GERD and Hiatal Hernia: When Is Surgery the Right Step?

Reflux happens when the valve between the oesophagus and stomach does not close well, so acid rises into the oesophagus. A hiatal hernia is a widening of the opening in the diaphragm that lets part of the stomach slip up into the chest. This weakens the valve and makes reflux worse.

1. Lifestyle: lose excess weight, avoid lying down straight after eating, raise the head of the bed, and cut back on fatty meals, caffeine and smoking.
2. Medicine: proton pump inhibitors and other medicines as prescribed.
3. Tests: if symptoms persist, an upper endoscopy, acid (pH) monitoring and oesophageal manometry confirm the diagnosis and guide treatment.
4. Surgery: for a selected group, as below.

• Symptoms that continue despite treatment and are proven to be caused by reflux.
• You do not want, or cannot take, medicines for many years because of side effects.
• A large hiatal hernia, or complications such as inflammation, ulcers or bleeding in the oesophagus.

It is usually done laparoscopically under general anaesthesia. The surgeon brings the stomach back into the abdomen and tightens the opening in the diaphragm with stitches, then wraps the top of the stomach around the lower oesophagus (fundoplication) to act as a new valve. Details are on our GERD and hiatal hernia treatment in Dubai page.

The most common issue is temporary difficulty swallowing, which goes away in most people within the first three months, along with bloating and trouble burping. In some patients the hernia or reflux can return years later, on top of the general risks of anaesthesia and surgery. You start with soft food and build up gradually as your doctor advises.

For people with obesity and chronic reflux, a gastric bypass may treat both problems at once. See Sleeve or bypass?.

Difficulty or pain swallowing, unexplained weight loss, repeated vomiting or vomiting blood, black stools, or chest pain (heart pain can feel like heartburn).