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Risks & Possible Complications

Anti-Reflux Surgery / Hiatal Hernia Repair
What the published evidence says about risk

This page summarizes the risks of laparoscopic anti-reflux surgery and hiatal hernia repair in plain language, using figures reported in large published studies. This is general information, not your individual risk assessment — Dr. Irshad will review your own risk factors with you directly as part of your consent discussion before surgery. Rates are generally higher for large paraesophageal hernias or redo surgery than for a first-time, straightforward repair.

Risks & possible complications

  • Death — rare, roughly 1 in 500 to 1 in 1,000 (0.03–0.2%). Large national registries consistently show this to be very low.
  • Any complication — roughly 4–10% in large registries, higher for complex or repeat repairs.
  • Difficulty swallowing (dysphagia) — common in the first few weeks as the wrap settles and swelling goes down; a smaller number of patients have longer-lasting difficulty.
  • Bloating or difficulty burping (gas-bloat syndrome) — fairly common, reported in roughly 1 in 3 patients to varying degrees; usually improves over the first year and is less common with a partial (rather than full) wrap.
  • Hernia or reflux returning over time — roughly 10–15%, higher after a repeat (redo) operation than a first-time repair.
  • Injury to the esophagus, stomach, or spleen during surgery — uncommon, well under 2%; recognized and repaired at the time of surgery when it occurs.
  • Need for a second operation — roughly 1 in 250 to 3 in 100 (0.4–3%) within 90 days.
Your own risk varies. Rates are higher for large paraesophageal hernias, prior abdominal surgery, and redo operations. Ask Dr. Irshad how these factors apply to you.

References

  1. Niebisch S, Fleming FJ, Galey KM, et al. Perioperative risk of laparoscopic fundoplication: safer than previously reported. J Am Coll Surg. 2012;215(1):61–8. PubMed
  2. Yanes M, Santoni G, Maret-Ouda J, et al. Mortality, Reoperation and Hospital Stay Within 90 Days of Primary and Secondary Antireflux Surgery in a Population-Based Multinational Study. Gastroenterology. 2021.
  3. Maret-Ouda J, Yanes M, Konings P, et al. Mortality from laparoscopic antireflux surgery in a nationwide cohort of the working-age population. Br J Surg. 2016;103(7):863–70. PubMed
  4. Catarci M, Gentileschi P, Papi C, et al. Evidence-Based Appraisal of Antireflux Fundoplication. Ann Surg. 2004;239(3):325–37.
  5. Müller-Stich BP, Kenngott HG, Gondan M, et al. Use of Mesh in Laparoscopic Paraesophageal Hernia Repair: A Meta-Analysis and Risk-Benefit Analysis. PLoS One. 2015;10(10):e0139547.

Common questions about risk

What is the risk of death from anti-reflux or hiatal hernia surgery?
Death is rare, occurring in roughly 1 in 500 to 1 in 1,000 patients (0.03–0.2%), based on large national registries.
How common is difficulty swallowing after hiatal hernia repair?
Difficulty swallowing (dysphagia) is common in the first few weeks after surgery as the wrap settles and swelling goes down. A smaller number of patients have longer-lasting difficulty.
Can a hiatal hernia come back after surgery?
Yes — the hernia or reflux returns in roughly 10–15% of patients over time, and this is more likely after a repeat (redo) operation than a first-time repair.
What is gas-bloat syndrome?
Gas-bloat syndrome is bloating or difficulty burping after fundoplication surgery. It is fairly common, affecting roughly 1 in 3 patients to varying degrees, and usually improves over the first year.
This page is general information, not medical advice or a consent form. It does not replace the individualized consent discussion you will have with Dr. Irshad, which accounts for your own health, anatomy, and the specific operation planned. If you are experiencing a medical emergency, call 911 or go to your nearest Emergency Department immediately. Published in compliance with the CPSO Advertising Standards Policy.

Questions about your risk?

Dr. Kashif Irshad — Division of Thoracic Surgery, William Osler Health System, Brampton Civic Hospital. Tel: (905) 458-4520 · Fax: (905) 458-4080 · thoracic@williamoslerhs.ca

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