Recovery Best Practices After Hiatal Hernia Surgery

The diaphragm is a large muscle that separates the chest and abdominal cavity. It has a small hiatus (opening) through which the esophagus (food pipe) passes before connecting to the stomach opening.

A hiatal hernia is a condition in which the upper part of the stomach bulges up through the diaphragm into the chest. Small hiatal hernias do not usually cause problems, and affected individuals may not even be aware of them. However, a large hiatal hernia can cause severe symptoms like backflow of stomach acid into the esophagus (heartburn and GERD symptoms), regurgitation of food into the mouth, chest pain, abdominal pain, shortness of breath, and early satiety (feeling full soon after eating). Acidic foods and fried foods can make the symptoms of hiatal hernia worse.

Please continue reading to learn more about surgical hiatal hernia repair, including best practices during the recovery period.

Why do I need hiatal hernia surgery?

If you have a small hiatal hernia, lifestyle changes, medications, and other treatments may help relieve acid reflux symptoms. However, if you have chronic reflux or gastroesophageal reflux disease (GERD) that does not respond to medical treatments, your healthcare professionals may recommend hiatal hernia surgery. Surgery may also be recommended if the bulging stomach portion is so tightly squeezed that its blood supply is cut off, which would be a medical emergency.

If left untreated, a hiatal hernia can lead to complications like esophagitis (inflammation), esophageal ulcers, Barrett’s esophagus, gastrointestinal bleeding, and scarring of the esophagus.

The goal of hiatal hernia surgery is to prevent acid reflux by creating a functioning sphincter (valve mechanism) that allows food to pass down into the stomach but keeps the contents of the stomach from moving back into the esophagus. The surgery is very successful in relieving symptoms of GERD. Some people undergo weight loss surgery in combination with hiatal hernia surgery.

What is the difference between laparoscopic surgery versus open repairs?

During a hiatal hernia surgery, the surgeon wraps the fundus (upper part of the stomach) around the lower part of the esophagus. This creates a sphincter (valve) that prevents the stomach contents from refluxing (going back) into the esophagus.

The procedure is called a Nissen fundoplication, and there are two ways to do it. Open repairs are done through a larger incision that gives the surgeon greater visibility during the procedure. However, these repairs require a longer recovery time and are recommended for very severe cases of hiatal hernia.

In many cases, surgeons perform a laparoscopic Nissen fundoplication instead. A laparoscopic repair is a minimally-invasive procedure done through 5-6 tiny incisions instead of a single large one. The advantages of a laparoscopic repair are that there is a lower risk of infection, less pain, less scarring, and a shorter recovery time after hiatal hernia surgery.

How long does it take for a hiatal hernia to heal after surgery?

You should expect to stay in the hospital for 1-2 days if you have an open repair. You may be able to go home the same day after laparoscopic surgery. Recovery time after hiatal hernia surgery is typically 6-8 weeks. However, this can vary depending on your general health status and healing process. Most people take. 2 weeks off work to recover from hiatal hernia surgery. However, people in more physically demanding jobs may need to stay off work for several weeks.

How painful is recovery from hiatal hernia surgery?

Many people experience discomfort and pain for 2-4 weeks after hiatal hernia surgery. Pain during the recovery process can usually be managed with medications. If you feel the discomfort is significant or if you have difficulty swallowing, contact your surgeon. Most people can resume their normal activities and routine in 2-4 weeks with no further issues and good long-term outcomes.

Can I bend over after hiatal hernia surgery?

You can bend over after hiatal hernia surgery, but it’s a good idea to avoid bending over after meals. There are no specific activity restrictions as such after hiatal hernia surgery. You can walk, climb stairs, exercise, mow the lawn, and have sex as long as these activities are not painful. In fact, a return to normal activity is encouraged because it helps to prevent blood clots and speeds up recovery after hiatal hernia surgery.

Wound care after hiatal hernia surgery

Your surgeon will probably tell you it is okay to shower 3 days after hiatal hernia surgery. You will need to avoid baths, swimming, and hot tubs for 2 weeks. The Steri-Strips (small pieces of tape) on your incisions will peel off on their own in 7-10 days. However, you should remove any bandages or gauze before showering. Do not put any ointments or creams on the incision area on your abdomen unless your surgeon tells you to.

Diet after hiatal hernia surgery

There are some dietary restrictions after hiatal hernia surgery. Your surgeon will start you on a clear liquid diet and soft foods for 2-3 weeks after the surgery. You may notice a “tight” feeling when you swallow during the early recovery period. This is because of swelling around the esophagus and will improve over time.

Even after you are given the green signal to eat a regular diet, try to avoid foods that can irritate your esophagus, such as spicy, acidic, or fatty foods, citrus fruits, coffee, tea, carbonated beverages, and alcohol. Ease back into your normal diet by eating smaller meals, starting with soft and easy-to-digest foods like clear liquids, soups, yogurt, scrambled eggs, mashed potatoes, rice, and steamed chicken, fish, or vegetables.

Bowel movements after hiatal hernia surgery

Most patients have their first bowel movement 1-5 days after hiatal hernia surgery. There can be more gas because belching is limited while the internal organs heal. Some patients also have loose stools for a few days. Patients taking pain medication may experience constipation. However, bowel function usually returns to normal within a week or two. Walking promotes bowel movements in an excellent way.

Do and don'ts after hiatal hernia surgery

Do’s

Take one to two weeks off work and get plenty of rest.
Do breathing exercises and coughing exercises as advised by your surgeon.
Eat smaller, more frequent meals.
Stay upright for 2-3 hours after meals to prevent reflux and heartburn.
Raise the head of your bed by 6-8 inches to prevent stomach acid backflow into the esophagus.
Call your surgeon’s office if you have a fever of 100.4 or higher, chills, difficulty swallowing, increasing pain, pus or redness at the incision site, persistent nausea, or inability to take even liquids.

Dont’s

Do not smoke or consume alcohol.
Do not drink through straws, as this carries air into the stomach.
Avoid foods that can irritate your esophagus or cause stomach acid reflux.
Avoid strenuous exercise and heavy lifting for four to six weeks after your procedure.
Do not drive or operate heavy machinery if you are on narcotic pain medication after hiatal hernia surgery.

References: