Hiatal Hernia & Reflux Surgery in Ludhiana — Laparoscopic

What it is

When the stomach moves into the chest.

A hiatal hernia happens when part of the stomach pushes upward through the diaphragm — the dome-shaped muscle separating the abdomen from the chest — and enters the chest cavity. The diaphragm has a natural opening (the hiatus) through which the oesophagus passes to join the stomach. When this opening stretches or weakens, the stomach can slide upward.

There are four types. Type I (sliding) is by far the most common: the junction of the oesophagus and stomach slides up and down through the hiatus, often causing reflux. Types II, III, and IV are paraoesophageal hernias, where part of the stomach (and sometimes other organs) sits permanently in the chest alongside the oesophagus. Paraoesophageal hernias carry a higher risk of complications and usually need surgical repair.

Hiatal hernias do not improve on their own. Small sliding hernias may be managed with medication and lifestyle measures. Larger or symptomatic hernias — and almost all paraoesophageal hernias — benefit from surgical repair to prevent progression and resolve symptoms.

The bottom lineSmall sliding hernias with mild symptoms can be managed medically. Large hernias, paraoesophageal hernias, or symptoms that persist despite full-dose PPI therapy are indications for surgical evaluation.

Symptoms

When to see a hiatal hernia specialist.

Hiatal hernias usually announce themselves through reflux symptoms, not a visible bulge. The earlier a true hiatal hernia is identified, the easier the eventual treatment.

Heartburn and reflux

A burning sensation behind the breastbone, especially after meals, when lying flat, or bending over. Acid taste in the mouth, regurgitation of food. Symptoms worse with spicy food, large meals, or late dinners.

Trouble swallowing

Food feeling stuck in the chest, needing to drink water to push food down, slow eating, regurgitation of undigested food. Sometimes mistaken for a "weak heart" — chest pain after meals is a classic atypical presentation.

Persistent symptoms despite PPIs

If you have been on full-dose proton pump inhibitors (omeprazole, pantoprazole, esomeprazole) for over 6 months without satisfactory relief — or if symptoms return immediately when you stop — surgical evaluation is appropriate.

Diagnosis

A combined clinical and endoscopic diagnosis.

Hiatal hernia diagnosis requires more than physical examination — the hernia is inside the chest and cannot be felt from outside. The workup combines a clinical history, an upper GI endoscopy (OGD), and often a barium swallow study or CT scan.

Upper GI endoscopy is the cornerstone investigation. It confirms the hernia, measures its size, identifies any complications (oesophagitis, Barrett's oesophagus, ulcers, strictures), and rules out other causes of reflux symptoms. For surgical planning of larger hernias, a CT scan with contrast is added to map the exact anatomy and identify any associated findings.

In selected patients — particularly those with atypical symptoms or a previously failed reflux operation — oesophageal manometry and 24-hour pH monitoring may also be performed to characterise oesophageal function before surgery. All of these tests are coordinated through The Hernia Institute^™, with results reviewed by the surgical team before any decision about surgery.

Treatment Options

The right operation, built for you.

Hiatal hernia repair is almost always laparoscopic. The choice of fundoplication technique — full wrap (Nissen) or partial wrap (Toupet) — depends on oesophageal motility and symptom pattern. For paraoesophageal hernias, the focus is reducing the stomach back into the abdomen and rebuilding the diaphragmatic hiatus.

— Option 01 —

Laparoscopic Nissen fundoplication

The most established anti-reflux operation worldwide. Through five small (5–10 mm) incisions, the stomach is returned to the abdomen, the diaphragmatic hiatus is closed with sutures, and the upper part of the stomach (the fundus) is wrapped 360° around the lower oesophagus to recreate a one-way valve.

Best for: patients with severe reflux, normal oesophageal motility, no significant swallowing difficulty
Recovery: desk work in 7–10 days, full activity in 3–4 weeks
Scars: five near-invisible 5–10 mm scars
General anaesthesia: always required

— Option 02 —

Laparoscopic Toupet (partial wrap)

A 270° partial fundoplication, instead of the full 360° wrap. The stomach is returned to the abdomen and the hiatus is closed in the same way as Nissen, but the wrap is partial, allowing easier swallowing and burping while still reducing reflux.

Best for: patients with weaker oesophageal motility, those at higher risk of post-operative dysphagia (swallowing difficulty), reflux with prominent regurgitation
Recovery: desk work in 7–10 days, full activity in 3–4 weeks
Scars: five near-invisible 5–10 mm scars
General anaesthesia: always required

For very large paraoesophageal hernias, mesh reinforcement of the diaphragmatic hiatus may be added. For patients who have had previous failed anti-reflux surgery, re-operative repair is also offered — discussed individually at consultation.

Your Journey

From first call to full recovery.

Most hiatal hernia patients complete the workup (endoscopy + imaging) within 2–3 weeks of first consultation, with surgery scheduled shortly after.

i

Consultation

30-minute appointment. Symptom assessment, review of any prior endoscopy, decision on which investigations are needed.

ii

Workup

Upper GI endoscopy, contrast study or CT, motility testing if indicated. Results reviewed by the surgical team before surgery is offered.

iii

Surgery

Admission morning of surgery. 90–120 minute laparoscopic procedure. Typical hospital stay 1–2 nights.

iv

Follow-Up

2-week, 6-week, and 3-month reviews. Gradual reintroduction of solid foods and dietary normalisation supervised by the team.

