Hiatal Hernia and Reflux

What it is

A hiatal hernia occurs when part of the stomach slides through the opening in the diaphragm into the chest, weakening the valve that prevents stomach contents from returning to the esophagus. The result is usually gastroesophageal reflux (GERD): heartburn, burning sensation, regurgitation, dry cough, hoarseness, and a lump-in-the-throat sensation, worsening when lying down or after large meals. Many patients live for years on medication without full control of symptoms. At Femi Saúde, the general surgery team, with Dr. Henrique Stachon, investigates the cause of the reflux, guides medical treatment, and, when indicated, corrects the hernia laparoscopically, rebuilding the antireflux valve, with recovery in just a few days.

Most common symptoms

• Heartburn and burning in the chest
• Regurgitation of food or acidic fluid
• Lump-in-the-throat sensation
• Dry cough and hoarseness
• Difficulty or pain swallowing
• Worsening when lying down or after meals

Causes and risk factors

• Weakening of the diaphragmatic hiatus
• Increased abdominal pressure (weight, pregnancy)
• Tissue aging
• Chronic coughing and repeated straining
• Smoking and large meals

How it is diagnosed

The surgeon assesses the symptoms, their frequency, and the response to medications already tried. Upper endoscopy is the initial exam: it identifies the hernia, evaluates inflammation of the esophagus, and rules out other causes. When surgery is being considered, 24-hour pH monitoring confirms the amount of reflux and its relationship to symptoms, and esophageal manometry evaluates the esophagus's movements, guiding the technique to be used. For large hernias, imaging exams, such as a contrast X-ray or CT scan, help plan the procedure.

How we treat it at Femi Saúde

Treatment starts with behavioral measures and acid-reducing medications, which are effective in most cases. Surgery is considered when symptoms persist despite treatment, when there is dependence on medication for many years, esophageal complications, or large hernias. In these cases, the general surgery team at Femi Saúde performs the repair laparoscopically: the hernia is reduced, the hiatus is closed, and the valve is rebuilt using the stomach itself (fundoplication). It involves small incisions, discharge within one or two days, and a progressive diet over the first few weeks.

What we offer