If you’ve been diagnosed with a large hiatal hernia, recent medical research brings important insights about your treatment. Two major studies published in 2024 confirm what surgeons have long suspected: hernia size matters, and choosing an experienced specialist significantly impacts your surgical outcome. For patients needing hernia repair in the Dallas-Fort Worth area, Dr. Mazen Iskandar at The Iskandar Complex Hernia Center offers exactly this type of specialized expertise.[1][2][3]
Understanding Type III and Type IV Hiatal Hernias
Before diving into the research, it helps to understand what these hernias are. Your diaphragm is a large muscle that separates your chest from your abdomen. It has a small opening called the hiatus where your esophagus (the tube that carries food to your stomach) passes through.[4]
In a hiatal hernia, part of your stomach pushes up through this opening into your chest cavity, where it doesn’t belong. There are four types of hiatal hernias, with Type III and Type IV being the most complex:[5][6][4]
Type III hernias (also called mixed hernias) happen when both the connection point between your esophagus and stomach AND a portion of your stomach slide up into your chest.[6][4]
Type IV hernias are the most serious. In these cases, not only does your stomach push into your chest, but other abdominal organs—like your intestines, colon, or spleen—can also move up through the opening.[7][4][6]
These larger hernias often cause bothersome symptoms including:[8][9][10][11]
- Severe heartburn and acid reflux
- Chest pain or pressure
- Difficulty swallowing food or liquids
- Feeling full after eating only small amounts
- Shortness of breath
- Food coming back up into your throat
When symptoms become significant or the hernia grows large, surgery is usually recommended to prevent serious complications.[2][12][4]
Study #1: Large Hernia Size Linked to Higher Complication Risk
The Research:
In November 2024, researchers led by Seitaro Nishimura published important findings in Cureus, a peer-reviewed medical journal. The study, titled “Association Between Large Hernia Size and Severe Postoperative Complications After Type III/IV Hiatal Hernia Repair,” examined patients who underwent repair of complex Type III or Type IV hiatal hernias between 2014 and 2024.[13][1][2]
Key Finding:
The research demonstrated that larger hiatal hernias are associated with an increased risk of severe complications after surgery. This means the bigger your hernia, the more challenging the repair becomes, and the higher the potential for problems during recovery.[1][2]
Why Size Matters:
Think of it like fixing a small tear versus a large hole in fabric. A small repair is straightforward, but fixing a large defect requires more extensive reconstruction, takes longer, and demands greater surgical skill. The same principle applies to hiatal hernias.[14][15]
Supporting research confirms these findings. Multiple studies show that larger hernia size correlates with:[12][15][14]
- Higher rates of early postoperative complications
- Increased likelihood of requiring intensive care unit admission
- Greater chances of hospital readmission within 30 to 90 days after surgery
- Longer recovery times
One study found that hernias larger than 7 centimeters (about 3 inches) or involving more than half the stomach are considered “large” and carry significantly higher surgical risks.[12]
The Bottom Line:
Large, complex hiatal hernias are challenging surgical cases that require experienced hands. The complications tracked in this research used the Clavien-Dindo classification system, which grades problems based on their severity. While most complications are minor and manageable, the research emphasizes that larger hernias demand specialized surgical expertise to minimize serious issues.[16][17][2][14][1]
Study #2: Advanced Surgical Technique Dramatically Reduces Recurrence
The Research:
Just three months earlier, in August 2024, Dr. Zena Saleh and colleagues from Cooper University Hospital published groundbreaking findings in Surgical Endoscopy, one of the world’s leading surgical journals. Their study, “Optimizing Outcomes in Paraesophageal Hernia Repair: A Novel Critical View,” examined 297 patients who underwent paraesophageal hernia repair between 2015 and 2023.[3][18][19][20]
Key Finding:
Surgeons who performed repairs using an advanced technique called the “critical view” achieved dramatically better outcomes than those using standard repair methods:[18][19][3]
- Hernia recurrence rate: Only 9.7% with the critical view approach compared to 20% with standard repair (a 51% reduction)[3][18]
- Reoperation rate: Just 0.5% compared to 10% with standard techniques (a 95% reduction)[18][3]
What is the “Critical View”?
