Hiatal hernias are repaired by thoracotomy with a single incision in the chest wall or by laparotomy with a single incision in the abdomen. Laparoscopic surgery involves the surgeon inserting a camera and tools through incisions in the abdomen and performing the surgery from a video monitor, states Mayo Clinic.
Surgery to repair a hiatal hernia requires the patient to be under general anesthetic. During surgery, the portion of the stomach that’s pushed through the hiatus is moved back into the abdominal cavity below the diaphragm, according to MedlinePlus. After the stomach is moved, the surgeon tightens the hiatus, repositions the stomach to reduce reflux and places stitches. In some cases, to reduce reflux, the surgeon may wrap the stomach around the esophagus and sew it into place in a procedure called fundoplication.
A hiatal hernia occurs when part of the top of the stomach (the fundus) pushes up through the hiatus, the small opening in the diaphragm through which the esophagus passes. Large hiatal hernias cause food and stomach acid to back up into the esophagus, leading to pain, severe inflammation of the esophagus, abnormal narrowing of the hiatus and chronic inflammation of the lungs due to aspirating gastric fluids.