Hiatus Hernia: Symptoms, Treatment and Surgery in Singapore
A hiatus (hiatal) hernia is when part of the stomach moves up into the chest through the opening in the diaphragm where the food pipe passes. Many cause no symptoms; others cause heartburn and reflux. Most are treated with lifestyle changes and medicine, and keyhole surgery is considered when symptoms persist or the hernia is a para-oesophageal type.
What is a hiatus hernia?
The food pipe (oesophagus) passes through an opening in the diaphragm, the sheet of muscle between the chest and the abdomen, to join the stomach. Where they meet, a valve normally helps keep stomach acid out of the food pipe. If the opening widens, part of the stomach can move up into the chest.
Sliding hiatus hernia
The most common type. The valve and the top of the stomach slide up into the chest. It is closely linked with acid reflux.
Para-oesophageal (rolling) hernia
Less common. Part of the stomach rolls up beside the food pipe while the valve may stay in place. It can twist or become trapped, so it is watched more closely and more often repaired.
Hiatus hernia symptoms
- Heartburn: a burning feeling behind the breastbone
- Acid or food coming back up, or a sour taste
- Burping, bloating or feeling full quickly
- Discomfort or pressure in the chest or upper belly after meals
- Difficulty swallowing
Large para-oesophageal hernias can also cause breathlessness after eating, or anaemia from slow bleeding.
Seek urgent care if you have
- Severe chest or upper belly pain with vomiting, or retching without being able to bring anything up
- Vomiting blood or black stools
- Inability to swallow food or saliva
Go to the emergency department or call 995. Chest pain can also come from the heart and should be checked urgently.
Tests for a hiatus hernia
Gastroscopy
A thin camera passed through the mouth shows the hernia, and any inflammation of the food pipe from reflux.
Contrast X-ray or CT
A barium swallow X-ray or CT scan shows the size and type of the hernia, which helps plan treatment.
Before reflux surgery
Tests of how the food pipe squeezes (manometry) and how much acid reaches it (pH monitoring) are often done before an anti-reflux operation.
Hiatus hernia treatment
Lifestyle changes
Smaller meals, not lying down for two to three hours after eating, raising the head of the bed, losing weight if needed, and cutting down on trigger foods, alcohol and smoking.
Medicines
Acid-reducing medicines, such as proton pump inhibitors, control reflux symptoms for most people.
Surgery
Considered when reflux persists despite medicine, when long-term medicine is not wanted or not suitable, for complications, or for a para-oesophageal hernia that causes symptoms.
A sliding hiatus hernia that causes no symptoms does not need surgery. For more on reflux, see KYM Surgery’s acid reflux site.
Hiatus hernia repair and fundoplication
Hiatus hernia surgery is usually done by keyhole surgery under general anaesthesia. The stomach is brought back down into the abdomen and the widened opening in the diaphragm is narrowed with stitches.
For people with reflux, the repair is usually combined with a fundoplication: the top of the stomach (the fundus) is wrapped around the lower end of the food pipe to strengthen the valve. Dr Kan Yuk Man performs both full (Nissen, 360°) and partial (Toupet and Dor) fundoplications, and will recommend the type that suits you.
After surgery
- Usually a short hospital stay
- Fluids, then soft or minced food for a few weeks
- Some difficulty swallowing at first is common and usually settles
- Bloating, more wind or difficulty burping can occur and usually improve with time
Hiatus hernia surgery cost in Singapore
The Ministry of Health fee benchmarks for the surgeon’s fee in private hospitals, including GST:
Actual fees depend on the size and type of hernia and the length of stay.
Source: MOH fee benchmarks for surgical procedures.
Frequently asked questions
Common questions about hiatus hernias and reflux surgery.
Does a hiatus hernia always need surgery?
No. Many hiatus hernias cause no symptoms and need no treatment, and reflux symptoms are usually controlled with lifestyle changes and medicine. Surgery is considered when symptoms persist, for complications, or for a para-oesophageal hernia that causes symptoms.
Can a hiatus hernia go away on its own?
The hernia itself usually does not go away, but its symptoms can often be controlled well without surgery.
Can a hiatus hernia cause chest pain?
It can cause burning chest pain from reflux, or pressure after meals. Chest pain can also come from the heart, so new or severe chest pain should always be checked urgently. Call 995 if you have chest pressure, breathlessness or pain spreading to the arm or jaw.
What is a fundoplication?
An operation in which the top of the stomach is wrapped around the lower end of the food pipe to strengthen the valve between them and stop reflux. It is often combined with hiatus hernia repair.
What can I eat after hiatus hernia surgery?
Most people start with fluids and then soft or minced food for a few weeks, eating small meals slowly while the area heals. Dr Kan’s team will give you a diet plan.
Will I still be able to burp after a fundoplication?
Most people can. Some find burping or vomiting harder, or have more bloating and wind for a while; this usually improves over time.
Reflux that medicine is not controlling?
Dr Kan Yuk Man, senior consultant surgeon, can assess your hiatus hernia and explain whether surgery would help.
Disclaimer: This article is for general information only and is not a substitute for medical advice. Please consult a qualified doctor for advice specific to your situation.
Clinical guidance based on the SAGES guidelines for the management of hiatal hernia (2013).