What the operation does
A hiatal hernia (called a hiatus hernia in the UK) is when part of your stomach moves up into your chest. It happens because the natural opening in your diaphragm, the muscle sheet between your chest and belly, has become too large, and the stomach bulges up through it.
The repair usually has two parts. According to MedlinePlus, the US National Library of Medicine’s health site, the surgeon first tightens the opening in the diaphragm with stitches, and some surgeons place a piece of mesh to make the area more secure. Then, in the most common version of the operation, called a fundoplication, the surgeon wraps the upper part of the stomach around the bottom of the esophagus (food pipe). That wrap tightens the valve and helps stop acid and food from coming back up.
This is a different operation from the more familiar groin or belly button hernia repair. If that is what you had, see our hernia repair recovery timeline instead.
Keyhole or open surgery
Which approach you had makes a big difference to how quickly you recover.
Keyhole (laparoscopic) surgery is the usual approach for a hiatus hernia, according to the NHS. MedlinePlus describes it as 3 to 5 small cuts in your belly, with a thin camera passed through one of them. Most people leave hospital within 1 to 3 days.
Open surgery uses one larger cut in the upper belly. MedlinePlus says the hospital stay is usually 2 to 6 days, and a tube may be placed into your stomach through the belly wall, which is taken out in about a week. Sometimes an operation that starts as keyhole has to switch to open partway through.
Both are done under general anesthesia, and MedlinePlus says the operation most often takes 2 to 3 hours.
The first days at home
Expect to feel tired and sore around the small wounds, and to have some bloating. You may also get gas pains in the belly. MedlinePlus suggests walking around to ease gas pains, and walking several times a day is part of the plan anyway.
Take your pain medicine before the pain gets bad. MedlinePlus advises getting your prescription filled on the way home so you have it ready, and taking it before the pain becomes severe. Do not drive, use machinery, or drink alcohol while you are taking narcotic (opioid) pain medicine, because it can make you very drowsy.
Plan the trip home. You will need someone to drive you. A soft seat belt cushion keeps the belt from pressing on the wounds.
Medicines in liquid or crushed form. Because swallowing is tight, MedlinePlus advises crushing pills and taking them with liquid for the first month. Ask your surgical team or a pharmacist about each medicine you take before you crush it.
The liquid diet: weeks one to four
This is the part of recovery people find hardest, so it helps to plan for it before surgery.
MedlinePlus describes a staged diet after anti-reflux surgery:
- About two weeks of clear liquids.
- About two weeks of full liquids after that.
- Then soft foods, before slowly moving back toward normal meals.
The NHS says it can take up to 6 weeks before you can eat what you want. Your own surgeon may use a slightly different plan, so follow their sheet if it differs.
A few rules make the liquid weeks go more smoothly, all from MedlinePlus:
Sip, do not gulp. Start with small amounts, about 1 cup (237 milliliters) at a time, and drink often through the day rather than in large amounts.
Avoid cold drinks. MedlinePlus advises avoiding cold liquids at this stage.
No fizzy drinks. MedlinePlus advises against carbonated drinks after this surgery.
No straws. Drinking through a straw brings extra air into your stomach. Drink straight from a cup instead.
Stocking up before surgery saves a lot of effort. Ask for your surgeon’s diet sheet ahead of time and buy what is on it, so you are not shopping on day two. Our guide on what to eat after surgery has more ideas for the soft food stage.
Moving on to soft and solid food
When you move to soft food and then to solids, MedlinePlus advises:
Chew everything well and take small bites.
Avoid foods that clump together, such as bread and rice.
Avoid cold foods for now, as with drinks.
Eat small amounts several times a day instead of three big meals. A smaller stomach load is also kinder to the bloating.
MedlinePlus notes it may take a few weeks before you handle solid food well. Go at your own pace and take a step back to softer food if something sticks.
Tight swallowing, bloating and wind
These are the three symptoms almost everyone notices, and they are usually a normal part of healing.
