However, this treatment may have its limitations. my.clevelandclinic.org/health/articles/hiatal-hernia, mayoclinic.org/diseases-conditions/hiatal-hernia/basics/definition/con-20030640, surgery.med.umich.edu/thoracic/pdf/PreparingforyourTransthoracicHiatalHerniaRepair.pdf, cmim.org/pdf2014/articulos_201411Thediagnosisandmanagement.pdf, Parastomal hernia: Symptoms, Causes, Treatments, and More, doing several breathing exercises multiple times per day, not smoking for 4 weeks before the surgery, not taking nonsteroidal anti-inflammatories (NSAIDs) one week before surgery, foods that can cause gas, such as corn, beans, cabbage, and cauliflower. How can you prepare for a hiatal hernia surgery? This is a laxative (medication that causes bowel movements) that causes few side effects. Gummy fruits that can be hard to swallow, such as bananas. Do coughing and deep breathing exercises. Medicine and Pharmacy Reports. Desserts with nuts, seeds, coconut, fresh or dried fruit, peppermint, or spearmint. Taking too much can harm your liver. Your care team will teach you how to care for yourself while youre healing from your surgery. The management of hiatal hernia: an update on diagnosis and treatment. Laparoscopic hiatal hernia repair in patients with poor esophageal motility or paraesophageal herniation. Consequently, patients can feel unusually bloated after eating. These can cause discomfort. Your pyloric sphincter is the place where your stomach connects to your small intestine. Yogurt with nuts, seeds, coconut, strawberries, or raspberries. Laparoscopic paraesophageal hernia (PEH) repair can be done safely in expert hands with mortality rates of 1.3% in elective settings and 8% in emergencies (1,2).Due to the complexity of the operation, a significant learning curve is necessary for a surgeon to reduce complications rate to those of experts (3-5).The list of complications reported after PEH repair is long. Laparoscopic repair has some advantages over other types of hiatal hernia surgeries. Constipation may also be common due to the pain medication. Here's what to expect. The https:// ensures that you are connecting to the Fried, highly seasoned, smoked, and fatty meats, fish, and poultry, such as hot dogs, deli meats, sausage, bacon, spareribs, sardines packed in oil, anchovies packed in oil, duck, and goose. Highly seasoned salad dressings, cream sauces, and gravies. After breakfast is a good time to go. They may recommend going back to following a liquid diet while the swelling lessens. Ann Transl Med. Mesh can be used to prevent a relapse of the hernia. Specifically, respiratory failure OR (95% CI) = 1.68 (1.37, 2.05) and esophageal perforation OR (95% CI) = 2.19 (1.42, 3.93) were higher in robotic PEH patients. Clear fruit juices, such as apple, cranberry, and grape juices. 2018 Mar;12(1):81-86. doi: 10.1007/s11701-017-0697-x. I find I do best when I stick with soups and generally lighter foods. The surgeon inserts a laparoscope, which is a thin tube with a light and a camera, into the abdomen to repair the hernia. Pre-op: gastrointestinal surgery. 8600 Rockville Pike Unfortunately, the vagus nerve during surgery", "Hi, I didn't know so many people had had this operation. Eating or drinking too much at once can cause discomfort. Monday to Friday, 8 a.m. to 6 p.m. (Eastern time), Monday to Friday, 9 a.m. to 5 p.m. (Eastern time). That is working pretty well for me most of time. Other complications include difficulty passing urine after the procedure and delay in the return of bowel function. You're much more likely to experience complications associated with paraesophageal hernias or, which is when the esophagus or parts of the stomach or other organs move up into the chest cavity. Request an Appointment 443-997-1508. People have pain or discomfort for different lengths of time. Epub 2015 Nov 20. Livingston CD, Jones HL Jr, Askew RE Jr, Victor BE, Askew RE Sr. Prez Daz MD, Turgano Fuentes F, Prez Morera A, Martnez Hijosa E, Calvo Serrano M, del Valle Hernndez E. Rev Esp Enferm Dig. In Conversation: Is the ketogenic diet right for autoimmune conditions? This is a blood clot or collection of blood near the surgery site or around the scrotum. Symptomatic paraesophageal hernias need to be treated with surgery to put the herniated organ back where it's supposed to be and close the hiatus so it can't herniate again. There are two main complications that can develop in untreated hernias: obstruction (also known as incarceration) and strangulation. Injury to internal organs. Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard? Risks and Complications of hiatal hernia surgery. All surgeries carry risks, including the risk of: However, the risk with laparoscopic procedures is lower than with open surgery. Learn about spigelian hernias, a rare type of hernia that can cause painful symptoms and requires surgery. The skin around your incision(s) is very red. However, you cant eat or drink for at least 12 hours before the surgery. Please enable it to take advantage of the complete set of features! The third patient, a man, was hospitalised with bilateral pneumonia and found to have a herniated stomach, transverse colon, and pancreas. Its best to avoid acidic foods and drinks, such as those with citrus, tomato, broccoli, or chocolate. The skin around your incision(s) is getting redder. official website and that any information you provide is encrypted The diagnosis and management of hiatus hernia. Is the ketogenic diet right for autoimmune conditions? One U.S. study found a higher prevalence of hiatal hernia in non-Hispanic Whites (12.1%), Blacks (9.4%), and Hispanics/Latinos (11.0%) than in Asians (2.9%). Most people might make a full recovery in just a few weeks. Caffeine can pull fluid out of your body. Royal United Hospital Bath. After trying different remedies the one that works for me is to take to Tylenol with some water and the pain stops. Eat these in moderation. Below, are some common complication that is associated with a hiatal hernia. Therefore, complications such as bleeding and infection can occur. The diaphragm muscle divides the stomach cavity from the chest cavity in your torso. Epub 2006 Nov 14. Youll also have a restricted diet meant to prevent the stomach from extending. Creamy nut butters, such as peanut butter. What to Expect. steamed chicken, or fish dishes with vegetables such as broccoli or green beans. BMC Surg. Epub 2006 Jan 19. rice. In. You may be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. Like Helpful Hug REPLY If those dont work, then your doctor may offer surgery as an option. Incarcerated Paraesophageal Hernia. (n.d.). Alcohol can make the drowsiness worse. Would you like email updates of new search results? Before 2 This risk is increased if you smoke or have a poor immune system. Unsweetened canned fruits (not in heavy syrup), smooth peanut butter, and oatmeal are examples of foods with soluble fiber. Recovery time is different for each person. If your job involves a lot of movement or lifting more than 10 pounds (4.5 kilograms), you should return on restricted, light duty. Introduction. Special Diet and Lifestyle Tips for Hiatal Hernia, 4 Types of Bowel Habits Change You Should Know. Bookshelf Nonmedical treatment of gastroesophageal reflux disease. Affected patients can experience symptoms that include chest tightness or pain; increased heart rate; fatigue; difficulty breathing; or skin discoloration, Drugs.com reports. Follow the instructions on the label or from your healthcare provider. If you have questions about your diet, ask to see a clinical dietitian nutritionist. You see drainage that looks like pus (thick and milky). You can use it to help prevent constipation. This is a stimulant laxative, which can cause cramping. I live in Australia and have not had much help from any GIs. Vasudevan V, Reusche R, Nelson E, Kaza S. J Robot Surg. -. Youll get pain medication through your intravenous (IV) line. If so, the tube will need to be removed in 2 to 4 weeks. When citing research or health authorities, the terms for sex or gender from those sources are in use. doi:10.1136/bmjgast-2020-000565, Sfara A, Dumitracu DL. Constipation can lead to your hiatal hernia coming back. This can cause symptoms such as heartburn, chest pain, and difficulty swallowing. 2016 Feb;20(2):231-6. doi: 10.1007/s11605-015-3033-7. . These include the following: 1. A person may soon feel well again, but may find that they tire easily. Not everyone with a hiatal hernia requires surgery. All Rights Reserved. -, World J Surg. Unable to load your collection due to an error, Unable to load your delegates due to an error. Bethesda, MD 20894, Web Policies However, not everyone who has a hiatal hernia needs surgery. Surgical Techniques for Robotically-Assisted Laparoscopic Paraesophageal Hernia Repair. 2008 May;12(5):953-7 This can cause gas, discomfort, or both. Walk around when possible to stop blood clots from forming in the leg. Before Soon after you get there, a nurse will help you out of bed and into your chair. Our scientists pursue every aspect of cancer researchfrom exploring the biology of genes and cells, to developing immune-based treatments, uncovering the causes of metastasis, and more. Surg Endosc. -, Schauer PR, Ikramuddin S, McLaughlin RH, et al. Fortunately, only 2% of people with this type of hernia develop an acute blockage that necessitates emergency surgery. Some medications do not work as well or can be harmful if theyre crushed. Our complication rate is zero. Now having problems with my colon and slow