A hiatal hernia occurs when part of the stomach pushes up through an opening in the diaphragm, known as the hiatus, and protrudes into the chest cavity.
This can allow food and stomach acid to back up into the esophagus, leading to heartburn, acid reflux, and other symptoms.
While hiatal hernia surgery aims to repair the anatomical defect and reduce reflux symptoms, some patients may experience weight loss after the procedure.
However, it’s important to understand the causes of weight loss after hiatal hernia repair and whether the weight loss is likely to be permanent.
I. Is Weight Loss After Hiatal Hernia Surgery Permanent?
Unfortunately, the short answer is no. Weight loss after hiatal surgery is not permanent in most cases. However, if a person changes their lifestyle after this surgery, they may not regain the lost kilos. And that’s provided they follow this new lifestyle and add a little exercise to their daily routine.
1. What is a Hiatal Hernia and How is it Related to Weight Loss?
The diaphragm normally has an opening called the hiatus that allows the esophagus to pass through and connect to the stomach.
A hiatal hernia develops when the upper part of the stomach squeezes up through this opening into the chest.
There are two main types of hiatal hernias:
- Sliding hiatal hernia: This is the most common type, accounting for 95% of cases. It occurs when the stomach and the section of the esophagus joining the stomach slide up into the chest through the hiatus.
- Paraesophageal hiatal hernia: This is less common but more serious. The stomach squeezes up next to the esophagus but remains in its usual position. However, the diaphragm opening widens, allowing other organs to potentially move up into the chest.
There are several ways that hiatal hernia repair can be related to weight loss after surgery:
- Post-surgical diet: After surgery, patients will be placed on a progressive diet starting with clear liquids and gradually reintroducing soft, bland foods over 2-3 weeks. This initial calorie restriction can lead to temporary weight loss.
- Reduced stomach capacity: The surgery may tighten or alter the stomach anatomy, resulting in a smaller functional stomach capacity after surgery. This earlier sensation of fullness can reduce calorie intake.
- Underlying conditions: Obesity is a major risk factor for hiatal hernias, so bariatric surgeries like gastric bypass are sometimes combined with hiatal hernia repair, leading to more significant weight loss.
- Difficulty swallowing: Some patients experience postoperative swelling or tightness that can make swallowing difficult, reducing food intake.
So while the goal of hiatal hernia surgery is to repair the anatomical defect rather than induce weight loss, these surgical factors can contribute to temporary weight loss after surgery in some patients.
2. How Much Weight Loss Typically Occurs After Hiatal Hernia Surgery?
The amount of weight loss after hiatal hernia surgery can vary substantially based on the individual and the type of procedure performed. On average:
- Patients who undergo hiatal hernia repair alone typically lose only 5-10% of their body weight. This modest weight loss is attributed mainly to the 2-3 week postoperative liquid diet.
- When hiatal hernia repair is combined with bariatric surgery like gastric bypass, patients may experience more significant weight loss of 20-30% of initial body weight.
- One study on laparoscopic Nissen fundoplication for hiatal hernia repair found an average weight loss of 3.9 kg (8.5 lbs) over 6 months after surgery. The loss was greater in women versus men.
- Obese patients are more likely to experience pronounced weight loss, given their higher calorie needs and the impact of dietary changes after surgery.
- Most patients begin losing weight immediately after surgery due to the liquid diet. But weight loss often plateaus after the transition back to normal foods.
So while small amounts of weight loss in the 5-10 lb range are common after hiatal hernia surgery alone, substantial weight loss requires additional bariatric surgical techniques targeting weight reduction.
II. What Causes Weight Loss After Hiatal Hernia Repair Surgery?
There are several potential mechanisms that can contribute to weight loss after hiatal hernia surgery:
- Dietary restrictions – The initial liquid diet and gradual reintroduction of soft foods over 2-3 weeks post-surgery results in an abrupt reduction in calorie intake, which leads to weight loss.
- Reduced stomach capacity – Depending on the surgical techniques used, the stomach may be wrapped or tightened around the esophagus during repair. This can leave patients feeling fuller faster, thereby reducing food intake.
- Difficulty swallowing – Post-op swelling and changes to the esophagus can make swallowing difficult for some patients initially, reducing food intake. This usually resolves within 2-3 weeks.
- Dumping syndrome – In some cases, food passes too quickly from the stomach into the small intestine after surgery. This leads to nausea, cramping, and diarrhea which can discourage overeating.
- Early satiety – Some patients experience sensations of fullness after eating smaller portions due to post-operative changes, allowing for weight loss.
- Increased resting metabolism – The body’s baseline metabolic rate increases after surgery to promote healing, burning more calories.
So the primary drivers of weight loss tend to be reduced calorie intake from diet changes and altered digestive anatomy, rather than the hiatal hernia repair itself directly causing weight loss.
III. What Diet is Recommended After Hiatal Hernia Surgery for Weight Loss?
The diet after hiatal hernia surgery focuses on promoting healing and avoiding irritation rather than weight loss. But it can support weight loss:
- Phase I (1-2 days) – Clear liquids like broth, juice, water, gelatin
- Phase II (3 days) – Full liquids like protein shakes, smoothies, yogurt, cream soups
- Phase III (2 weeks) – Pureed foods like mashed potatoes, apple sauce, bananas, scrambled eggs
- Phase IV (4-6 weeks) – Soft foods like steamed vegetables, shredded chicken, fish, pasta, cooked grains
- Phase V – Regular foods can be slowly reintroduced about 6 weeks post-op
Other diet tips:
- Take small, frequent meals rather than large portions
- Chew foods thoroughly – at least 20 chews per bite
- Avoid irritants like spicy, acidic, fried, or gas-producing foods
- Stay hydrated with water and nutritious fluids
- Limit caffeine, carbonation, alcohol as these can aggravate reflux
So while substantial weight loss is not the goal, this gradual post-operative diet eases the digestive system back to normal function while promoting some weight loss through reduced calorie intake.
IV. What Lifestyle Changes Are Required to Maintain Weight Loss After Hiatal Hernia Surgery?
The following lifestyle habits can help maintain weight loss after hiatal hernia repair surgery:
- Exercise regularly – Light walking and activity in the first 6 weeks, followed by gradual increase in intensity. Aim for 30-45 minutes daily.
- Support body healing – Get adequate sleep and avoid stress. Manage pain and discomfort properly.
- Monitor food intake – Keep a food diary. Be mindful of portion sizes, hunger cues, macronutrients.
- Eat slowly – Allow 20-30 chews per bite. This promotes satiety and avoids overeating.
- Stay hydrated – Drink 64+ oz of water daily to support healing.
- Reduce irritants – Limit alcohol, caffeine, carbonation, and spicy foods.
- Quit smoking – Smoking impairs healing and can exacerbate reflux.
- Elevate the head – Sleep with head elevated 30-45 degrees to avoid nighttime reflux and promote healing.
- See your doctor – Follow up as instructed to monitor recovery and guidance on diet, activity, and medications.
Permanent weight loss requires lifestyle habits that promote long-term health through a nutritious diet, daily activity, stress management, and avoiding behaviors that could compromise healing after surgery.
V. Can Laparoscopic Hiatal Hernia Repair Also Contribute to Weight Loss?
Yes, laparoscopic hiatal hernia repair can also result in some weight loss, though not as substantial as open surgery.
Laparoscopic repair involves small incisions in the abdomen through which instruments are inserted and the hernia is repaired internally. Benefits include:
- Faster recovery – Most patients go home 1-2 days after laparoscopic surgery versus 4-5 days with open surgery. Less pain and scarring may promote mobility and appetite recovery.
- Shorter liquid diet – Laparoscopic patients can usually advance to soft foods after 7-10 days rather than 2-3 weeks. This may mitigate weight loss.
