Hiatal hernias are relatively common but not always well understood. They can cause a range of symptoms, including acid reflux, chest discomfort and difficulty swallowing. While some people find relief through simple lifestyle changes, others may require further treatment if symptoms persist or begin to interfere with their daily life.
In this post, we’ll walk you through the main symptoms of hiatal hernias, how they’re diagnosed and when surgical treatment, including laparoscopic hernia repair, might be the right choice.
What is a hiatal hernia?
A hernia is the medical term for when an internal part of the body pushes through a weakness in the muscle or tissue and causes a lump.
A hiatal hernia happens when part of your stomach moves up through the diaphragm (the large muscle that separates your chest from your abdomen) and into your chest area. The diaphragm has a small opening called the hiatus, which allows the oesophagus (food pipe) to pass through to the stomach. When the stomach pushes up through this opening, it’s called a hiatal hernia.
There are two main types of hiatal hernia:
- Sliding hiatal hernia – the most common kind, where the stomach and oesophagus slide in and out of the chest through the hiatus
- Para‑oesophageal hernia – less common but more serious, where part of the stomach pushes up and sits next to the oesophagus, which can lead to strangulation (the blood supply to that part of the stomach gets cut off and is a medical emergency)
Symptoms of a hiatal hernia
Some people with a hiatal hernia might not notice any symptoms at all. But when symptoms do show up, they’re often linked to conditions like acid reflux and an increased risk of gastro‑oesophageal reflux disease (GORD).
A hiatal hernia can weaken the valve between the stomach and oesophagus, making acid reflux worse.
Symptoms can include:
- Heartburn (a burning feeling in your chest)
- Acid reflux (a sour taste that rises in the mouth)
- Food or liquid coming back up
- Bloating and burping
- Feeling sick or vomiting
- Trouble swallowing
- Pain in the chest or upper abdomen
- Shortness of breath, particularly with larger hiatal hernias
Even if your symptoms seem mild, it’s a good idea to speak with a doctor if you notice any changes that persist or affect your daily life.
Diagnosing a hiatal hernia
If you’re having frequent reflux or discomfort in your upper abdomen, it’s worth getting checked out.
Your doctor will first talk through your symptoms, medical history and perform a physical exam. If they believe you may have a hiatal hernia, they might recommend tests such as:
- Barium swallow X‑ray – you’ll drink a liquid that coats your digestive tract and makes it easier to see your stomach and oesophagus on an X‑ray
- Upper gastrointestinal endoscopy – a small camera on a flexible tube is passed through your mouth to look closely at the oesophagus and stomach
- Oesophageal manometry – how well the muscles in your oesophagus can contract (squeeze) is measured using a thin, flexible tube with sensors attached
These tests help confirm the diagnosis and determine what kind of treatment is right for you.
When does a hiatal hernia need treating?
Not all hiatal hernias need treatment, particularly if they aren’t causing noticeable symptoms.
However, treatment may be needed if you have:
- Frequent or intense acid reflux or heartburn
- Symptoms that make everyday life more difficult
- Other issues like oesophagitis (inflammation), ulcers or Barrett’s oesophagus (a change in the cells lining the oesophagus)
If you’re unsure whether your symptoms are related to a hernia, speaking with a specialist can help put your mind at ease.
You can learn more about when you should have hernia surgery in our informative blog post, ‘How long can you wait to have hernia surgery?’.
Treating a hiatal hernia
Once a hiatal hernia has been diagnosed, the right treatment will depend on the type and severity of your symptoms. For many people, simple changes in lifestyle and diet are enough to bring relief. Others may need medication or surgery to manage more persistent or troublesome symptoms.
Non-surgical treatments of hiatal hernias
In some hiatal hernia cases, the first step is to try lifestyle and diet changes.
Some people find relief by:
- Avoiding foods that trigger symptoms, like spicy or fatty meals
- Eating smaller meals more often
- Losing weight if needed
- Raising the head of your bed to ease night‑time acid reflux
- Waiting before lying down after meals
- Quitting smoking and limiting alcohol
You might also be prescribed medication to reduce acid levels in your stomach, like antacids, H2 blockers or proton pump inhibitors (PPIs).
If these approaches don’t ease your symptoms, surgery could be the next step.
Hiatal hernia surgery
Surgery might be recommended if your hiatal hernia is causing you significant symptoms that are affecting your daily life, or is large.
Surgery can be performed using laparoscopic (keyhole) or robot-assisted methods.
Laparoscopic hernia repair
Laparoscopic hernia repair (a type of keyhole surgery) is the most common approach. It involves making several small cuts in your abdomen to insert a camera and surgical tools.
The main aims of surgery are to:
- Move the stomach back into place
- Tighten the opening in the diaphragm
- Reduce reflex symptoms
Often, the surgeon will also perform a procedure called fundoplication. This means wrapping the top part of the stomach around the lower oesophagus to strengthen the valve that stops acid from flowing back up to your throat.
Robot-assisted surgery
In some cases, particularly for more complex hernias, robot‑assisted surgery might be used.
There are many benefits of robot-assisted surgery, such as:
- Less pain after the operation
- Lower chance of complications
- A quicker recovery
- Minimal risk of scarring
Both laparoscopic and robot-assisted hiatal hernia repair are minimally invasive techniques that offer you an enhanced recovery and outcome.
Recovering from hiatal hernia surgery
Most people recover well after surgery and are back to their usual routine within a few weeks. You might stay in the hospital for a day or two, and depending on your job, return to work in a week or so.
Full recovery after laparoscopic surgery or robot-assisted surgery usually takes around four to six weeks. You’ll start with a soft diet, ease back into normal eating and need to avoid heavy lifting during the early stages.
With the right care and support, most people feel a real improvement and can get back to daily life feeling much more comfortable.
Book a consultation with Mr Achal Khanna
If you’ve been living with ongoing reflux, chest discomfort or other upper digestive symptoms, it’s worth exploring whether a hiatal hernia could be the cause. Getting the right diagnosis can bring peace of mind and help prevent symptoms from getting worse over time.
Mr Achal Khanna is an upper gastrointestinal surgeon who specialises in diagnosing and treating hiatal hernias through minimally invasive techniques. He offers advanced treatments that aim to reduce your symptoms and improve your quality of life.
To find out more and discuss your options, book a private consultation with Mr Khanna today.