Overview
Fixing the doorway between chest and abdomen.
The diaphragm is the muscular sheet that separates the chest from the abdomen, and it has a small opening — the hiatus — through which the esophagus passes to join the stomach. When that opening stretches, the upper part of the stomach can slide upward into the chest. The result is a hiatal hernia, which weakens the body's natural anti-reflux barrier and often produces years of heartburn, regurgitation, and chest pressure.
Small sliding hiatal hernias are very common and may not need surgery. Larger sliding hernias and paraesophageal hernias — where part or all of the stomach sits up in the chest — are different. They cause symptoms, they get worse over time, and they should usually be repaired before they become emergencies. Repair restores the normal anatomy and almost always includes a fundoplication to recreate the anti-reflux valve.
Who is a candidate?
We consider surgery for patients with a hiatal hernia plus persistent reflux despite medication, for paraesophageal hernias of any size, and for hiatal hernias causing symptoms like swallowing trouble or chest pressure. Pre-operative workup typically includes upper endoscopy, a barium swallow, esophageal manometry, and sometimes pH testing to confirm the diagnosis and choose the right operation. Older patients with paraesophageal hernias are still good candidates — repair is well tolerated and prevents the rare but serious complications of gastric volvulus or strangulation.
How we perform it
The operation is performed under general anesthesia, robotically through five small incisions across the upper abdomen. The stomach is gently brought back into the abdomen, the hernia sac is dissected away from the chest, and the diaphragm opening is closed snugly around the esophagus. We then perform a fundoplication — usually a partial (Toupet) or full (Nissen) wrap of the upper stomach around the esophagus — to recreate the anti-reflux valve. Sometimes biologic mesh is used to reinforce the diaphragm closure. The whole operation takes about 2–3 hours.
Recovery
Most patients stay one or two nights in the hospital. Pain is mild and managed with non-opioid medication in most cases. You'll start with clear liquids and advance through a soft diet over the first four weeks — small, frequent meals; nothing dry; no carbonated drinks or large pieces of bread or meat. Most patients are back to desk work within a week and full activity within two to three weeks. Swallowing usually improves dramatically; some patients have temporary difficulty with the first bites of solid food, which resolves.
Why Florida Surgical
Hiatal hernia repair done well requires careful diaphragm closure, an appropriate fundoplication tailored to esophageal function, and avoidance of recurrence — the biggest pitfall in this operation. Dr. Decio is fellowship-trained in foregut surgery and performs a high volume of robotic hiatal hernia and anti-reflux work. We perform manometry and pH testing routinely so the wrap fits the patient's physiology, not a template.
Frequently asked questions
Will I be able to burp and vomit after a Nissen fundoplication?
Many patients have decreased ability to burp in the first few months as the wrap settles, and vomiting through the wrap is difficult for the first weeks. Both usually return — though belching may stay reduced. For patients particularly bothered by this, we offer a partial fundoplication (Toupet) instead.
Can hiatal hernias come back after surgery?
Yes, particularly in larger paraesophageal hernias. Long-term recurrence rates are 10–15%. Most recurrences are small and don't need re-operation. We use absorbable biologic mesh in larger repairs to reduce recurrence.
What can I eat after surgery?
Clear liquids for 24 hours, then full liquids and pureed soft foods for two weeks, then a soft diet for two more weeks. You'll be back to a normal diet by 4–6 weeks. Avoid dry meats, bread, and carbonated drinks until you're cleared.
Do I have to stop my reflux medication right away?
Yes — most patients stop their PPI on the day of surgery. We treat any breakthrough symptoms with as-needed antacids in the first few weeks while the wrap settles.
Will this fix my chronic cough or hoarseness?
If those symptoms are caused by reflux, they often improve dramatically. If they have other causes (sinus, asthma, vocal cord pathology), they may not. We discuss this with you in pre-operative planning.