Hiatus hernia repair

Keyhole surgery to pull the stomach back below the diaphragm, tighten the diaphragm opening, and usually wrap part of the stomach around the lower food pipe to reduce acid reflux from a hiatus hernia.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

It is keyhole surgery to fix a hiatus hernia and reduce acid reflux, usually with a stomach wrap (fundoplication).
It is mainly for severe reflux not controlled by medicines, or for larger rolling hernias, not for everyone with a hernia.
Reflux often improves, but the operation can cause bloating and trouble belching or vomiting, and reflux can return over years.
Difficulty swallowing, chest pain, or being unable to keep fluids down after surgery should be reported promptly.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSurgical operation

AnaestheticGeneral anaesthetic

How long it takesUsually about 1.5–3 hours

Hospital stayOften 1–2 nights in hospital

Time off workAbout 2–6 weeks

When you'll see resultsReflux often improves quickly; final result over weeks as swallowing settles

On the NHS?Available on the NHS for selected people; private care is used for speed or choice

A general guide. Your surgeon will give you advice for your situation.

Best fit

Can reduce or stop acid reflux and heartburn.

Pause if

Your reflux is mild or well controlled by medicines and lifestyle changes, so surgery offers little benefit.

Main recovery point

You stay in hospital, start on fluids and soft food, and take pain relief. Shoulder-tip and tummy discomfort from the gas is common and settles.

Good aftercare

Clear dietary advice with dietitian support for the soft-diet phase.

First 1–2 days

You stay in hospital, start on fluids and soft food, and take pain relief. Shoulder-tip and tummy discomfort from...

First 2 weeks

Follow a soft or sloppy diet as advised, eat small amounts slowly, and avoid fizzy drinks. Build up gentle...

Weeks 2–6

Gradually return to a more normal diet and activity. Avoid heavy lifting and strenuous exercise until your surgeon...

6 weeks to a few months

Bloating and any swallowing difficulty usually ease as healing settles. Your team will review how your reflux and...

Medical line illustration of hiatus hernia diaphragm for Hiatus hernia repair. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is hiatus hernia repair?

A hiatus hernia is when part of the stomach slides up through the opening in the diaphragm (the hiatus) into the chest. Many people have no symptoms, but it can cause acid reflux and heartburn. A larger 'rolling' or paraoesophageal hernia can also cause chest discomfort, swallowing trouble and, rarely, become an emergency.

Hiatus hernia repair is usually keyhole (laparoscopic) surgery. The surgeon pulls the stomach back down, tightens the diaphragm opening with stitches, and usually wraps part of the stomach around the lower food pipe (a fundoplication) to act as a valve and reduce reflux.

Surgery is generally considered when reflux is severe and not controlled by medicines and lifestyle changes, when medicines are not tolerated, when there are complications, or for larger rolling hernias. Most people with a small hernia and mild reflux do not need surgery.

This operation aims to control reflux, not to cure it forever. Reflux can return over time, and the operation can cause its own side effects, such as bloating and difficulty belching or being sick.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Nissen (full 360°) wrap

The top of the stomach is wrapped fully around the lower food pipe. Strong reflux control, but more likely to cause bloating and difficulty belching or being sick.

Toupet (partial 270°) wrap

A partial wrap from behind. Often chosen to lower the chance of swallowing problems and gas-bloat, with slightly less reflux control.

Dor / anterior (partial) wrap

A partial wrap from the front. Another option aimed at balancing reflux control against side effects.

Hernia repair without a wrap

For some larger rolling hernias, the main aim is to return the stomach and close the diaphragm; a wrap may or may not be added.

Repair with mesh

Occasionally mesh is used to reinforce a large diaphragm opening. This is selective, because mesh near the food pipe carries its own risks.

Surgery versus long-term medicines for reflux

Point	Medicines (PPIs)	Surgery
Main aim	Reduce acid	Reduce reflux of contents
Daily tablets	Usually ongoing	Often reduced or stopped
Bloating/belching	Uncommon	Can be a side effect
Reversibility	Stop the tablet	Surgery is harder to reverse

Medicines and surgery both have trade-offs. Surgery can reduce the need for tablets but adds operative risk and possible side effects. The choice depends on your symptoms, tests and preferences.

Preparing for your surgery

See the operating surgeon, who will review your symptoms and tests; many people have a camera test (endoscopy) and tests of swallowing and acid beforehand.
Tell the team about all medicines, especially blood thinners, and any health conditions.
Stop smoking if you can, and discuss weight, as both affect reflux and recovery.
Follow fasting instructions for the day of surgery.
Plan for a soft or sloppy diet for a few weeks after surgery, and stock up accordingly.
Arrange a lift home, as you will usually stay one or two nights.
Plan time off work and help at home for the first couple of weeks.

What happens

On the day, you will meet the surgeon and anaesthetist to confirm the plan and consent. The operation is done under general anaesthetic, almost always by keyhole surgery through several small cuts in the upper tummy.

The surgeon gently pulls the stomach back down below the diaphragm, narrows the widened diaphragm opening with stitches, and usually wraps part of the stomach around the lower food pipe to form a new valve. A full or partial wrap may be chosen depending on your situation.

The operation usually takes around one and a half to three hours. Most people stay in hospital for one to two nights and start on fluids and a soft diet before going home. Occasionally, keyhole surgery needs to be changed to open surgery if it is safer.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Your reflux is mild or well controlled by medicines and lifestyle changes, so surgery offers little benefit.
Tests suggest your symptoms are not actually caused by reflux, so a wrap may not help.
You have a swallowing or motility problem that a wrap could make worse.
You are too unwell for a general anaesthetic and keyhole surgery.

Delay surgery if…

You have an active infection or are acutely unwell.
Important tests, such as endoscopy or studies of swallowing and acid, have not been done.
Blood-thinning medicines need adjusting before surgery.
Weight or smoking could be improved first to lower your risk.
You cannot manage a soft diet and the support needed during recovery.

Alternatives to discuss

Continuing acid-reducing medicines such as proton pump inhibitors, with lifestyle changes.
Weight loss, stopping smoking, smaller meals and raising the head of the bed.
Watchful waiting for a small, symptom-free hernia.
Endoscopic anti-reflux procedures in selected centres, though evidence and availability vary.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

Always used for this operation; you are fully asleep throughout.

Benefits

Can reduce or stop acid reflux and heartburn.
Often reduces or removes the need for daily acid-reducing tablets.
Can ease symptoms caused by a large rolling hernia, such as chest discomfort.
May lower the risk of complications from a large rolling hernia.

Risks & complications

More common

Difficulty swallowing in the early weeks as the area is swollen
Bloating and increased wind, and difficulty belching
Not being able to be sick (vomit) easily after surgery
Shoulder-tip or tummy discomfort from the gas used in keyhole surgery

Less common

Longer-lasting swallowing difficulty needing a stretch (dilatation)
Reflux returning over time
The wrap slipping or coming undone, sometimes needing further surgery
Wound infection or a small bleed

Rare but serious

Injury to the food pipe, stomach, spleen or other organs
Needing to change keyhole surgery to open surgery
Mesh-related problems where mesh is used
Blood clot in the leg or lung, or a chest infection

The trade-off with this operation is that it controls reflux but can cause bloating, difficulty belching and trouble being sick, and reflux can come back over years. Full wraps control reflux more strongly but cause more of these side effects than partial wraps. Ask your surgeon which wrap they recommend and why, and what is known about your tests before deciding.

Published figures to discuss

How well surgery works, and the chance of side effects, depends on patient selection, the type of wrap and the surgeon's experience. Reflux can return over time, and some side effects ease as healing settles. The figures below are broad ranges from NHS information and reviews, not promises for any individual.

Figure	Reported range	How to interpret it	Source / confidence
Lasting symptom relief	A large majority have good reflux control, but long-term failure or recurrent reflux is often reported around 10–15%	Some people see reflux return over time and restart medicines.	Current treatments for gastro-oesophageal reflux disease: review — PMCpmc.ncbi.nlm.nih.govPublished figure
Difficulty swallowing	Common in the early weeks; one standardised series reported persistent dysphagia around 2%, with symptom-questionnaire studies higher	More likely with a full wrap than a partial wrap.	Current treatments for gastro-oesophageal reflux disease: review — PMCpmc.ncbi.nlm.nih.govPublished figure
Bloating and difficulty belching (gas-bloat)	Common early; one standardised series reported persistent gas-bloat around 12.7%, while broader symptom studies vary widely	More likely with a full (Nissen) wrap.	Current treatments for gastro-oesophageal reflux disease: review — PMCpmc.ncbi.nlm.nih.govPublished figure
Further surgery for the wrap slipping or reflux returning	Reported in roughly fewer than 1 in 10 over the medium to long term	Includes redo surgery for a failed or slipped wrap.	Current treatments for gastro-oesophageal reflux disease: review — PMCpmc.ncbi.nlm.nih.govPublished figure

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Most people are home within a couple of days and back to light activity within two to three weeks, but swallowing and bloating can take longer to settle and you will need a soft diet at first.

First 1–2 days

You stay in hospital, start on fluids and soft food, and take pain relief. Shoulder-tip and tummy discomfort from the gas is common and settles.

First 2 weeks

Follow a soft or sloppy diet as advised, eat small amounts slowly, and avoid fizzy drinks. Build up gentle activity; many return to light work within two to three weeks.

Weeks 2–6

Gradually return to a more normal diet and activity. Avoid heavy lifting and strenuous exercise until your surgeon agrees, often around six weeks.

6 weeks to a few months

Bloating and any swallowing difficulty usually ease as healing settles. Your team will review how your reflux and swallowing are doing.

What's normal — and not a worry

Difficulty swallowing solid food at first, easing as swelling settles
Bloating, more wind and feeling full quickly in the early weeks
Shoulder-tip discomfort from the gas used during keyhole surgery
Needing a soft diet and small, slow meals for a few weeks

Aftercare

Follow the advised soft or sloppy diet, eating small amounts slowly and chewing well.
Avoid fizzy drinks early on, as they can worsen bloating.
Take pain relief as advised and keep wounds clean and dry.
Build up walking gently, but avoid heavy lifting and straining early on.
Do not drive until you can do an emergency stop comfortably and your team agrees.
Discuss with your team whether and when to stop acid-reducing medicines.
Keep follow-up appointments and report ongoing swallowing trouble or returning reflux.

Before-surgery checklist

Soft and sloppy foods stocked at home
Pain relief bought or prescribed
Lift home and help for the first week or two arranged
Time off work booked
List of current medicines, including reflux tablets, to discuss
Clinic and out-of-hours contact numbers saved

Scars and how they heal

Keyhole surgery leaves several small scars on the upper tummy, which usually fade well over months. If the operation needs to be changed to open surgery, the scar will be larger. Sun protection helps scars settle.

⚠ Get urgent help if…

Being unable to swallow your own saliva or keep any fluids down
Severe or worsening chest or tummy pain
A high temperature, feeling shivery or generally very unwell
Vomiting blood, or black or bloodstained stools
Increasing redness, heat, swelling or discharge from a wound
A red, hot, swollen or painful calf, or sudden breathlessness or chest pain

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result usually means much less reflux and heartburn and, for many people, fewer or no acid tablets. Symptoms often improve quickly, with the final result clearer once early swallowing difficulty and bloating settle.

The operation aims to control reflux rather than cure it for life. Some reflux can return over the years, and some people are left with bloating or a changed ability to belch or be sick. Ask your surgeon what proportion of their patients are satisfied long term and what to expect if symptoms return.

How long it lasts

Many people get lasting relief, and studies suggest a large majority still have good control years after surgery, although reflux can gradually return and some people restart medicines. The wrap can loosen or slip over time. Keeping a healthy weight and following dietary advice can help. If reflux returns, treatment may be medicines again or, less often, further surgery.

Combining with other procedures

Hiatus hernia repair is sometimes considered alongside other upper tummy surgery, or as part of treatment for a large rolling hernia. Some people exploring weight-loss surgery discuss reflux at the same time. Any combined plan should be clearly explained so you understand the added risks and recovery.

Follow-up & long-term care

You are usually reviewed after surgery to check your wounds, diet progress, swallowing and reflux control. Tell your team if swallowing stays difficult, if reflux returns, or if bloating is hard to manage, as there are ways to help and, occasionally, further tests or treatment are needed.

Eat smaller, slower meals and follow long-term dietary advice if bloating persists.
Review acid-reducing medicines with your team rather than stopping suddenly.
Keep a healthy weight to help protect the repair.
Seek review if reflux or swallowing problems return.

Revision and secondary surgery reality

Reflux can return over the years and may need medicines again.
The wrap can loosen or slip, and a small proportion of people need redo surgery.
Longer-lasting swallowing difficulty sometimes needs a stretch (dilatation).
Redo anti-reflux surgery is more complex than the first operation and carries higher risk.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

Clear dietary advice with dietitian support for the soft-diet phase.
Written warning signs, including being unable to swallow saliva or keep fluids down, with a named contact route.
A plan for reviewing and, where appropriate, stopping acid medicines safely.
Follow-up to check reflux control and swallowing, with a route to further tests or treatment if symptoms return.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The complexity of the hernia and the type of wrap
Tests before surgery, such as endoscopy and swallowing/acid studies
Surgeon and anaesthetist fees
Theatre and facility costs, and the length of hospital stay
Whether mesh is used
Follow-up appointments and any further tests

Make sure your written quote includes

The surgeon's and anaesthetist's fees
Pre-surgery tests included (endoscopy, swallowing and acid studies)
Theatre, facility and hospital stay costs
Any mesh or materials used
Follow-up appointments and dietitian input
The cancellation policy
What happens, and who pays, if there is a complication or symptoms return

On the NHS? Hiatus hernia repair is available on the NHS for selected people, usually after tests and when reflux is severe or medicines are not enough; private care is used mainly for timing, choice of surgeon or self-pay.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

Do my tests show that surgery is likely to help my symptoms?
Do you recommend a full or partial wrap for me, and why?
How likely am I to have bloating or trouble swallowing afterwards?
How likely is my reflux to come back over time?
Will I be able to stop my acid tablets, and when?
What happens if symptoms return or I have ongoing swallowing trouble?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Do I need surgery for my hiatus hernia?

Most people do not. Surgery is mainly for severe reflux not controlled by medicines and lifestyle changes, when medicines are not tolerated, when there are complications, or for larger rolling hernias. Many people manage well with tablets and lifestyle changes.

Will I be able to stop my reflux tablets?

Many people reduce or stop them, but not everyone, and some restart over time. Do not stop them suddenly; discuss timing with your team.

Why might I struggle to belch or be sick afterwards?

The stomach wrap acts as a one-way valve, which can make burping and vomiting harder. This is common early on and is usually less of an issue with a partial wrap.

How long will I be on a soft diet?

Usually a few weeks, building up gradually as swallowing settles. Eating small amounts slowly and avoiding fizzy drinks helps.

Can the reflux come back?

Yes, it can return over the years, and the wrap can loosen. Many people still have good control long term, but the operation controls reflux rather than curing it for life.

Is it available on the NHS?

Yes, for selected people who meet the criteria, usually after tests. People may choose private care for timing or choice of surgeon.

Find a verified surgeon for hiatus hernia repair

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

No verified consultants list this procedure yet — browse the full directory.

See all surgeons for hiatus hernia repair →

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Hiatus hernia Guy's and St Thomas' NHS — Fundoplication surgery for severe acid reflux Hull University Teaching Hospitals NHS — Nissen fundoplication and hiatus hernia repair NICE — Endoscopic radiofrequency ablation for GORD (IPG461) Current treatments for gastro-oesophageal reflux disease: review — PMC Persistent dysphagia and gas-bloat after laparoscopic fundoplication — PMC

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.