This advanced surgical technique requires significant skill and experience to execute properly. It involves:[19][3]
- Complete mobilization of the esophagus up to the level of the inferior pulmonary vein (a major blood vessel in the chest)
- Full dissection and clearing of the posterior mediastinum (the space behind your breastbone)
- Careful visualization of specific anatomical landmarks including the left crus of the diaphragm and left gastric artery
- Precise exposure that allows the surgeon to see the spleen in the background while retracting the distal esophagus
The study showed that 65% of these advanced repairs were performed robotically, 22% laparoscopically, and 14% through open surgery. The types of hernias repaired included Type III (48%), Type I (36%), Type IV (13%), and Type II (2%).[19][18]
Why This Matters:
This research proves that surgical technique and experience directly impact your long-term results. The critical view approach dramatically reduces the likelihood that your hernia will come back or that you’ll need another surgery down the road. However, this sophisticated technique requires extensive training and expertise to perform safely and effectively.[3][18][19]
What These Two Studies Tell Us Together
When we look at both studies side-by-side, a clear picture emerges:
Size and complexity increase risk. Recent research confirms that larger Type III and Type IV hernias present greater surgical challenges and higher complication risks.[2][1]
Expert technique reduces complications and recurrence. The August 2024 study proves that advanced surgical approaches performed by experienced specialists lead to far better outcomes—cutting recurrence rates in half and nearly eliminating the need for repeat surgery.[18][3]
Experience is essential. Multiple studies consistently demonstrate that surgeons who regularly perform complex hernia repairs achieve superior patient outcomes, fewer complications, and lower recurrence rates. In fact, recent research shows that revisional hiatal surgery (fixing a hernia that comes back) is so complex that it should only be performed at specialized tertiary care centers with high surgical volumes.[21][22][23]
Why Dr. Mazen Iskandar is A Leading Choice in DFW
Dr. Iskandar embodies exactly what this research tells us to look for: specialized training, extensive experience, mastery of advanced techniques, and a dedicated focus on complex hernia surgery.[24][25][26]
Unmatched Credentials and Training
Medical Education: Dr. Iskandar earned his medical degree from the prestigious American University of Beirut, one of the leading medical schools in the Middle East. He completed his general surgery residency at Mount Sinai Beth Israel in New York City, one of the nation’s top teaching hospitals.[25][24]
Advanced Fellowship Training: After residency, Dr. Iskandar pursued specialized fellowship training in minimally invasive and bariatric surgery at NYU-Langone in Brooklyn. This additional training provided him with advanced skills in complex abdominal procedures, including hiatal hernia repair.[24][25]
Academic Experience: Before joining Baylor Scott & White Health in 2019, Dr. Iskandar served as an assistant professor of surgery at Mount Sinai School of Medicine in New York City. In this role, he taught surgical residents and fellows while conducting research to advance the field. He currently serves as an Associate Professor on the Texas A&M School of Medicine[25][24]
Board Certifications: Dr. Iskandar is board-certified in both general surgery and metabolic bariatric surgery by the American Board of Surgery. These certifications require rigorous examination and demonstrate his mastery of surgical principles and techniques.[25]
Professional Recognition and Leadership
Fellow of the American College of Surgeons (FACS): This prestigious designation recognizes surgeons who demonstrate the highest standards of surgical practice, ethics, and professionalism.[24][25]
Professional Memberships: Dr. Iskandar is a Fellow of the American Society for Metabolic and Bariatric Surgery and a member of the Society of American Gastrointestinal and Endoscopic Surgery. These organizations represent the leading edge of minimally invasive surgical techniques.[25]
Surgeon of Excellence: In January 2024, Dr. Iskandar earned the “Surgeon of Excellence in Hernia Surgery” accreditation from the Surgical Review Corporation, recognizing his outstanding surgical outcomes and adherence to the highest quality standards.[27]
Thought Leader: Dr. Iskandar has published numerous peer-reviewed articles, book chapters, and presentations in hernia and bariatric surgery. In 2025, he was selected to author two chapters for Surgical Endoscopy and Other Interventional Techniques, one of the world’s most respected surgical journals. This invitation reflects his recognition as a leading authority in minimally invasive hernia repair.[28][25]
The Iskandar Complex Hernia Center Difference