Tight swallowing. MedlinePlus says you may feel tightness when you swallow for 6 to 8 weeks, caused by swelling inside the esophagus. In most people the difficulty swallowing goes away within the first 3 months after surgery.
Bloating. MedlinePlus describes a complication called gas bloat, where the stomach overfills with air or food and you cannot relieve the pressure by burping or vomiting. It says these symptoms slowly get better for most people. Skipping straws helps, since MedlinePlus notes they bring air into your stomach, and so does sticking to small, frequent meals.
Wind. The NHS says it can take a few months to recover from bloating, farting, and difficulty swallowing. That is a long time, but it is an expected one, so it is not by itself a sign the operation has gone wrong.
Sleep and comfort
Lying flat can feel uncomfortable on a sore, bloated belly, and many people sleep better propped up for the first few weeks. A firm bed wedge holds the angle all night in a way a stack of pillows does not. If you still get any reflux, the NHS suggests raising the head end of your bed by 10 to 20 cm (about 4 to 8 inches) so your chest and head are above your waist, and not eating within 3 or 4 hours of going to bed. Our guide on sleeping after abdominal surgery covers positions and getting in and out of bed without straining the wounds.
Loose clothing helps too. The NHS advises against clothes that are tight around the waist for hiatus hernia symptoms, and it is more comfortable over fresh wounds anyway.
Wound care and showering
How you care for the wounds depends on how they were closed, so check your discharge sheet. MedlinePlus says:
If stitches, staples, or glue were used, you may usually remove the dressings and shower the day after surgery.
If tape strips were used, cover the wounds with plastic wrap before showering for the first week, taping the edges to keep water out. Do not try to wash the strips off. They fall off on their own after about a week.
Do not soak in a bath or hot tub, or go swimming, until your surgeon says it is OK.
Lifting, activity and work
Walk several times a day, and slowly increase how much you do around the house. MedlinePlus advises not lifting anything heavier than 10 pounds (4.5 kilograms, about the weight of a gallon of milk) and avoiding pushing or pulling until your surgeon tells you that you can do more. In practice that means no full grocery bags, laundry baskets, or vacuuming at first.
Back to work. MedlinePlus says most people go back to work 2 to 3 weeks after keyhole surgery and 4 to 6 weeks after open surgery, and that most people return to normal activities in 4 to 6 weeks. If your job is physical, agree a return plan with your surgeon, since the lifting limit applies at work too.
Driving. You should not drive while taking opioid pain medicine. Beyond that, the decision depends on being able to sit comfortably, wear a seat belt, and react quickly. See our guide on driving after surgery for how to judge when you are ready.
The longer term
MedlinePlus says heartburn and other reflux symptoms should improve after surgery, although some people still need heartburn medicine afterward. Both MedlinePlus and the NHS note there is a chance you may need more surgery in future, for example if the wrap is too tight, loosens, or a new hiatal hernia develops. If reflux or swallowing problems come back months or years later, see your doctor rather than assuming you have to live with it.
When to call your surgeon
MedlinePlus lists the following as reasons to contact your surgeon after anti-reflux surgery:
- A temperature of 101°F (38.3°C) or higher
- Wounds that are bleeding, red, warm to the touch, or have thick yellow, green, or milky drainage
- A belly that swells or hurts
- Nausea or vomiting for more than 24 hours
- Swallowing problems that stop you from eating, or that do not go away after 2 or 3 weeks
- Pain medicine that is not helping your pain enough
- Trouble breathing, or a cough that does not go away
- Being unable to eat or drink
- Yellowing of your skin or the whites of your eyes
A simple thermometer at home makes the fever question quick to answer. If you are struggling to breathe, get emergency help rather than waiting for a callback.
The bigger picture
Recovery from hiatal hernia surgery is less about the wounds, which usually heal quickly after keyhole surgery, and more about patience with eating. Plan the liquid weeks before you go in, sip rather than gulp, keep meals small, and expect tight swallowing and bloating to fade gradually over weeks to months. Most people are back at work within a few weeks and back to normal activities within about six.