A hiatal hernia (also called a hiatus hernia) occurs when part of the stomach pushes upward through the diaphragm into the chest cavity. It is one of the most common conditions encountered in upper-GI clinics in Dubai, and is the single biggest anatomical cause of chronic acid reflux (GORD). Many people live with a small sliding hiatus hernia without symptoms, while others suffer daily heartburn, regurgitation, chest pain, chronic cough or even difficulty swallowing. When lifestyle changes and acid-suppressing medication are no longer enough — or when the hernia is large or paraoesophageal — laparoscopic repair with a fundoplication offers a definitive cure. Dr. Vanesha Varik is a female specialist general & laparoscopic surgeon at Medcare Hospital Al Safa, Dubai, who manages the full spectrum of hiatal hernias and reflux disease. This guide explains the condition in plain language, when surgery is the right answer, and what to expect.
What is a hiatal hernia?
The diaphragm is the muscular sheet that separates the chest from the abdomen. The oesophagus passes through a small opening in the diaphragm called the hiatus before joining the stomach. A hiatal hernia occurs when this opening becomes stretched or weakened and part of the stomach slides upward into the chest.
Hiatal hernias are extremely common — small ones are present in up to 1 in 5 adults over the age of 50 — but only a minority cause significant symptoms.
The four types of hiatal hernia
- •Type I (Sliding) — by far the most common (~95%). The gastro-oesophageal junction slides up into the chest. Strongly associated with acid reflux.
- •Type II (Pure paraoesophageal) — rare. The junction stays in place but the gastric fundus rolls up alongside the oesophagus.
- •Type III (Mixed) — both sliding and paraoesophageal components. Most large symptomatic hernias.
- •Type IV (Complex) — other organs (colon, spleen, small bowel) also herniate into the chest. Always needs surgery.
Symptoms
Reflux-related symptoms (most common):
- •Burning chest pain (heartburn), worse after meals or lying down
- •Acid or food regurgitation, especially at night
- •Sour taste, bad breath, dental erosion
- •Chronic cough, hoarseness, asthma-like symptoms
- •Sleep disturbance
Mechanical symptoms (suggest larger or paraoesophageal hernia):
- •Difficulty swallowing (dysphagia), food getting stuck
- •Chest pain or pressure after eating, often relieved by belching
- •Early satiety, bloating, shortness of breath when lying flat
- •Iron-deficiency anaemia from chronic ulceration (Cameron's ulcers)
- •Vomiting, retching that fails to bring anything up — surgical emergency
How hiatal hernia is diagnosed
- •Upper GI endoscopy (gastroscopy) — the most important test. Confirms the hernia, grades any oesophagitis, takes biopsies for Barrett's oesophagus, excludes ulcers and cancer.
- •Barium swallow — gives a beautiful anatomical picture, particularly useful for large or paraoesophageal hernias.
- •24-hour pH and impedance study — measures actual acid exposure when the diagnosis of reflux is unclear.
- •Oesophageal manometry — tests how well the oesophagus pumps food down. Mandatory before any anti-reflux surgery to choose the right type of fundoplication.
When is surgery needed?
Surgery is recommended when:
- •Reflux symptoms persist despite optimised PPI (proton-pump inhibitor) therapy
- •You don't want to take long-term reflux medication
- •PPI side-effects, intolerance or concerns about long-term use
- •Large hiatal hernia (≥ 5 cm) even if symptoms are mild
- •Any paraoesophageal component (Type II–IV)
- •Complications: severe oesophagitis, stricture, Barrett's oesophagus, anaemia
- •Volvulus or obstruction — emergency surgery
The surgery: laparoscopic hiatal hernia repair + fundoplication
Modern hiatal hernia surgery is performed laparoscopically through 4–5 small incisions. Under general anaesthesia, the surgeon:
- •Reduces the stomach back into the abdomen
- •Mobilises the lower oesophagus and dissects the hernia sac off the chest
- •Closes the widened diaphragmatic hiatus with strong sutures (cruroplasty)
- •Reinforces with a biological or composite mesh if the defect is large
- •Performs a fundoplication — wrapping part of the stomach around the lower oesophagus to recreate a one-way valve. Either a 360° Nissen wrap or a 270° posterior Toupet wrap (chosen based on manometry findings)
Operating time is typically 90–150 minutes.
Recovery after laparoscopic anti-reflux surgery
- •Hospital stay: 1–2 nights
- •Diet: liquids day 1, soft purée diet for 2 weeks, then gradual return to normal solids over 4–6 weeks
- •Common temporary side-effects: difficulty belching, increased flatulence, mild dysphagia for solids in the first few weeks (“gas bloat syndrome”). Settles in most patients
- •Return to desk work: 7–10 days
- •Return to gym/heavy lifting: 4–6 weeks
- •PPI medication is usually stopped on the day of surgery
Outcomes and long-term results
Laparoscopic anti-reflux surgery is one of the most satisfying operations in modern surgery. Long-term studies show:
- •85–95% of patients report excellent or good control of reflux symptoms 10 years later
- •Up to 90% are completely off PPI medication
- •Quality of life scores improve dramatically and persist long-term
- •Recurrence of large hernias is around 5–10% over 10 years (lower with mesh reinforcement)
Female patient considerations
Reflux disease is particularly common in women, especially after pregnancy and around menopause. A female surgeon may be preferred for discussion of body-image, weight, hormonal contributors and the upper-abdominal/chest examination. Dr. Vanesha Varik combines technical expertise with a discreet, women-led environment at Medcare Hospital Al Safa.