Patients who experience severe symptoms of a hiatal hernia such as chronic heartburn, swallowing problems, chest pain or gastrointestinal bleeding that are not controlled by medications may require surgery to correct the issue. This type of hernia is essentially a bulge in the stomach that protrudes through the diaphragm and up into the esophagus. When this bulge becomes too large, it may allow food and gastric acids to wash upward into the esophagus (gastric reflux), causing heartburn. Surgical resolution of this issue involves pulling the bulge back down into the abdomen, creating a stronger valve between the stomach and esophagus and sealing the hole that has been created in the diaphragm. This is done in part by wrapping the top part of the stomach around the bottom part of the esophagus in an open or minimally invasive surgery, the latter of which is called a Nissen fundoplication procedure.