Specialized Focus: Under Dr. Iskandar’s leadership, the Baylor Scott & White Center for Hernia Surgery was established specifically to manage hernia cases ranging from simple to highly complex and recurrent hernias. This focused approach means every aspect of your care is optimized for hernia treatment.[26][25]
Referral Destination: Physicians throughout Texas and beyond refer their most challenging hernia cases to Dr. Iskandar because of his exceptional expertise and outcomes. As referring physicians note, “Dr. Iskandar is a surgeon to call when other doctors run out of options for complex hernia patients”.[29][26][24]
One of Only Two in Texas: The Iskandar Complex Hernia Center is one of only two Hernia Centers of Excellence in Texas dedicated exclusively to complex hernia repair, providing patients with unparalleled expertise and comprehensive care.[30][31]
Advanced Surgical Techniques and Technology
Minimally Invasive and Robotic Surgery: Dr. Iskandar’s philosophy emphasizes achieving durable, favorable outcomes through better patient preparation and innovative techniques, including robotic surgery. Research consistently shows that minimally invasive approaches lead to faster recovery, less pain, and lower complication rates compared to traditional open surgery.[22][32][33][24][25]
Customized Treatment Plans: Dr. Iskandar uses the most current research and proven methods to customize each patient’s treatment plan based on their specific anatomy, hernia size, health status, and individual needs.[32][33][24]
Comprehensive Approach: For large hiatal hernias, surgical repair typically involves multiple steps:[34][4]
- Returning the stomach and any other displaced organs back to the abdomen
- Carefully repairing the enlarged opening in the diaphragm to the proper size
- When appropriate, using specialized mesh reinforcement to reduce recurrence risk
- Creating an anti-reflux valve (fundoplication) to prevent acid reflux
Dr. Iskandar’s mastery of these techniques, combined with his use of advanced technology, maximizes the chances of a successful, lasting repair.[32][24][25]
Real Patient Results
The Iskandar Complex Hernia Center has transformed the lives of countless patients dealing with complex hernias. Jose Gonzalez shares his experience:
“After two years of increasing pain and discomfort following an operation, my quality of life was getting worse and worse as the months went on. Dr. Iskandar told me in the first meeting that he was 90% sure he could repair my growing hernia with no recurrence. A few months after surgery, Dr. Iskandar told me I was back to normal. Now I can ride my motorcycles and go off-roading in my Jeep. I can move around without discomfort and pain. It’s a night-and-day change”.[26]
What to Expect from Your Hiatal Hernia Surgery
Understanding the basics of hiatal hernia repair can help reduce anxiety about the procedure:
Pre-Surgery Preparation: Dr. Iskandar emphasizes thorough patient preparation, including optimizing your overall health, managing any related conditions, and ensuring you understand what to expect.[24][25]
Surgical Approach: Most repairs are performed using minimally invasive laparoscopic or robotic techniques through small incisions. These approaches offer faster recovery and less discomfort than traditional open surgery.[22][34][32]
Hospital Stay: Depending on the complexity of your hernia and your overall health, most patients stay in the hospital for 1-3 days after surgery.[35][34]
Recovery Timeline: While individual recovery varies, most patients return to light activities within 2-3 weeks and full activities within 4-6 weeks.[34]
Long-Term Outcomes: When performed by experienced surgeons using advanced techniques, hiatal hernia repair offers excellent long-term results with high rates of symptom relief and low recurrence rates.[36][34][3][18]
Taking Control of Your Health
If you’re living with a large Type III or Type IV hiatal hernia in the Dallas-Fort Worth area, you don’t have to suffer with uncomfortable symptoms or worry about serious complications. The research is clear: size matters, technique matters, and experience matters.[14][1][2][3][18]
Dr. Mazen Iskandar offers all three:
- Recognition of complexity: He understands that larger hernias require specialized surgical expertise[1][2]
- Mastery of advanced techniques: He performs the sophisticated surgical approaches proven to reduce complications and recurrence[3][18]
- Extensive experience: He has dedicated his career to complex hernia surgery with outcomes that make him a regional referral center[26][24][25]
Schedule Your Consultation
The Iskandar Complex Hernia Center is located at the Baylor Scott & White Center for Hernia Surgery in Waxahachie, Texas, serving patients throughout the DFW metroplex and beyond. Dr. Iskandar accepts both direct patient appointments and physician referrals.[26][25]
Contact Information:
- Location: 2360 N Interstate 35E, Suite 310, