Reflux surgery for hiatus hernia.

If heartburn persists despite medication or a large hiatus hernia causes symptoms, surgery can help. The stomach is moved back into place, the gap in the diaphragm is narrowed and the entrance to the stomach is reinforced with a cuff.

  • Surgery and gastroenterology
  • Keyhole surgery
  • German statutory insurance at the Bürgerspital

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  • 5–10 mmis the size of the small openings in the abdominal wall
  • 1–5nights in hospital, depending on the findings
  • 1–2weeks until you can do light work
  • 4–6weeks without sport or heavy lifting

Typical figures from the abdominal surgery department for minimally invasive procedures. Your personal plan is discussed at the preliminary consultation.

Reflux and hiatus hernia

When stomach acid flows back.

At the junction between the oesophagus and the stomach there is a closing mechanism that keeps food and stomach juices in the stomach. If it does not work reliably, acidic contents rise again and again. Typical symptoms are heartburn, a burning sensation behind the breastbone, and acid regurgitation, often after eating or when lying down. Some people notice coughing, hoarseness or pressure when swallowing instead. Doctors speak of reflux disease when the symptoms noticeably affect everyday life or the lining is damaged.

Often the cause is a hiatus hernia. The oesophagus passes through an opening in the diaphragm, the hiatus, into the abdomen. If this gap widens, the entrance to the stomach slides a little way up into the chest, and the closing mechanism loses the support of the diaphragm. Less often, part of the stomach pushes up alongside the oesophagus – in extreme cases almost the whole stomach. Such large hernias often cause pressure after eating, a feeling of fullness or difficulty swallowing.

Treatment usually starts with general measures and acid-reducing medication. If you are overweight, losing weight can make a big difference; for symptoms at night, raising the head of the bed and avoiding late meals help. According to the current guideline, surgery is an option if reflux has been confirmed for a long time, if there are complications such as severe inflammation or a narrowing, or if medication is not tolerated or does not help enough. Large hernias alongside the oesophagus that cause symptoms should be operated on.

As a rule, the operation is performed as keyhole surgery. The part of the stomach that has slipped up is moved back into the abdomen, and the widened gap in the diaphragm is narrowed with stitches – the hiatoplasty. The upper part of the stomach is then wrapped around the end of the oesophagus as a cuff – the fundoplication: all the way round in the Nissen technique or about three quarters of the way round in the Toupet technique. Which form is suitable also depends on how strongly the oesophagus contracts.

The operation

What the procedure can achieve.

Reposition

The part of the stomach that has slipped up through the diaphragm is returned to the abdomen. With larger hernias, the hernia sac is removed.

Tighten

Stitches reduce the widened opening in the diaphragm so that the stomach does not slide through again. A mesh for reinforcement is only considered for large gaps.

Reinforce

A cuff made from the upper part of the stomach wraps completely or partly around the end of the oesophagus. It supports the closing mechanism that holds back reflux.

The path

Clarity first, then surgery.

Before reflux surgery, the reflux must be reliably confirmed and the findings must be suitable for an operation. This takes some time and protects you from a procedure that would not help.

  1. Gastroscopy

    It shows inflammation, narrowing or changes in the lining and makes a hiatus hernia visible. Tissue samples clarify any abnormal areas.

  2. Measurements

    A thin probe passed through the nose records over 24 hours how often stomach contents flow back and whether this matches the symptoms. A pressure measurement rules out disorders of oesophageal movement that may argue against surgery.

  3. Decision

    Surgery and gastroenterology weigh things up together. The consent discussion covers the procedure, risks and alternatives, including the option of continuing with medication.

  4. Surgery

    Under general anaesthesia, usually as keyhole surgery through a few small openings. After the procedure, you go to the recovery room and then to the ward.

  5. The first weeks

    Moving about is encouraged from the start. Until swallowing is easy again, soft food is on the menu; this usually takes a few weeks.

  6. Aftercare

    Heavy lifting and sport have to wait a few weeks. If swallowing difficulties persist or new symptoms appear, they are investigated promptly.

Insurance

Who pays for the operation.

Statutory health insurance

Covered by statutory insurance.

If the operation is medically indicated – for example with confirmed reflux that medication does not relieve sufficiently, or with a large hiatus hernia that causes symptoms – German statutory health insurance covers the procedure and the stay at Bürgerspital Wertheim, a hospital with a public healthcare mandate.

For the first appointment, bring your health insurance card, a referral if you have one, previous test results and your current list of medications.

Private insurance or self-pay

According to your policy or by arrangement.

Private health insurers reimburse the medically necessary operation according to their policy terms. Privately insured and self-pay patients can also have the operation at the Main-Tauber-Klinik, a private clinic under the same roof.

Self-pay patients agree the costs with the clinic in advance.

Specialists

Your surgeons at a glance.

Reflux operations are performed by specialists in general and abdominal surgery who operate at both clinics in Wertheim. Reflux and hiatus hernia are among the conditions they frequently treat.

  • Maksims MargolinsSpecialist in General SurgeryWertheim
  • Dr. med. Gerhard SchüderSpecialist in General, Visceral and Vascular Surgery / Specialist in Special Visceral SurgeryWertheim
  • Rangel ShahanskiSpecialist in General SurgeryWertheim
  • Mohamad ShalabiSpecialist in General and Visceral SurgeryWertheim

Locations

Where treatment takes place.

Each clinic shows on its own website how the treatment works there.

Frequently asked questions

Good to know.

Isn’t medication enough?

For many people, it is: acid-reducing medication usually relieves the symptoms well. Surgery is an alternative for selected patients, for example if symptoms persist even though the medication is taken correctly, or if lifelong use is not wanted. With severe obesity, a gastric bypass may be an option instead of the cuff.

Does every hiatus hernia need surgery?

No. A small sliding hernia without symptoms does not need an operation. Rarely, a large hernia becomes trapped: sudden severe pain in the upper abdomen or chest with retching but no vomiting is an emergency – in that case, go to an emergency department immediately or call an ambulance on 112.

How long will I stay in hospital?

Usually a few days, depending on the size of the hernia and how your recovery goes. You can often drink on the day of the operation; after that, food is reintroduced step by step.

Can I eat normally afterwards?

After a transition period, as a rule, yes. At first, solid mouthfuls go down less easily because the tissue at the entrance to the stomach is still swollen. Soft food, thorough chewing and smaller portions help you through this time.

What are the side effects and risks?

Difficulty swallowing, bloating and problems with belching are fairly common, especially at first. As with any abdominal operation, bleeding, infections and injuries to neighbouring organs are possible, but rare. Only rarely do persistent symptoms make a further procedure necessary.

Can the reflux come back?

Yes. Even after a successful operation, symptoms or the hernia can return over the years. Medication is then usually used again first; a further operation is only decided on jointly after a thorough assessment.

Does the operation protect against Barrett’s oesophagus or cancer?

That has not been proven. Surgery is performed because of the symptoms and consequences of reflux. A known Barrett’s oesophagus still needs its regular check-up endoscopies after the operation.

Does health insurance pay for the operation?

As a rule, yes: medically indicated reflux surgery is covered by statutory health insurance and, for patients with statutory insurance, takes place at Bürgerspital Wertheim. Privately insured patients are reimbursed according to their policy, including at the Main-Tauber-Klinik.

Further reading

More on the topic.

In-depth articles from the group's clinics.

Consultation

Personal consultation.

Describe your request – the right clinic will get back to you.

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