incidentally found hiatal hernias that cause no or minimal symptoms can often be managed with lifestyle modification and proton pump inhibitor therapy. Surgery is recommended when symptoms persist despite adequate medical treatment, when the hernia is large or of a paraesophageal type, or when complications have developed. Your surgeon will assess the type, size, and clinical significance of your hernia before recommending any intervention.
A sliding hiatal hernia, the most common type, occurs when the stomach-oesophageal junction moves above the diaphragm and back, and is closely associated with chronic GORD.
A paraesophageal hernia occurs when a portion of the stomach herniates into the chest alongside the oesophagus and becomes fixed in that position. Paraesophageal hernias are less common but carry a higher risk of serious complications, including incarceration, strangulation, and gastric volvulus, and are generally repaired electively once identified [1].
When repair is combined with fundoplication, approximately 85-90% of appropriately selected patients achieve significant and sustained improvement in reflux symptoms at 5-10 years [2].
Anatomic recurrence on imaging, particularly in large paraesophageal hernias, can occur in 10-25% of patients over time, though many are asymptomatic and do not require further surgery [6]. Outcomes are best in patients with classic reflux symptoms and objectively confirmed GORD on pre-operative testing.
The two are closely related and commonly performed together.
Anti-reflux surgery (fundoplication) reinforces the lower oesophageal sphincter to control reflux. Hiatal hernia repair specifically addresses the diaphragmatic defect that allows the stomach to herniate into the chest. In most patients, both components are performed during the same operation.
Most patients spend 1-2 nights in hospital and return to desk-based work within 1-2 weeks. A staged soft diet is followed for 4-6 weeks, and heavy lifting is restricted for the same period. Most patients return to their normal routine within 3-4 weeks, with swallowing progressively improving over the first 3 months as post-operative oedema resolves.
This depends on which type of fundoplication is performed. A complete Nissen fundoplication significantly reduces the ability to belch and vomit in most patients, which can cause gas and bloating. A partial Toupet fundoplication carries a lower risk of these symptoms. Your surgeon will select the most appropriate technique based on your oesophageal manometry results and symptom profile [5].
Laparoscopic hiatal hernia repair is a Medicare Benefits Schedule (MBS) item when performed for a clinically appropriate indication. Private health insurance generally covers hospital admission and anaesthesia costs, subject to your policy level and any applicable waiting periods. We recommend confirming your entitlements with your fund before your consultation.
Seek emergency medical attention if you develop sudden, severe chest or upper abdominal pain, the inability to swallow, persistent vomiting, vomiting blood, or signs of gastric obstruction. These symptoms may indicate acute incarceration or gastric volvulus, both of which are surgical emergencies primarily associated with paraesophageal hernias. Elective repair, where appropriate, prevents these potentially life-threatening complications [1].
In many cases, yes. Repair of a hiatal hernia and fundoplication are routinely performed together as a single procedure. If you have a concurrent gallbladder condition or have been assessed for other upper GI conditions such as achalasia, your surgical team will advise whether a combined approach is appropriate in your individual circumstances.
Medical disclaimer
The information on this page is for general educational purposes only. It does not constitute medical advice, diagnosis, or treatment recommendations, and does not create a doctor-patient relationship. Individual circumstances vary significantly, and nothing on this page should be used as a substitute for personalised advice from a qualified medical professional.
If you have concerns about your health, please seek medical attention promptly. To discuss your specific condition and treatment options with our team, please book a consultation by calling us at (03) 9466 7338.
References
[1] Siegal SR, Dolan JP, Hunter JG. Modern treatment of paraesophageal hernia. Langenbecks Arch Surg. 2017;402(1):1-8. https://doi.org/10.1007/s00423-016-1521-3
[2] Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27-56. https://doi.org/10.14309/ajg.0000000000001538
[3] Maret-Ouda J, Markar SR, Lagergren J. Gastroesophageal Reflux Disease: A Review. JAMA. 2020;324(24):2536-2547. https://doi.org/10.1001/jama.2020.21360
[4] Garg SK, Gurusamy KS. Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev. 2015;(11):CD003243. https://doi.org/10.1002/14651858.CD003243.pub3
[5] Broeders JAJL, Mauritz FA, Ahmed Ali U, et al. Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg. 2010;97(9):1318-1330. https://doi.org/10.1002/bjs.7174
[6] Lidor AO, Steele KE, Stem M, Fleming AM, Schweitzer MA, Nguyen T. Long-term quality of life and risk factors for recurrence after laparoscopic repair of paraesophageal hernia. JAMA Surg. 2015;150(5):424-431. https://doi.org/10.1001/jamasurg.2014.2685