Hiatal hernias occur when a portion of the stomach protrudes through the diaphragm, the muscle separating the abdomen and chest. The severity of the condition is often categorized by size, although the dimensions alone do not dictate the necessity for surgical intervention. Symptomatic hernias, regardless of their exact measurement, are more likely to warrant consideration for surgical repair than smaller, asymptomatic ones. A hiatal hernia is categorized and may warrant surgery, with the symptoms influencing the decision to operate.
The determination of whether surgical intervention is required is based primarily on the presence and severity of associated symptoms and complications. These include, but are not limited to, severe acid reflux unresponsive to medical management, esophageal damage, Barrett’s esophagus, strictures, bleeding, or difficulty swallowing. While a large hernia might be more prone to causing these issues, a smaller one can also lead to significant discomfort and health problems.