hiatal hernia repair Huntsville AL / Nissen fundoplication

What a Hiatal Hernia Is

The diaphragm has a small opening, called the hiatus, where the esophagus passes through on its way to the stomach. A hiatal hernia occurs when part of the stomach pushes up through that opening into the chest cavity. This changes the angle and pressure at the junction between the esophagus and stomach, which is part of why hiatal hernias are so closely linked to chronic acid reflux.

How It Causes Reflux

Normally, the muscle at the bottom of the esophagus acts like a one-way valve, letting food down into the stomach and keeping stomach acid from coming back up. A hiatal hernia disrupts that valve, making it easier for acid to move upward into the esophagus. That's what produces the burning, regurgitation, and discomfort most people associate with acid reflux or GERD.

Many patients manage reflux with medication for years before it becomes clear that the underlying cause is structural, not just acid production that medication can suppress.

When Surgery Is the Right Call

Most reflux is managed successfully with medication and doesn't need surgery. Surgery becomes a reasonable option when reflux persists despite medication, when a patient doesn't want to stay on acid-suppressing medication indefinitely, or when the hernia itself is large enough to cause symptoms beyond reflux, like difficulty swallowing or chest discomfort.

How Repair Works

We repair the hernia laparoscopically, pulling the stomach back below the diaphragm and closing the opening so it can't push through again. In most cases, we also perform a Nissen fundoplication at the same time, wrapping the top of the stomach around the lower esophagus to reinforce the valve and reduce reflux going forward.

This is an outpatient or short-stay procedure, with most patients home within a day and back to normal activity within two to three weeks.