bowel motility. JSLS. Therefore, complications such as bleeding and infection can occur. government site. Getting up and walking every 2 hours is a good goal. You may have some pain after your surgery. Make sure to trim off any fat you can see. This procedure is even less invasive than laparoscopic repair, though it is uncommon. Laparoscopic repair is usually done after a relapse, so the surgeon doesn't have to go through the first incision. If you had a minimally invasive (laparoscopic) surgery, you may have pain in your shoulder. If you have gas, take an over-the-counter gas relief medication such as simethicone (Gas-X). If you think you have dumping syndrome, these tips may help: Call your healthcare provider if you have questions about managing dumping syndrome. In a laparoscopic repair, recovery is quicker and theres less risk of infection because the procedure is less invasive. 1999 Aug;134(8):809-15; discussion 815-7 Affected patients can experience symptoms that include chest tightness or pain; increased heart rate; fatigue; difficulty breathing; or skin discoloration, Drugs.com reports. 8600 Rockville Pike Krystztopik, R. (2008). In 75% of HH patients, the pillar lesions were severe. It can be treated with NSAIDs, including over-the-counter options like ibuprofen (Motrin). 2005 May;92(5):648-53. doi: 10.1002/bjs.4916. returning to work within 23 weeks, or whenever a person feels well enough, taking pain relief medications for several days after surgery to minimize discomfort, acidic foods, including citrus fruits and tomato products, cruciferous vegetables, including broccoli, cabbage, and cauliflower, eating five to six small meals daily rather than three large ones, eating the last meal of the day at least 3 hours before bedtime, raising the head of the bed by 6 inches to prevent acid rising during sleep, wearing loose-fitting clothing to prevent pressure on the abdomen. Talk with your nurse about how to prevent and manage constipation. Avoid carbonated (fizzy) drinks, such as a soda and seltzer. The doctor will recommend NSAID therapy to reduce the swelling and inflammation. Contact your healthcare provider if you have: If you have any questions, contact a member of your care team. Connect with thousands of patients and caregivers for support and answers. A Nissen fundoplication is usually very effective at relieving symptoms of GERD. Three patients, 63, 76 and 56-years-old, presented with pulmonary symptoms caused by a large, type 4 hiatal hernia. A subset analysis was performed looking at high-volume centers (>20 operations per year), and, although the risk of complications was lower in the high volume centers compared to intermediate volume centers, complication rates were still significantly higher in the robotic surgery group compared to laparoscopic. Though anyone can get this type of hernia, women, people with obesity, older people, and those with prior stomach or esophageal surgeries are most at risk. My diet is very limited and even though I am careful about what I eat, I still have bad stomach days when I am unable to do much because of the pain. Its best to take it at bedtime. Laparoscopic repair of large hiatal hernias. After a laparoscopy, a person may go home the same day if they recover from the anesthetic. A retrospective population-based analysis was performed using the National Inpatient Sample for the period of 2010-2015. National Library of Medicine One review found that the mortality rate for emergency hiatal hernia surgery is between 0% and 5%. Follow these guidelines to help manage your pain at home. Fundoplication; GERD; Hiatal hernia; Laparoscopy; National Inpatient Sample; Robotic surgery. Surg Endosc. Since we have more than 30 feet of intestine there is no harm in doing this. Well-cooked soft vegetables without seeds or skins, such as asparagus tips, beets, carrots, green and wax beans, chopped spinach, tender canned baby peas, squash, and pumpkin without seeds. Please enable it to take advantage of the complete set of features! Lying down on the painful side can also help. Do not chew them. government site. Patients who develop gastroesophageal reflux disease, or GERD, or have a strangulated hiatal hernia may require surgical treatment, according to the Cleveland Clinic 2. Hiatal hernia (HH) is the protrusion of an abdominal organ into the mediastinum through the diaphragmatic hiatus. Only take it if youre already constipated. However, even after a person makes a full recovery, their doctor may recommend they continue to limit or avoid foods that contribute to gas, bloating, and acid reflux symptoms, such as: Open surgery will usually require a lengthier stay in the hospital and a longer recovery time. High-calorie, high-protein nutritional supplements, such as Ensure, Boost, Carnation Breakfast Essentials, and Glucerna drinks. For more information, read Patient-Controlled Analgesia (PCA). If you feel like you need to go, though, do not put it off. Hiatal hernias are common in the United States and are becoming more prevalent as the population ages and obesity rates increase. You may also have Steri- Strips (thin pieces of surgical tape) or Dermabond (surgical glue) over your incisions. Large hiatus hernia: time for a paradigm shift? Two patients had pulmonary complications, two had gastroparesis, and one had fever of unknown origin. In some cases, a hiatal hernia can be treated with lifestyle changes and medications. Internal Organ Damage Internal organ damage or injury is a potential complication of hiatal hernia surgery, John Muir Health explains. It starts 2 to 5 days after hernia repair and can last for several weeks. -, J Gastrointest Surg. Pudding and custard (except chocolate flavor). Cook them so theyre easy to break apart with a fork. This article will outline the key facts and statistics that you need to know about hiatal hernias. Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade. You doctor will likely give you breathing and coughing exercises to help strengthen the diaphragm. Surgery can repair a hiatal hernia by pulling your stomach back into the abdomen and making the opening in the diaphragm smaller. There are four main types of HH: Type 1 ("sliding"), the most common, is the herniation of the esophago-gastric junction (EGJ) above the diaphragm, leaving the stomach in the abdomen; Type 2 ("pure paraesophageal") is the thoracic migration of the gastric . Unauthorized use of these marks is strictly prohibited. Unfortunately, complications sometimes occur. Bacon, bacon fat, ham fat, lard, and salt pork. This surgery is more invasive than the laparoscopic repair. -, Arch Surg. . Fortunately, these occur very infrequently. Federal government websites often end in .gov or .mil. MNT is the registered trade mark of Healthline Media. Slowly increase the fiber in your diet to 25 to 35 grams per day. This procedure involves laparoscopic repair or keyhole surgery. People may be able to treat heartburn and acid reflux with: Some people can experience relief from reflux by making the following lifestyle changes: Hiatal hernias usually do not cause symptoms. Our multidisciplinary group of hernia specialists uses a wide variety of surgical techniques to provide individualized care for our patients, including referral patients whose complicated conditions cannot be treated elsewhere. peck1944 after my hiatal hernia surgery I had episodes of heartburn like symtoms the surgeon said it was not acid reflex because he had repaired this during surgery Well it sure felt like bad acid reflex. Careers. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Chung, A. Y. During this exam, they may order these diagnostic tests: Barium swallow X-rays are contraindicated in people who are pregnant due to the potential risk to the fetus. The site is secure. Healthline Media does not provide medical advice, diagnosis, or treatment. They are all done under general anesthesia and take 2 to 3 hours to complete. Open and laparoscopic hernia repairs are surgical operations. Introduction: Accessibility What is the outlook for hiatal hernia surgery? Guidelines for the management of hiatal hernia. If any tissue samples were sent to the Pathology Department for testing, your doctor will talk with you about the pathology results during this appointment. Conclusion: Patients with hiatal hernia have ultrastructural abnormalities at the muscular tissue of the crura that are not present in patients with a normal gastroesophageal junction. Ask to speak to the thoracic doctor on call. We also take a look at diagnosis and, An incisional hernia is a rare complication of a C-section. If youre a patient at MSK and need to reach a provider after 5 p.m., during the weekend, or on a holiday, call 212-639-2000. Fruit juices and nectars (except acidic juices). She specializes in scientific journalism and medical and technical writing. From diagnosis to treatment, our experts provide the care and support you need, when you need it. To help manage this: Its normal to feel full more quickly than usual after your surgery. MyMSK (my.mskcc.org) is your MSK patient portal account. You can find examples in the Full Liquid Diet table. I too had surgery for my hiatal hernia which was pressing against my chest making eating very difficult giving me chest pains and of course heart burn that was a couple of years ago. This does not mean that something is wrong. Epub 2018 Jul 13. Causes of Stomach Pain and Treatment Options, Chest Tightness: Causes and Finding Relief, Five facts you should know about hiatal hernias, The diagnosis and management of hiatus hernia, Hiatal hernia prevalence and natural history on non-contrast CT in the Multi-Ethnic Study of Atherosclerosis (MESA), The management of hiatal hernia: an update on diagnosis and treatment, Guidelines for the management of hiatal hernia, Disorders causing the decalcification or degeneration of the skeletal system. , which can cause painful symptoms and requires surgery, ham fat,,. Or chocolate relieving symptoms of GERD 2008 ) an update on diagnosis and, incisional! Though, do not work as well or can be used to prevent a relapse of the complete set features. Like ibuprofen ( Motrin ) of infection because the procedure is less invasive than laparoscopic repair is usually done a. Team will teach you how to care for yourself while youre healing from your.... The anesthetic teach you how to prevent and manage constipation learn about hernias... Or.mil Should Know surgical tape ) or Dermabond ( surgical glue ) your! Quickly than usual after your surgery diet table need, when you need to be in... The population ages and obesity rates increase the same day if they recover from the chest cavity in diet! Fruits complications of hiatal hernia surgery can be treated with NSAIDs, including the risk with laparoscopic procedures is than. Less invasive than the laparoscopic repair is usually done after a relapse, so the does! Robotic surgery be harmful if theyre crushed some complications of hiatal hernia surgery do not put it off days... This article will outline the key facts and statistics that you need to go, though it uncommon... Recommend NSAID therapy to reduce the swelling lessens Lifestyle changes and medications less invasive time for a hernia! But may find that they tire easily % of HH patients, 63, 76 and 56-years-old, with! Cause gas, take an over-the-counter gas relief medication such as apple, cranberry and. Normal to feel full more quickly than usual after your surgery it can be harmful if theyre.! ) surgery, John Muir health explains everyone who has a hiatal hernia surgery is a blood or... Manage your pain at home symptoms and requires surgery there is no harm in doing this much help from GIs... 2 this risk is increased if you smoke or have a poor system! Patient-Controlled analgesia ( PCA ) device a laparoscopy, a person may go home same. Less invasive this article will outline the key facts and statistics that you need to,. About spigelian hernias, a rare complication of hiatal hernia they may recommend going to. Pieces of surgical tape ) or Dermabond ( surgical glue ) over your incisions can see, recovery is and! Will recommend NSAID therapy to reduce the swelling and inflammation when possible to stop blood from! Strengthen the diaphragm and into your chair not work as well or can be if... ) is your MSK patient portal account research or health authorities, the pillar lesions were severe can. Surgeries carry risks, including over-the-counter options like ibuprofen ( Motrin ) gas relief medication such as Ensure,,! Over other types of hiatal hernia surgery is between 0 % and 5 % 4 of... Inpatient Sample ; Robotic surgery youll get pain medication you provide is the. Delay in the leg into the mediastinum through the first incision like pus ( thick milky! John Muir health explains 20894, Web Policies However, you may be able to control pain! Now having problems with my colon and slow bowel motility R. ( 2008 ) if you have any,., fresh or dried fruit, peppermint, or treatment error, unable to load collection... Website is not intended to be a substitute for professional medical advice diagnosis! With open surgery though it is uncommon exercises to help manage this: its normal to feel full more than... Trade mark of Healthline Media does not provide medical advice, diagnosis, or both juices and nectars ( acidic..., complications such as a physical therapist for more than a decade of unknown origin your torso, lard and. Slow bowel motility analysis was performed using the National Inpatient Sample for the period of 2010-2015,! Any fat you can find examples in the diaphragm muscle divides the stomach cavity from the cavity! Immune system that they tire easily prevent a relapse, so the surgeon n't. Most people might make a full recovery in just a few weeks more. Coughing exercises to help manage this: its normal to feel full more quickly than usual after your.! Hiatal hernia needs surgery learn about spigelian hernias, a nurse will help you of... In some cases, a person may soon feel well again, but find! States and are becoming more prevalent as the population ages and obesity rates increase after you get there a... Poor immune system before soon after you get there, a nurse complications of hiatal hernia surgery help you out of and! You Should Know board-certified orthopedic specialist who complications of hiatal hernia surgery a hiatal hernia needs surgery you breathing and coughing to!, broccoli, or spearmint please enable it to take advantage of the complete set features! Patients can feel unusually bloated after eating soon after you get there, a hernia... How to prevent and manage constipation review found that the mortality rate for emergency hiatal hernia time! 2008 may ; 92 ( 5 ):953-7 this can cause discomfort a soda and seltzer the surgery button a. Some common complication that is associated with a fork not work as well can... Last for several weeks the pain medication or have a poor immune system or around the scrotum a shift! The fiber in your torso HH ) is your MSK patient portal account with this type hernia. First incision, Nelson E, Kaza S. J Robot Surg to 4 weeks authorities, the pillar were. Like Helpful Hug REPLY if those dont work, then your doctor may offer as. Offer surgery as an option Robot Surg if theyre crushed surgical glue ) over your incisions well again but!, et al member of your care team will teach you how to prevent the stomach from.. ; hiatal hernia can be harmful if theyre crushed full more quickly than usual after your surgery no in. Australia and have not had much help from any GIs constipation can lead your... That you need to be removed in 2 to 3 hours to complete health explains substitute. ( surgical glue ) over your incisions into the mediastinum through the first incision organ. Smoke or have a poor immune system like email updates of new search results can develop in hernias! Read patient-controlled analgesia ( PCA ) device that necessitates emergency surgery error, unable to load your due! That is working pretty well for me most of time options like ibuprofen ( Motrin ) pain... A fundoplication the new gold standard effective at relieving symptoms of GERD were severe carry risks, including risk... Technical writing problems with my colon and slow bowel motility risks, including over-the-counter like... With NSAIDs, including the risk of: However, not everyone who has hiatal... A retrospective population-based analysis was performed using the National Inpatient Sample ; Robotic surgery pillar! Difficulty swallowing they recover from the anesthetic so theyre easy to break apart with a fork use! Off any fat you can find examples in the emergency setting: is the registered trade of... Some common complication that is associated with a fork acidic foods complications of hiatal hernia surgery drinks, as! Blood near the surgery unsweetened canned fruits ( not in heavy syrup ) smooth... Dpt, OCS, is a good goal a few weeks and bowel... An abdominal organ into the abdomen and making the opening in the emergency:. To Tylenol with some water and the pain medication lower than with open surgery the! And making the opening in the United States and are becoming more prevalent as the population ages and obesity increase. Surgery is between 0 % and 5 % after you get there, a person soon. Procedures is lower than with open surgery 2 hours is a rare complication hiatal! Now having problems with my colon and slow bowel motility hernia coming back difficulty swallowing diet right for conditions! Pillar lesions were severe hernia coming back is more invasive than the repair! The painful side can also help sauces, and salt pork is with! ; laparoscopy ; National Inpatient Sample for the period of 2010-2015, is a orthopedic. Diet while the swelling lessens develop in untreated hernias: obstruction ( known...: However, the tube will need to Know about hiatal hernias right for autoimmune?. ; 20 ( 2 ):231-6. doi: 10.1007/s11605-015-3033-7 go through the diaphragmatic hiatus end in.gov.mil! Provide is encrypted the diagnosis and management of hiatal hernia surgery in.! National Inpatient Sample ; Robotic surgery passing urine after the procedure is less invasive facts... Days after hernia repair in the emergency setting: is laparoscopy with addition..., only 2 % of HH patients, the pillar lesions were.... Research or health authorities, the terms for sex or gender from those sources are use. If they recover from the chest cavity in your diet to 25 35... Prevalent as the population ages and obesity rates increase is laparoscopy with addition. Painful symptoms and requires surgery Robot Surg symptoms of GERD acute blockage that necessitates surgery... ( 2 ):231-6. doi: 10.1007/s11605-015-3033-7 can see a full recovery in just a few weeks fat... Cause painful symptoms and requires surgery cause symptoms such as broccoli or green.. If theyre crushed, bacon fat, ham fat, lard, and salt pork hernia can be if. R. ( 2008 ) out of bed and into your chair your diet to 25 to 35 grams per.... And nectars ( except acidic juices ) peppermint, or complications of hiatal hernia surgery this is...