Hiatal Hernia

A hiatal hernia occurs when part or all of your stomach pushes through an opening in the muscle that separates the abdomen from the chest (diaphragm). Thus, part of the stomach bulges upwards into the chest. The opening in the diaphragm is called the hiatus and the part of stomach bulging through is the hernia.
Mild heartburn may be a sign of reflux disease or it may be linked to a hiatal hernia. But if your hiatal hernia symptoms are more severe, you may need surgery.
Mr Sanjeeva Kariyawasam
Hiatal Hernia surgeon Perth

How should you treat a hiatal hernia?

A hiatal hernia results from part of the upper portion of the stomach bulging through an opening in the diaphragm. The diaphragm is a thin sheet of muscle that separates the chest from the abdomen. The diaphragm is also one of the main muscles we use to breathe. The opening in the diaphragm is a natural opening that allows the oesophagus to carry food into the stomach.

If the opening stretches then there is a potential for part of the upper portion of the stomach to push or be pulled upwards through the opening and into the chest cavity. This part of the stomach may stay permanently through the opening in the chest. Or it may move up and down as you breathe, cough or swallow. Small (1-2cm) hiatal hernias are common and may be found in 1 in 5 people.

If they cause no symptoms they need no treatment. But in time all hernias will increase in size. Symptoms of a hiatal hernia may range from mild heartburn to severe chest pain and difficulty swallowing. Treatment regimens need to be tailored to your needs and to an analysis of the findings of investigations.

The surgeons at Upper GI West have decades of experience investigating and analysing the varied symptoms associated with hiatal hernias. We are also fully trained in their management and surgery because of our extra speciality training as upper GI surgeons. This surgery is not part of routine general surgery training. It involves advanced laparoscopic experience operating around the diaphragm as well as extensive open surgical experience operating in the upper abdomen and chest.

Hiatal Hernia

Hiatal hernia treatment can vary from simple lifestyle changes to medication and/or surgery

What are some of the symptoms of a hiatal hernia?


On the way down:

  • Dysphagia (food or liquid feeling stuck in the throat or oesophagus)
  • Odynophagia (pain in the central chest or back of throat on swallowing or passage of food or liquid through the oesophagus)

At the level of the hernia:

  • Tightness in chest
  • Severe chest pain or spasms (may feel like a heart attack)
  • Reduced appetite
  • Reduced food portion sizes
  • Shortness of breath on eating
  • Shortness of breath on bending over
  • General deconditioning and tiredness on minimal activity
  • Bleeding causing
    • anaemia
    • vomiting blood,
    • pitch-black highly offensive motions (melena)

On the way back up:

  • Heartburn (central burning pain moving up chest)
  • Water brash (liquid in throat)
  • Volume reflux (liquid and solid in throat)
  • Recurrent sore throat
  • Voice changes
  • Recurrent sinus issue
  • Recurrent aspiration events
    • Waking up coughing and spluttering
    • Worsening of asthma or COPD
    • Recurrent chest infection/ pneumonia

“If your symptoms are mild, you may be able to manage your condition with diet changes and medication. Mild heartburn may be a sign of gastro-oesophageal reflux disease (GORD) and it may be linked to a hiatal hernia. If your hiatal hernia symptoms are more severe, you may need surgery.”
Mr Alan Thomas
Hiatal Hernia surgeon Perth

Our first step is to give you a clear diagnosis. That will define the way forward: lifestyle changes and medication, or surgery. The highly qualified professionals at Upper GI West have extensive experience with hiatal hernia repair.

If you need surgery, you are in good hands because our team of surgeons are highly trained in operations around the hiatus and mediastinum and their anaesthetic and theatre staff along with the ward staff are well versed with the preoperative management and care of hiatal hernia patients.

Types of hiatus hernia surgery

“There are a few centres in the world still practising open abdominal or even open chest surgery for repair of hiatal hernias. But we at Upper GI West would almost always recommend laparoscopic (keyhole) repair. Utilising our extensive experience and training we are able to successfully repair over 99% of hiatal hernias irrespective of their size using keyhole techniques”
Mr Krishna Epari
Hiatal Hernia surgeon Perth

What to expect after a hiatal hernia surgery?

Recovery after hiatus hernia surgery will vary slightly depending on your fitness and general health. Simple repairs may only require an overnight hospital stay. Even complex repairs in relatively unfit people usually only involve a 2-3 day inpatient stay. Over 99% of procedures are performed laparoscopically with only 5 little incisions of 5-8mm.

We place all our patients on a modified diet after surgery for 6 weeks. This broadly involves 2 weeks of liquid, 2 weeks of puree and 2 weeks of a soft diet before a full diet is recommenced. Patients are also required to avoid constipation and not lift anything heavier than 5 kg for up to 6 weeks post-procedure. These requirements are in place to allow the internal swelling and scarring from surgery to settle down and strengthen and to avoid vomiting.

What you may experience after surgery:

  • Some chest or upper abdomen discomfort
  • Difficulty swallowing
  • You may feel that you are easily tired

The symptoms will usually ease within a couple of days.

Assoc Prof Mo Ballal
Hiatal Hernia surgeon Perth

Key Points

Medication and lifestyle changes can often address symptoms from a small hiatal hernia
In more symptomatic, uncontrolled, complex or severe cases, keyhole surgery may be needed
Ensure your surgeon has appropriate training and experience with hiatus hernia surgery

Why come to Upper GI West?

Upper GI West has some of the most experienced and advanced surgeons in this field.

  • We are able to endoscope our own patients to fully define the anatomy of the area.
  • We are able to order, assess and interpret additional investigations and results such as functional barium tests, high-resolution manometry and pH studies.
  • We are able to offer all surgical and endoscopic options.
  • We have in house dietetic and surgical cover for optimal management of your condition.

Our expert surgeons offer surgery for all upper gastrointestinal conditions. We believe that you deserve the highest quality service throughout your treatment. We bring together Perth’s most experienced upper GI surgeons. It means you benefit from both your surgeon’s individual expertise and from the collective experience of our whole team.

Our surgeons work hard to deliver the best possible outcomes for you as a patient. Speak to our friendly team to find out how we can help you with your upper GI health issues.