When those symptoms cannot be controlled despite lifestyle changes and appropriate medication, surgical treatment should be discussed. The hiatal hernia repair is almost exclusively performed using a minimally invasive laparoscopic (keyhole) approach. 

The stomach is completely reduced, the hernia sac excised, and the defect closed (cruroplasty). If the gap in the diaphragm is too large (closure under tension) or if the tissues are very weak, the repair will be reinforced with placement of a soft mesh that is fixed using fibrin glue. Use of tackers to fix the mesh is contraindicated due to the risk of major complications. 

This mesh will be totally reabsorbed with 18 months and replaced by healthy scarring tissue, thus significantly reducing the potential risk of local damage to the lower oesophagous. Once completed, a partial fundoplication (stomach wrapped around the lower oesophagous) is created for better control of the reflux symptoms.

After being discharged home and while waiting for the swelling from surgery to settle down, a puree diet is generally maintained for 2 weeks, before progressively introducing normal food. Caution should be taken with bread, sticky rice, red meat and fizzy drinks. Heavy lifting or any strenuous activities should be avoided for 6-8 weeks.