When the stomach protrudes upwards through the hiatal opening in the diaphragm, it creates a hiatal hernia that often does not require treatment outside of heartburn or acid reflux drugs to manage its symptoms. In extreme situations, a hiatal hernia may need to be repaired surgically, explains Mayo Clinic. For this surgery, doctors return the protruding piece of stomach to its original location and use stitches to narrow the hiatal opening, according to Aria Health.
Hiatal hernia surgery is done either laparoscopically or traditionally using an open incision. The laparoscopic method is minimally invasive and heals faster. Doctors make small incisions near the site of the hernia through which they insert a scope and tools necessary to perform the repair. Depending on the extent of the hernia, doctors may install a reinforcing mesh in the diaphragm or suture the stomach to the abdomen to hold it in place, explains Aria Health.
In a standard hiatal hernia, the union of the stomach and diaphragm pushes through the hiatal opening. This type of hernia rarely requires a surgical treatment. Most commonly, younger patients whose hiatal hernias induce serious acid reflux opt for a surgical repair in the hopes of avoiding lifetime drug treatment. Paraesophageal hiatal hernias require surgery more often. In these, a more remote section of the stomach protrudes through the hiatal opening. This can cut off blood flow to that section of the stomach, or twist, tear or puncture the digestive tract, which can be fatal, notes Aria Health.