Hiatal and paraesophageal hernia repair is a minimally invasive surgical procedure that restores normal anatomy when part of the stomach pushes through the diaphragm into the chest. Hiatal hernias commonly cause reflux, regurgitation, and swallowing symptoms. Paraesophageal hernias are larger and can cause chest pain, anemia, difficulty swallowing, shortness of breath, and risk of stomach twisting (volvulus). Repairing the hernia improves symptoms, prevents complications, and restores proper function of the esophagus and stomach.

A hiatal or paraesophageal hernia occurs when the opening in the diaphragm becomes enlarged, allowing the stomach or other abdominal organs to move into the chest. During surgery, the stomach is repositioned into the abdomen, the hernia sac is removed, and the hiatus is tightened with sutures. Mesh reinforcement may be used in selected cases. A fundoplication or LINX device may be added to improve reflux control depending on anatomy and symptoms.

Improved reflux symptoms. Reduced regurgitation. Better swallowing. Relief of chest discomfort. Improved breathing in large hernias. Prevention of volvulus and strangulation. Restored anatomy. Minimally invasive approach with faster recovery.

Patients with symptomatic hiatal hernia. Patients with large paraesophageal hernias. Patients with GERD not controlled by medication. Patients with regurgitation, aspiration, chronic cough, or anemia. Patients with imaging showing stomach or organs in the chest. Patients preparing for bariatric surgery who require hernia correction.

The procedure is performed laparoscopically or robotically. Small incisions are made in the abdomen. The stomach and any herniated organs are gently repositioned into the abdomen. The hernia sac is removed. The hiatal opening is closed with sutures. Mesh reinforcement may be used depending on anatomy. A fundoplication or LINX device may be added to improve reflux control and restore valve function.

Temporary difficulty swallowing. Gas bloating. Recurrence of hernia. Rare risks include bleeding, infection, or injury to surrounding organs. Large hernias may require longer operative time and careful postoperative monitoring. Patients with severe motility disorders may require modified techniques.

Timeline Most patients go home the same day or next day. Light activity is resumed within a few days. Soft diet for one to two weeks. Full recovery typically occurs within two to four weeks. Swallowing improves gradually as swelling resolves.

Most patients experience long-lasting relief of reflux, regurgitation, and chest discomfort. Anatomy is restored and risk of volvulus is eliminated. Long-term success is improved with weight management, avoiding heavy lifting early after surgery, and ongoing follow-up.

Dr. de la Cruz-Muñoz is a nationally recognized bariatric, metabolic, and foregut surgeon with extensive experience in both hiatal and complex paraesophageal hernia repair. His expertise in reflux physiology, foregut anatomy, and minimally invasive techniques ensures safe, durable outcomes. Our practice provides bilingual care and supports patients from Miami, Puerto Rico, the Dominican Republic, and Latin America.

Hiatal and paraesophageal hernia repair is often combined with fundoplication or LINX to improve reflux control. Preoperative evaluation with EGD, manometry, or pH testing helps determine the safest and most effective surgical approach.

Patients may undergo CT scan, barium swallow, or endoscopy to assess hernia size, organ involvement, and esophageal function. These studies guide surgical planning and ensure optimal outcomes.