- Less impact on stomach – Laparoscopic techniques may alter stomach anatomy less drastically than open surgery, but some restriction can still occur.
- Metabolic changes – The increase in metabolic rate during healing still occurs, which burns more calories.
Overall, while the mechanisms of weight loss around diet changes, reduced capacity, and increased metabolism still apply to laparoscopic repair, this minimally invasive approach may involve faster recovery of appetite and less radical changes to digestive anatomy that could promote weight loss.
VI. Is Weight Loss More Significant in Obese Patients After Hiatal Hernia Surgery?
Obese patients are at higher risk for developing a hiatal hernia due to increased abdominal pressure from excess weight pressing on the stomach. For obese patients, the following factors may amplify weight loss after hiatal hernia surgery:
- Combined procedures – Bariatric techniques like gastric sleeve or bypass are often combined with hiatal hernia repair for obese patients to induce more significant weight loss.
- Post-op diet impact – The drastic change from a high calorie diet to a liquid diet after surgery represents a more severe calorie reduction for obese patients, accelerating weight loss.
- Motivation – Some obese patients are highly motivated to adhere to the post-operative diet to jumpstart additional weight loss.
- Metabolic changes – A study showed morbidly obese patients experience a 20-25% increase in metabolic rate after surgery versus 5-15% for non-obese patients.
However, one study found that while obese patients lost more absolute weight after Nissen fundoplication, body mass index (BMI) reduction was similar between obese and non-obese patients. So enhanced weight loss in the obese is correlated to the extent of obesity rather than the surgery itself.
VII. How Does Hiatal Hernia Surgery Affect Symptoms of GERD (Acid Reflux Disease)?
Hiatal hernia repair surgery is commonly performed to relieve symptoms of gastroesophageal reflux disease (GERD). Effects include:
- Restored anatomy – Repairing the hernia reduces the backflow of stomach contents into the esophagus, which causes symptoms.
- Strengthened esophageal sphincter – Surgical techniques like fundoplication reinforce the lower esophageal sphincter to minimize acidic backwash.
- Halted medication needs – Many patients are able to stop medications like proton pump inhibitors after successful surgery.
- Improved quality of life – With reduced reflux and heartburn after surgery, patients experience significant improvement in quality of life.
However, a risks include gas bloating or difficulty belching since the surgery fundamentally alters the anatomy in the digestive tract. Patients should discuss risks vs benefits of surgery with their doctor.
VIII. Are There Alternative Treatments to Surgery for Hiatal Hernias and Associated Weight Issues?
While hiatal hernia repair surgery is the most definitive treatment, some alternative options to manage hiatal hernias and associated weight issues include:
- Lifestyle and diet changes – Losing weight, not smoking, limiting foods that aggravate reflux, and wearing loose clothing around the abdomen.
- Medications – Options like antacids, H2 blockers (Pepcid), and proton pump inhibitors can reduce stomach acid.
- Wedge pillow – Sleeping propped up avoids nighttime reflux.
- Avoid heavy lifting – Preventing activities that increase intra-abdominal pressure may help contain the hernia.
- Endoluminal techniques – Specialized instruments can be used during endoscopy to alter anatomy.
- Weight loss programs – Structured programs with dietary changes, activity increases, and behavior modification techniques.
However, surgery remains the standard and most effective approach for large, symptomatic hiatal hernias. Non-surgical alternatives may only provide temporary symptom relief.
In summary, the limited research available shows the weight loss experienced in most patients after hiatal hernia surgery alone is modest, usually less than 10% of total body weight.
This is attributed to post-operative dietary restrictions and other transient changes to anatomy, capacity, and metabolism rather than the surgery itself.
For sustained, substantial weight loss of 20-30%, bariatric techniques must be combined with hiatal hernia repair.
However, even without dramatic weight reduction, carefully repairing a symptomatic hiatal hernia alone can significantly improve quality of life by alleviating acid reflux.