GERD & Hiatal Hernia Surgery
Gastroesophageal reflux disease (GERD) occurs when stomach acid repeatedly flows backward into the esophagus, causing symptoms such as heartburn, regurgitation, chest discomfort, and chronic throat irritation.
Many patients achieve excellent symptom control with lifestyle modifications and medications. However, for some individuals, symptoms persist despite treatment or are caused by a structural problem known as a hiatal hernia.
A hiatal hernia develops when part of the stomach moves upward through the diaphragm into the chest. While many hiatal hernias are small and cause few symptoms, larger hernias can worsen acid reflux, make swallowing difficult, or increase the risk of complications.
At The Medical Group of New Jersey, our board-certified general surgeons work closely with gastroenterologists to determine when surgery is the most appropriate treatment option. Using advanced minimally invasive and robotic-assisted techniques whenever possible, we help patients achieve lasting symptom relief while restoring the normal anatomy of the stomach and esophagus.
Symptoms & Initial Evaluation
Most patients referred for surgical evaluation have experienced GERD symptoms for months or years despite treatment with acid-reducing medications. Others are referred after testing identifies a large hiatal hernia or complications related to chronic reflux.
Common symptoms include:
- Frequent heartburn
- Acid regurgitation or a sour taste in the mouth
- Difficulty swallowing
- Chest discomfort unrelated to the heart
- Chronic cough
- Hoarseness or frequent throat clearing
- A sensation of food becoming stuck when swallowing
- Symptoms that worsen after meals or when lying down
Patients with larger hiatal hernias may also experience:
- Early fullness during meals
- Upper abdominal or chest pressure
- Shortness of breath after eating
- Anemia from chronic irritation or bleeding (less common)
Seek prompt medical attention for:
- Severe chest pain
- Difficulty swallowing that rapidly worsens
- Vomiting blood
- Black, tarry stools
- Persistent vomiting
- Sudden severe abdominal or chest pain
These symptoms may indicate a serious complication requiring urgent evaluation.
Comprehensive Evaluation
Before recommending surgery, your surgeon will review your symptoms, previous treatments, and diagnostic testing to determine whether an operation is likely to provide lasting benefit. A physical examination and review of prior imaging and endoscopy results help guide the next steps in evaluation.
Diagnosis & Risk Assessment
Several specialized tests help determine whether surgery is appropriate and assist with operative planning.
Upper Endoscopy (EGD)
Upper endoscopy allows your physician to directly examine the esophagus, stomach, and beginning of the small intestine. It can identify:
- Esophagitis (inflammation)
- Barrett’s esophagus
- Hiatal hernia
- Ulcers
- Narrowing (strictures)
- Other conditions that may mimic reflux
Biopsies may also be obtained if necessary.
Upper GI Contrast Study (Barium Swallow)
A barium swallow uses X-ray imaging to evaluate how food and liquid move through the esophagus. This study helps identify:
- Hiatal hernias
- Esophageal narrowing
- Swallowing abnormalities
- Stomach position and anatomy
It is particularly useful when planning surgical repair.
Esophageal Manometry
Manometry measures the strength and coordination of the muscles that move food through the esophagus. This test helps determine:
- Whether the esophagus contracts normally
- Which type of anti-reflux procedure is most appropriate
- Whether another swallowing disorder is present
Ambulatory pH Monitoring
When the diagnosis of GERD is uncertain, pH monitoring measures how often stomach acid enters the esophagus over a 24- to 96-hour period. This test helps confirm reflux and identify patients most likely to benefit from surgery.
Risk Assessment
Your surgeon will consider several factors before recommending surgery, including:
- Severity and frequency of symptoms
- Response to medical therapy
- Size of the hiatal hernia
- Barrett’s esophagus or other complications
- Overall health
- Body weight
- Previous abdominal surgery
- Personal treatment goals
This comprehensive assessment helps determine whether surgery offers meaningful long-term benefit.
Treatment & Management
Most patients with GERD improve with lifestyle modifications and medications. Surgery is generally recommended only when symptoms remain significant despite appropriate medical therapy or when structural abnormalities contribute to ongoing reflux.
Lifestyle & Medical Management
Before considering surgery, treatment often includes:
- Weight management
- Avoiding late-night meals
- Elevating the head of the bed
- Limiting trigger foods
- Smoking cessation
- Proton pump inhibitors (PPIs)
- H2 receptor blockers
Many patients achieve excellent long-term symptom control with these approaches.
Surgical Treatment
Surgery may be recommended for patients with:
- Persistent reflux despite medication
- Large hiatal hernias
- Barrett’s esophagus in selected cases
- Medication intolerance
- Regurgitation that does not improve with medication
- Complications related to chronic reflux
Common procedures include:
- Laparoscopic or Robotic Hiatal Hernia Repair: The stomach is returned to its normal position, and the opening in the diaphragm is repaired to reduce the risk of recurrent herniation.
- Fundoplication: The upper portion of the stomach is wrapped around the lower esophagus to strengthen the valve that prevents acid reflux.
- Magnetic Sphincter Augmentation (LINX®): Selected patients may be candidates for placement of a small ring of magnetic beads around the lower esophagus to reinforce the natural anti-reflux barrier while preserving swallowing function.
Your surgeon will discuss which procedure best matches your anatomy, symptoms, and treatment goals.
Recovery & Follow-Up
Most minimally invasive hiatal hernia and anti-reflux procedures require only a short hospital stay, with many patients returning home within one or two days.
Follow-up appointments ensure proper healing, monitor symptom improvement, and help patients transition back to normal activities safely.
Prognosis & Long-Term Care
For appropriately selected patients, surgery provides excellent long-term relief of GERD symptoms and improves quality of life. Many patients experience significant reduction or complete resolution of heartburn, regurgitation, and other reflux-related symptoms while decreasing or eliminating their need for long-term acid-suppressing medications.
At The Medical Group of New Jersey, our general surgeons work collaboratively with your healthcare team to provide personalized surgical care that restores function, relieves symptoms, and supports lasting digestive health.
Related Services & Internal Links
- General Surgery
- Gastroenterology
- GERD & Acid Reflux Care
- Upper Endoscopy (EGD)
- Nutrition Counseling
- Primary Care