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Anti-Reflux Surgery for Hiatal Hernia — Repair With a Fundoplication Wrap

Centre in Ahmedabad · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad

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You have been told you have a hiatal hernia. You are still on acidity tablets, month after month. The real question is not whether a hernia is there. It is whether an operation can give you what the tablets cannot. That means no food coming back up, sleep without a cough, and an end to a tablet you were told to take for life. This page explains how that choice is made and what the operation involves. It also explains when Dr Harsh Shah advises against it, which is just as common.

Dr Harsh Shah repairs hiatal hernias and treats reflux at Apollo Hospital, Bhat, Gandhinagar. He sees patients at the Gota OPD in Ahmedabad. He is trained in surgical gastroenterology, which covers the food pipe, the stomach and the diaphragm. For each operation, the note records the size of the gap, the stitches, any mesh and the type of wrap. Anyone who sees you later will know exactly what was done.

Dr Harsh Shah, hernia surgeon, Ahmedabad

Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Hernia Surgeon
· Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
★★★★★ 4.9 · 200+ Google reviews

Call +91 63555 64601 WhatsApp your endoscopy report

Last updated: 04 Oct 2026 · Reviewed by Dr Harsh Shah, MS, MCh (GI), DrNB (GI) · Gujarat Medical Council Reg. No. G-38738

ગુજરાતીમાં વાંચો: ગુજરાતી · हिंदी में पढ़ें: हिंदी

When a hiatal hernia needs an operation

A hiatal hernia is not a reason to operate by itself. Surgery is for reflux that tablets do not control, or for a large hernia that causes symptoms.

The diaphragm is the sheet of muscle between the chest and the belly. The food pipe passes through a gap in it. In a hiatal hernia, that gap has widened. The top of the stomach has slipped up through it into the chest. That is all it means. On its own, it is not a reason for surgery.

The common kind is the sliding hernia. Many adults have one and never know. When it does cause trouble, the trouble is reflux. That means burning behind the breastbone, a sour taste, or food coming back up when you bend or lie down. It can also mean a cough or a hoarse voice that chest treatment does not settle. A sliding hernia is fixed for its reflux, not for the hernia. If tablets control your symptoms and you are happy to take them, surgery is a choice, not a need. Dr Harsh Shah will tell you so.

The other kind is the para-oesophageal hernia. Here a fold of stomach climbs up beside the food pipe. In the large ones, much of the stomach sits in the chest. Sometimes the bowel or the fatty apron of the belly goes up with it. The risk here is not acid. It is the stomach being squeezed. You may feel full after a few mouthfuls, or have chest pain or shortness of breath after meals. Small, slow bleeds can cause low blood counts. Now and then the stomach twists and blocks. A hernia of this kind that causes symptoms is repaired for what it may do. Your fitness for anaesthesia decides, not your age.

The two main kinds of hiatal hernia, and why each is repaired
Sliding herniaPara-oesophageal hernia
What has movedThe top of the stomach slides up through the gapA fold of stomach climbs up beside the food pipe
Main problemReflux: burning, sour taste, food coming back upFullness, chest pain after meals, bleeding, twisting
Reason to operateReflux that tablets do not control, proven on testsSymptoms from the hernia itself, if you are fit for anaesthesia
If there are no symptomsNo operationWatch with a clear plan, especially if frail or elderly

When surgery is not advised

Dr Harsh Shah advises against an operation in these cases:

  • The burning is well controlled on tablets and nothing comes back up.
  • Tests show acid is not the cause. A sensitive food pipe that is operated on for reflux gets worse, not better.
  • A para-oesophageal hernia causes no symptoms in someone frail or elderly. Watching, with a clear plan if things change, is safer.
  • The muscle of the food pipe can no longer push food down. This changes the operation, and sometimes rules it out.
  • The tests are not finished. Surgery offered before the tests are done is the most common reason this operation disappoints.

The operation — the sac, the gap, the mesh question and the wrap

Anti-reflux surgery removes nothing. It pulls the stomach back down, narrows the gap in the diaphragm with stitches, and wraps the stomach top to rebuild the valve.

The valve sits where the food pipe joins the stomach. The operation rebuilds it in four steps.

1. The sac comes out, all of it. The hernia sac is the lining that went up into the chest with the stomach. The surgeon works along the sac rather than on the food pipe. This keeps both vagus nerves safe. These nerves help the stomach empty normally after surgery. A sac that is pushed back but left behind is a hernia waiting to come back.

2. The food pipe is freed. It is freed up into the chest until enough of it rests below the diaphragm without pulling. This is what gives length. Pulling the stomach down and stitching it there does not. Sometimes, even after this, the food pipe is still too short. Then a step to lengthen it is added. This is called a Collis gastroplasty. It is not common, and it is planned ahead, not done on the spot. After it, you stay on acid tablets. That is why it is talked about before the operation, not after.

3. The gap is closed, and the mesh choice is made. The two muscle pillars of the diaphragm are stitched together behind the food pipe with permanent stitches. The gap is made snug, not tight. A gap made too narrow causes lasting trouble swallowing. Mesh is used only when needed, not as routine. It helps when the gap is large or the muscle is too thin to hold stitches. When the muscle is sound, trials found mesh gave no lasting gain. When mesh is used here, it is a kind the body slowly absorbs, placed behind the food pipe. A hard, permanent mesh is not placed against the food pipe. It can wear into it, sometimes years later. That is far worse than the hernia coming back. Small pads can support the stitches where the muscle is thin. If the gap is still under strain, a small release cut in the diaphragm can ease it.

4. Then the wrap. The top of the stomach is wrapped around the lower food pipe. This rebuilds the valve. There are two main kinds of wrap:

  • A partial wrap (Toupet, 270°) goes most of the way round, from behind. Over the long run it controls reflux about as well as a full wrap. It causes less trouble swallowing, less bloating, and less of the “cannot burp” feeling that patients find hardest.
  • A full wrap (Nissen, 360°) goes all the way round. It may suit you if your food pipe muscle works normally and reflux is severe, and you accept the trade-offs.

If the food pipe muscle is weak, a partial wrap is a must, not a choice. A full wrap on a weak food pipe makes swallowing very hard. This is why a pressure test of the food pipe (manometry) is done before the wrap is chosen, never after.

Laparoscopic, robotic or open — how the approach is chosen

For a planned repair, the usual approach is laparoscopic. That means five small cuts, a camera, and the whole operation done through them. It is the standard approach for most sliding and medium-sized hernias.

A robotic repair is keyhole surgery done with wristed instruments and a magnified 3D view. It helps most where the work is deep in the chest and stitching is awkward. That means the very large hernias, and repeat operations where scar tissue must be cleared. It is offered for those cases. There is a separate page on robotic hiatal hernia surgery in Ahmedabad. It is not shown here as better for every patient, because no trial has shown that.

Open surgery is kept for a belly scarred by many past operations. Some people have real symptoms but too much risk for a full repair. For them, pulling the stomach back down and fixing it in place, without a wrap, is a sound and well-tolerated operation.

What patients say

★★★★★

“Excellent doctor. I have undergone Surgery for toupet fundoplication with harsh Shah doctor. Sir has given good treatment for early recovery. Treating patients very friendly.”

Ravi Bob · Google review

★★★★★

“My mother recently underwent hernia surgery at Apollo Hospital, Gandhinagar under the care of Dr. Harsh J. Shah, and my mother recovering very well. Dr. Harsh Shah is a highly skilled and compassionate surgeon. He explained everything clearly, made my mother feel comfortable throughout the treatment, and performed her surgery with great care. The nursing staff and the entire hospital team were polite, attentive, and provided excellent hospitality from admission to discharge. I sincerely thank Dr. Harsh Shah and the entire Apollo Hospital team for their outstanding care. I highly recommend Dr. Harsh Shah for hernia surgery and Apollo Hospital, Gandhinagar for their excellent medical service”

Sanju Kukda · Google review

A patient of Dr Harsh Shah talks about life after a Toupet wrap for reflux and a hiatal hernia. Shared with consent, on Dr Shah’s own channel.

Your patient journey — five steps

  1. Book your consultation. Bring every endoscopy report you have, any barium test, and a list of the acidity tablets you have taken. Note how long each one worked. Your story does most of the work here. Which symptom troubles you most decides the rest.
  2. Tests, and the treatment plan. An endoscopy to see the lining and measure the hernia. A pressure test of the food pipe, because the wrap cannot be chosen without it. A 24-hour acid test, if it is not yet proven that acid causes your symptoms. A CT scan for large hernias, to see what else has moved up. Only after these does Dr Harsh Shah tell you if surgery is right, which wrap, and what it will and will not fix.
  3. The surgery. You are admitted on the morning of surgery, or the evening before if you are travelling. Nothing to eat or drink from midnight. A simple repair takes about two hours. A large or repeat one takes longer. You walk the same evening and sip water once fully awake.
  4. A short hospital stay. This is not a day-care operation. Expect one or two nights, and longer if a lengthening step was needed or a drain was left. Day one: clear fluids, out of bed, breathing exercises, and the drain out if there is one. Day two: soft food. You go home once you are eating, walking and comfortable on tablets.
  5. Follow-up and full healing. You are seen at two weeks, then at six to eight weeks. Food moves in stages over about six weeks: liquids, then soft, then normal. Eat small meals often. Most people are back at a desk job within two weeks, and at the gym by six weeks.

Cost, insurance and admission

Hiatal hernia and anti-reflux surgery is covered by most health insurance, with cashless admission at Apollo Hospital, Bhat. Attach the endoscopy and manometry reports to the request.

You get a written estimate before admission. No figure on a web page can replace it, because what moves the cost is specific to you:

  • whether the repair is laparoscopic, robotic or open
  • whether mesh is used, and which kind
  • whether a lengthening step is needed
  • the room you choose, and how long you stay
  • whether this is a first or a repeat operation (repeats take longer and cost more)

The insurance request is sent with your endoscopy and pressure test reports attached. The paperwork moves faster when the reason for surgery is on record. That is one more reason the tests come first. Our coordinator handles the request. You are told what is and is not approved before admission, not after. If mesh is planned, its cost is shown and approved ahead of time. There is a fuller note on hernia surgery and your insurance claim. There is also one on anaesthesia for hernia surgery, if that part worries you.

What to bring: all past reports and films, your list of medicines, your insurance card and policy number, an ID, and someone who will stay with you.

Recovery, what can go wrong, and the honest part about recurrence

Some trouble swallowing in the first weeks is normal. The wrap and the gap are swollen. For most people it settles by six to eight weeks on a staged diet. Bloating and not being able to burp are common early on. They ease over the next few months. After a full wrap, not being able to burp or vomit is part of the operation. You agree to it before surgery. It is not counted as a complication. If swallowing is still hard after three months, it is checked, not just waited out. A swallow X-ray and an endoscopy show if the wrap has slipped or twisted, if the gap is too tight, or if a muscle problem was missed. Most of these can be fixed, some just by stretching.

Recurrence, said plainly. Suppose everyone who had this operation had a barium X-ray a few years later. A fair number would show some of the hernia back on the film. Most of those people have no symptoms and need nothing done. Only a few ever need a second operation. What matters is not the film. It is whether you have symptoms. Dr Harsh Shah treats the patient, not the film. Body weight is the biggest thing you can control. Losing weight before surgery is part of the treatment, not just advice. Some things raise the risk: weak connective tissue, a badly curved spine, or hernias that run in the family. These are flagged before surgery so that you know what to expect.

Less common problems are named, not hidden:

  • a tear in the food pipe or stomach, which is repaired during the same operation
  • air getting into the chest during the work there, which usually settles by itself
  • injury to a vagus nerve, so the stomach empties slowly
  • bleeding or infection
  • where a permanent mesh lies against the food pipe, the mesh wearing into it. This is rare and can appear years later. It is why such mesh is not used here.

Questions patients ask

Will I be able to stop my acidity medicine?

That is the aim of the operation. For most people whose reflux was proven on tests beforehand, yes. It is not promised. If a lengthening step was needed, you will stay on acid tablets. This is discussed before you agree to surgery.

My endoscopy says "hiatus hernia" but I feel nothing. Do I need surgery?

No. A sliding hernia found by chance, with no symptoms, is not a reason to operate. There is a separate note on what a hiatal hernia on your endoscopy report means.

Is mesh always used?

No. At the diaphragm, mesh is used only when needed. That is when the gap is large or the muscle is thin. The kind used is one the body absorbs, and it is placed so it does not touch the food pipe. The with-or-without-mesh note explains why.

Why do I need manometry before the operation?

Manometry is a pressure test of the food pipe. It shows whether the muscle can push food down. That one result decides whether you get a partial wrap or could cope with a full one. A wrap chosen without it may have to be undone.

How long before I can eat normally?

Liquids first, then soft food, then normal food, over about six weeks. Eat small meals often. Swallowing feels tight at first. That is the swelling, and it settles. There is a longer note on what each week of recovery looks like.

Can a large hernia be repaired without opening the chest?

Almost always, yes. Even large hernias are repaired through the belly, by keyhole or robotic surgery. The work is carried up into the chest from below. Opening the chest is now rare. It is kept for repeat operations where there is a lot of scarring.

What are the danger signs I should not wait on?

Severe pain in the upper belly or chest, with retching but no vomiting, and not being able to keep anything down. Together these can mean the stomach has twisted. It is an emergency. Go to the hospital. Do not wait for an appointment.

Where Dr Harsh Shah sees and operates

Dr Harsh Shah — Gota OPD, Ahmedabad
SF-203, 2nd Floor, Olive Greens, Sarkhej–Gandhinagar Highway, Gota, Ahmedabad, Gujarat 382481
Directions to the Gota OPD · +91 63555 64601

Dr Harsh Shah — Apollo Hospital, Bhat, Gandhinagar
Plot No. 1 A, Apollo Hospital International Limited, GIDC Bhat Industrial Estate, Gandhinagar, Gujarat 382428
Directions to Apollo, Bhat · +91 63555 64601

More on this site: robotic hiatal hernia surgery · hernia surgery at Dr Harsh Shah’s practice · what each week of recovery looks like

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