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Recovering from hiatal hernia surgery requires careful consideration of dietary choices. Healthcare professionals sometimes advise against consuming chocolate post-surgery. In this blog, we explore the reasons behind this recommendation and the consequences of disregarding it. We also provide alternatives and wellness strategies for a smooth recovery. 

The Complex Nature of Hiatal Hernia Surgery

Before we delve into the specifics of avoiding chocolate post-surgery, it's crucial to understand the intricacies of hiatal hernia surgery. Hiatal hernias occur when a portion of the stomach protrudes into the chest cavity through the diaphragm's opening (hiatus). The surgery involves repositioning the stomach by moving the stomach out of the chest cavity and into the abdominal cavity.  The enlarged hole in the diaphragm (hiatus) is reduced in size but sewing diaphragm muscle together.  Sometimes a piece of mesh may be used to reinforce the hiatus repair.  Finally, an antireflux procedure such as a fundoplication (aka wrap) or magnetic sphincter augmentation (aka LINX) is performed.  Usually, the primary goal of the surgery is to alleviate reflux symptoms such as heartburn, regurgitation and chest pain.  

Dietary Considerations After Hiatal Hernia Surgery

The period following hiatal hernia surgery is pivotal for recovery.  There are two important dietary considerations during the recovery period.  

Firstly, the integrity of the hiatal hernia repair relies solely on the sutures holding the tissue together for the first few weeks.  Scar tissue and the healing process do not reinforce the repair until several weeks after surgery.  The suture repair can easily fall apart with forceful contraction of the diaphragm, leading to recurrence of the hiatal hernia or herniation of the wrap into the chest.  Retching and vomiting are the main causes of forceful contraction of the diaphragm. Consequently, dietary choices are extremely important during the recovery period to avoid retching and vomiting. This gets to the most important dietary consideration after hiatal surgery:  avoid foods that can get stuck in the esophagus.  When food gets stuck, not only will it cause severe chest pain, but it will also cause retching and vomiting.  

Typically, the fundoplication is swollen immediately after hernia surgery.  This swelling can prevent food or large pills from passing through easily.  I start patients on a liquid diet for the first week or two after surgery.  Anything that can be poured is considered a liquid.  In the second or third week, if the liquids go down smoothly, I then recommend advancing to soft foods.  I ask patients to avoid bread, rice, and chunks of meat for at least 2 weeks and until soft foods go down ok; these foods tend to get easily stuck in the wrap.  Also, just as important, is to chew well and eat slowly for a few months.

The second dietary consideration aims to prevent symptoms that could complicate recovery and increase discomfort after surgery.  After hiatal hernia surgery, chest pain and esophageal sensitivity are common from the extensive dissection around the esophagus and chest during surgery.  Therefore, foods that typically exacerbate heartburn and reflux should be avoided.  It's in this context that healthcare professionals often recommend avoiding chocolate.

Why No Chocolate After Hiatal Hernia Surgery?

While the recommendation to abstain from chocolate post-surgery might not be backed by extensive scientific studies, it's rooted in a sound understanding of the effects of chocolate on the lower esophageal sphincter and reflux symptoms.  Studies in healthy volunteers in the 1960’s and 70’s showed that eating chocolate relaxes the lower esophageal sphincter, which is the barrier that prevents gastric contents from refluxing into the esophagus.   Eating chocolate, can therefore, increase heartburn and reflux symptoms, as the barrier between the stomach and esophagus is relaxed by chocolate.  This is why chocolate is alway on the list of food to avoid in patients who have GERD or heartburn.  Chocolate also contains lipids or fats and caffeine, which can stimulate the production of stomach acid.  

The Consequences of Consuming Chocolate After Hiatal Hernia Surgery

The decision to ignore the advice to avoid chocolate post-surgery can result in a range of consequences, albeit minor, including:

Acid Reflux: Acid reflux is a common concern for individuals with hiatal hernias, and the consumption of specific foods and beverages, including chocolate, can trigger this condition.  Although the hiatal hernia repair is meant to bolster the lower esophageal sphincter and prevent acid reflux, and alleviate acid reflux symptoms, it can be difficult in the immediate post-operative period to tease out whether symptoms of chest pressure and heartburn are due to actual reflux or just typical post-surgical inflammation and esophageal sensitivity.  Avoiding such triggers, such as chocolate, is recommended to minimize these symptoms and the distress caused by these symptoms.