Recovery

What to expect after surgery.

Day 0
The day of surgery
Admitted in the morning, surgery typically completed by early afternoon. Sips of water by evening. Most patients stay one or two nights in hospital, with a 24-hour contact number on discharge.
Day 1–2
The first 48 hours
Liquid diet only. Walking encouraged from the first evening. Mild shoulder-tip discomfort (from CO2 used during laparoscopy) settles within a day or two. Most patients are discharged within 48 hours.
Day 3–14
The first two weeks
Soft, sloppy diet (mashed potatoes, dal, soups, yoghurt). No bread, rice, meat, or fizzy drinks. Return to desk work by day 7–10 if comfortable. Walking and light activity, but no heavy lifting.
Week 3–4
Diet progression
Gradual reintroduction of solid foods, one new food at a time, well-chewed. Mild swallowing difficulty for the first few weeks is normal and improves as the wrap settles. Light exercise resumed.
Week 6 onwards
Return to full activity
Heavy lifting and gym work cleared at six weeks. Almost all dietary restrictions lifted. By three months, the vast majority of patients eat completely normally and are off all reflux medications.

Why The Hernia Institute^™

A centre built around one specialty.

Specialists, not generalists

Every operation at THI is performed by a surgeon whose primary clinical focus is hernia and abdominal wall surgery — not a general surgeon who also does hernias.

Evidence-based, tailored

The recommended technique is grounded in current international guidelines and then adapted to your anatomy, lifestyle, and risk profile. Documented and shared with you before the day of surgery.

Modern operating theatre

4K laparoscopy, premium energy platforms (Sonicision, LigaSure), a curated mesh library, and a nursing team trained specifically in abdominal wall recovery.

Common Questions

Things patients often ask.

Do I need surgery? Can't I just stay on medication?

PPI medications (omeprazole, pantoprazole, esomeprazole) are effective for most patients with reflux from small sliding hiatal hernias. But they are not curative — they reduce acid; they do not fix the mechanical defect. Many patients are happy to remain on PPIs long-term. Others want to come off medication, particularly given recent concerns about long-term PPI use (vitamin B12 deficiency, kidney effects, bone density).

For larger hernias, paraoesophageal hernias, persistent symptoms despite full-dose PPIs, regurgitation, or complications like Barrett's oesophagus, surgical repair is appropriate. Book a consultation — you will leave with a clear plan.

Will I need mesh? Will I be able to burp or vomit after surgery?

Most hiatal hernia repairs do not need mesh — the hiatus is closed with sutures and the fundoplication wrap provides anti-reflux protection. Mesh is reserved for very large hiatal defects, recurrent hernias, or paraoesophageal hernias where the hiatus is severely stretched.

After fundoplication, most patients can burp normally (though it may take a few weeks). Vomiting is less effective than before — but possible. The "gas bloat" some patients experience early on settles in most cases within a few months as the wrap relaxes.

How long will I be off work?

For desk-based work: 7–10 days after laparoscopic fundoplication. For physically demanding work involving heavy lifting: 4–6 weeks. The diet restrictions during the first three weeks (soft food only) often shape the return-to-work timeline more than the surgery itself. We provide a written, signed return-to-work certificate during your consultation.

What does it cost?

Costs vary by the complexity of the repair (sliding vs paraoesophageal), whether mesh is needed, your room category, and your insurance. We provide a transparent itemised estimate during your consultation. Cashless tie-ups (ECHS, CGHS, Star Health and other major insurers) are in progress and not yet live; in the meantime, we help you file reimbursement claims end-to-end. For outstation or international patients, we offer a fixed-price package on request.

My fundoplication from years ago has stopped working. Can it be redone?

Yes. Re-do anti-reflux surgery is technically more demanding than a first-time fundoplication and is best done at specialist centres that see it regularly. Common reasons for fundoplication failure include slipped wrap, herniation of the wrap into the chest, or a too-tight wrap. We assess each case carefully, often with repeat endoscopy and contrast study, before deciding on the best re-operative approach.

Will my consultation be with a hernia surgeon, or a general surgeon?

Always with a hernia surgeon. Every consultation at The Hernia Institute™ is with Dr. Bawa, Dr. Mishra, or Dr. Rengan — none of whom are general surgeons rotating between disciplines.

Hiatal Hernia

When the stomach moves into the chest.

When to see a hiatal hernia specialist.

Heartburn and reflux

Trouble swallowing

Persistent symptoms despite PPIs

A combined clinical and endoscopic diagnosis.

The right operation, built for you.

Laparoscopic Nissen fundoplication

Laparoscopic Toupet (partial wrap)

From first call to full recovery.

Consultation

Workup

Surgery

Follow-Up

What to expect after surgery.

The day of surgery

The first 48 hours

The first two weeks

Diet progression

Return to full activity

A centre built around one specialty.

Specialists, not generalists

Evidence-based, tailored

Modern operating theatre

Things patients often ask.

Persistent reflux or trouble swallowing? Start here.

Inguinal Hernia

Umbilical Hernia

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