Indications for surgical repair of hiatal hernia include failure of strict medical management (intractability); reflux esophagitis with ulcerations, stricture, or bleeding; recurrent aspiration pneumonia; large sliding hernias; and all paraesophageal hernias. The purpose of surgery is twofold: to reposition the stomach below the diaphragm and to re-establish gastroesophageal competence. Three approaches (transabdominal, transthoracic and laparoscopic) and three primary techniques (Belsey, Hill, and Nissen) are used, depending on the preference of the surgeon. The advent of minimally invasive techniques has brought about a shift in the operative approach of patients with hiatal hernia. Today the laparoscopic repair of a hiatal hernia has almost completely replaced the open approach through either a laparotomy or a left thoracotomy. If either procedure is performed well, the magnitude of surgical stress is low. General endotracheal anesthesia is typically used and the operative time is 2–3 hours, depending on the skills of the surgeon. Intraoperative blood transfusions are rarely required.

Expected postoperative hospital stay

The expected postoperative hospital stay ranges from 7–10 days for open procedures and 2–5 days for the minimally invasive approach. Length of stay is also influenced by the age and associated medical condition of the patient.