Stomach Pain: Some individuals have heightened sensitivity to fats and caffeine. Consuming chocolate after hiatal hernia surgery can disrupt the digestive system due to the presence of fats and caffeine, potentially leading to stomach discomfort and pain.

Rocky Recovery:  Patients, as mentioned earlier, typically experience chest and abdominal pain, as well as heartburn-like symptoms in the postoperative period - even when surgery goes smoothly.  Combined with the other typical post-operative symptoms of nausea, incision pain, and general tiredness, it is reasonable to minimize activities, foods, and other environmental factors that can exacerbate these symptoms.  Therefore, avoiding chocolate and other foods that can disrupt the digestive system, is recommended.

Bottom line is chocolate will not harm the hiatal hernia repair or cause any long-term consequences if eaten after surgery.  It simply may increase postoperative discomfort during recovery and increase anxiety about the effectiveness of the hiatal hernia surgery.  Eating chocolate is certainly not as bad as retching or vomiting, which should be avoided at all cost if possible. 

Dietary Alternatives and Wellness Strategies

While the temporary exclusion of chocolate from your post-surgery diet is advised, we can explore alternative dietary choices and wellness strategies that promote healing without compromising your comfort. Here are some options to consider:

Fruit: Fresh fruits such as apples, pears, and bananas can provide a naturally sweet and satisfying alternative to chocolate. Not only are they nutritious, but they are also gentle on the stomach.  But remember, raw fruits should be avoided in the first 1-2 weeks until the swelling from the hiatal hernia repair has resolved.

Yogurt: Opt low fat yogurt, which can be a soothing option for those seeking a creamy treat.

Herbal Teas: Herbal teas, including chamomile or ginger tea, can offer a soothing and caffeine-free alternative. They are known for their calming properties and can be a delightful beverage during the recovery period.

Water: Staying hydrated is essential for the healing process. Water aids in digestion and overall well-being.

Consult Your Healthcare Provider

It's essential to remember that the decision to include or exclude specific foods from your post-hiatal hernia surgery diet should be made in consultation with your healthcare provider or surgeon. They can offer personalized dietary recommendations based on the specifics of your surgery, your individual recovery progress, and your overall health status.

Incorporating a Holistic Approach to Healing

In addition to dietary considerations, it's vital to adopt a holistic approach to healing after hiatal hernia surgery. This approach includes lifestyle modifications such as:

Stress Management: Reducing stress can have a positive impact on your digestive health. Techniques like deep breathing, meditation, and yoga can be beneficial.

Elevating the Head of Your Bed: This simple adjustment can help prevent stomach acid from flowing back into the esophagus, reducing the risk of acid reflux during sleep.

Small, Frequent Meals: Consuming smaller, more frequent meals can be easier on your digestive system, reducing the risk of post-surgery discomfort.

Balancing Nutritional Needs

While avoiding chocolate is recommended, it's essential to maintain a well-balanced diet that meets your nutritional needs during the recovery phase. Working with a registered dietitian or nutritionist can help you create a meal plan that supports your recovery and overall health.

In Conclusion

The decision to avoid chocolate after hiatal hernia surgery is rooted in the potential impact of its ingredients on post-operative comfort. While scientific studies might not conclusively support this recommendation, it aligns with a broader approach to dietary care for individuals with hiatal hernias. By prioritizing your well-being, making thoughtful dietary choices, and consulting your healthcare provider, you can contribute to a smooth and successful recovery.

Your journey towards recovery is a vital phase in regaining your health and comfort. By considering these recommendations and seeking professional guidance, you can navigate this phase with confidence and set the stage for a healthier future.

The leading minimally-invasive general and hernia repair surgeon on the West Coast, serving patients in the greater SF Bay Area. 

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