Hiatus hernia surgery in Oxford
A hiatus hernia is an incredibly common condition, with most people over the age of 40 having a small hiatus hernia. While small hiatus hernias are managed within the spectrum of gastro-oesophageal reflux treatment, very large (often called "Giant") hiatus hernias require more specialist treatment due to the complexity of operating in the upper abdomen and lower chest at the same time.
I provide specialist surgical care for complex and giant hiatus hernias, often treatable through keyhole minimally invasive surgery.
Most patients are seen within 1-2 weeks of enquiry
What is a hiatus hernia?
The diaphragmatic hiatus is the narrow, muscle-bound gap in the middle of the diaphragm (the muscle sheet between the chest and abdominal cavities) through which the gullet (oesophagus) passes before entering the stomach.
A hiatus hernia is where some or all of the stomach, or other organs (e.g. colon, spleen, pancreas) slide up into the chest alongside the oesophagus.
Small hiatus hernias are common, and generally comprise 2-5cm of stomach sliding up, moving the junction of the stomach and oesophagus into the chest. This predisoposes to gastro-oesophageal reflux but they can often be ignored.
More complex hiatus hernias, also called giant or paraoesophageal hiatus hernias, can contain other organs or sometimes the whole stomach.
What are the consequences of a hiatus hernia?
All hiatus hernias predispose to gastro-oesophageal reflux, however very large hernias can cause more reflux, regurgitation and a predisposition to recurrent chest infections. They can also cause more significant problems involving the stomach, oesophagus, bowel, heart and lungs.
Gastric volvulus is where the stretched stomach attachments allow the stomach to twist, resulting in blockage of foods entering and leaving the stomach, and sometimes causing loss of blood supply to the stomach. When the stomach twists and untwists intermittently people suffer pain, vomiting and difficulty swallowing. Sometimes the stomach doesn't untwist spontaneously or can involve other organs such as the colon, and requires emergency surgery.
The hernia in the chest can also cause compression of the heart and lungs, resulting in shortness of breath and reduced exercise tolerance.
When is surgery for hiatus hernias sensible?
The majority of large hiatus hernias cause symptoms, however this is not always apparent until a detailed history is taken.
Elective hiatus hernia surgery is advised in several circumstances:
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Episodes of chest pain and difficulty swallowing suggestive of intermittent gastric volvulus
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Reflux uncontrolled by medication
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Recurrent chest infections
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Chest pain and shortness of breath (after exclusion of other causes)
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Concern regarding future progression of the hernia and the need for surgery when older and less fit.
Are there any non-operative options for hiatus hernia?
The only absolute indication for surgery in hiatus hernia is acute incarceration (i.e. stomach or other organ become trapped and twisted in the hernia).
Other than managing symptoms with anti-acid medications and modifying diet towards softer and smaller meals, there is no non-operative option.
What pre-operative tests are needed before hiatus hernia surgery?
A structured work-up is essential before considering surgery.
Investigations may include:
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Upper GI endoscopy – to assess inflammation and anatomy
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CT scan or barium swallow
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Oesophageal physiology where appropriate
This ensures surgery is appropriate, safe, and tailored to your physiology.
What is the difference between hiatus hernia and anti-reflux surgery?
Hiatus hernia surgery can reasonably be regarded as extensive anti-reflux surgery. The latter steps are identical, featuring closure of the hiatus and a wrap of the upper stomach around the lower oesophagus.
The initial step includes reducing the contents and the lining of the hernia from the chest, which is done by keyhole surgery from the abdomen. The larger the hernia, the more that must be retrieved from the chest.
What do you do in hiatus hernia surgery?
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5 or 6 keyhole incisions in the abdomen
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Contents and lining of the hernia are pulled back into the abdomen from chest
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The enlarged hiatus is made smaller with sutures
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The upper stomach is wrapped around the lower oesophagus - this helps keep the stomach in the abdomen and prevents reflux
Risks and considerations
While most people make a full recovery and are discharged from hospital within a day or two, it is important to be clear that this is a major operation.
All operations carry risks of infection, bleeding, blood clots in the legs and lungs, as well as stress to other body systems (particularly the heart and lungs).
This operation specifically carries risks of injury to other organs near the repair (lungs, oesophagus, spleen, stomach, heart) - this is thankfully rare - as well as an unacceptable long-term functional outcome due to difficulty in swallowing.
Recovery after hiatus hernia surgery
Most people go home within two days of surgery, tired and a little sore but able to be physically active.
While the swelling around the oesophagus settles it is important to eat a "soft and sloppy" diet - this is best regarded as food like cottage pie - i.e. no large chunks and moist so can easily be swallowed and passed through the oesophagus.
It is important to avoid strenuous exercise for two weeks, and heavy lifting for six weeks in total, but it is important to be up and active straight after surgery to reduce the risk of complications.
Self-pay hiatus hernia surgery in Oxford
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I offer a comprehensive self-pay pathway:
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Rapid access to consultation and investigations
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Structured specialist assessment
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Surgery without long waiting times
Guide price:
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£8,000 – £12,000 for surgery
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If required, pre-operative endoscopy and functional assessment a further £2500-£3500
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A personalised quotation will be provided following assessment
Why choose my practice?
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Experienced consultant general surgeon
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Specialist interest in reflux and hiatus hernia surgery
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Advanced laparoscopic techniques
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Careful patient selection (critical for good outcomes)
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Focus on long-term symptom control
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Clear, honest and evidence-based advice
Book a consultation
If you are struggling with reflux symptoms or considering alternatives to long-term medication, I would be happy to assess you.
Call my secretary on 07947 177843
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I also provide specialist care for general surgical conditions including: