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Hiatus hernia surgery
Condition Guide

Hiatus hernia & reflux
Laparoscopic repair & fundoplication

A hiatus hernia happens when part of your stomach slips up through the diaphragm — the muscle that separates your chest from your belly. It often causes heartburn and acid reflux. A keyhole repair puts the stomach back in place and rebuilds the valve so reflux is controlled. Dr. Irshad performs over 100 of these repairs a year, including large, complex hernias.

Repair + wrap
Procedure
Day case–1 night
Hospital stay
Keyhole
Minimally invasive
100+ / year
Performed

What is a hiatus hernia?

Normally your stomach sits below the diaphragm. In a hiatus hernia, part of it pushes up into the chest through an opening called the hiatus. Small ones may cause only mild reflux; large (paraesophageal) hernias can cause pain, trouble swallowing, or breathing problems.

Signs & symptoms

  • Frequent heartburn or acid reflux
  • Food or liquid coming back up
  • Chest or upper-tummy discomfort
  • Trouble swallowing
  • Feeling full very quickly
  • Reflux that wakes you at night

How it’s diagnosed

  • Upper endoscopy to look inside
  • Barium swallow X-ray
  • Sometimes manometry and pH testing — these measure the valve and muscle and how much acid comes up, and help guide the type of wrap

Surgical options

  • Nissen fundoplication (full 360° wrap) — the gold standard for severe reflux
  • Toupet (partial 270° wrap) — gentler on swallowing
  • Paraesophageal repair — returning the stomach, closing the gap (sometimes reinforced with a biologic mesh) and adding a wrap
Patient tool
How much is reflux affecting your life?

Take the GERD-HRQL questionnaire — a validated symptom score doctors use — and see where your result falls, with feedback you can share with your doctor.

Open tool →
Dr. Irshad’s approach

Laparoscopic repair

Through a few keyhole cuts, Dr. Irshad returns the stomach to its proper place, closes the widened opening in the diaphragm, and builds a new valve from part of your own stomach to stop reflux.

Even very large hernias can almost always be fixed this way, rarely needing open surgery. Most patients go home the same day or after one night.

Your recovery, step by step

Hospital

Same-day or one overnight stay for most patients.

Weeks 1–2

Soft diet of mashed and pureed foods; no heavy lifting.

Weeks 3–4

Gradual return to normal eating; some temporary bloating is normal.

6 weeks

Full return to normal activities, including exercise.

Download recovery guide (PDF)A printable guide to take home.

Common questions

Will I still be able to burp or vomit after a fundoplication?
After a full 360° Nissen wrap, burping and vomiting are harder at first. Most patients adapt. Dr. Irshad chooses the wrap type (360° vs 270°) based on your manometry results to keep this to a minimum.
My hernia is very large — is keyhole surgery still possible?
Yes. In the large majority of cases, even giant paraesophageal hernias can be repaired with keyhole surgery. Dr. Irshad specializes in complex hiatal repairs and rarely needs to convert to open surgery.
I’ve been on antacids for years. Do I really need surgery?
Medications manage symptoms but don’t fix the mechanical problem. Surgery is often the best option for large hernias, symptoms that persist despite medication, or complications such as Barrett’s esophagus or recurrent aspiration.

Preparing for your surgery at William Osler

Your operation takes place at William Osler Health System (Brampton Civic Hospital). These are the hospital’s general instructions for getting ready, the day itself, and afterwards — always follow any specific advice Dr. Irshad gives you. Full details are on the Osler Surgical Services page.

Before your surgery
  • Do not eat anything (including gum) after midnight the night before. Unless told otherwise, you may have clear fluids — water, pulp-free juice, black coffee or tea — up to 2 hours before.
  • No alcohol, smoking, or marijuana for 24 hours before surgery.
  • Shower the evening before and the morning of surgery (with chlorhexidine soap if you have it). Skip lotion, perfume, makeup and nail polish.
  • Bring your OHIP card and photo ID, all your medications in their original containers (inhalers, insulin, supplements), and your CPAP machine if you use one.
  • Arrange a responsible adult to drive you home — a taxi, Uber or Lyft does not count, and surgery may be cancelled without one.
  • Leave jewellery, money and valuables at home.
The day of your surgery
Arrive about 2 hours before your scheduled time. Register at the central registration desk in the main lobby at Brampton Civic Hospital (2100 Bovaird Drive East), then go to the Day Surgery area. Staff will help you change, check your vitals, confirm the details from your pre-anaesthesia visit, and start an IV before you go to the operating room. Your family member can wait in the surgery waiting area.
After your surgery
You’ll wake up in the Post-Anaesthesia Care Unit, then move to Day Surgery or an inpatient room (or the Intensive Care Unit if you need closer monitoring). For the first 24 hours after the anaesthetic, have an adult with you, do not drive or operate machinery, avoid alcohol, and hold off on big decisions. A follow-up appointment is booked before you leave. Learn more about discharge and pain management.
The pre-anaesthesia clinic
Before your operation you’ll get a call from the pre-anaesthesia clinic for an education call or an in-person visit, where the team reviews your health, your medications and your anaesthetic plan.

Medically reviewed by Dr. Kashif Irshad, MD, MSc, FRCSC · Last updated July 2026

A referral from your family doctor or specialist is all that’s needed to be seen by Dr. Irshad. Find the referral forms and clinic details below.

Referral information →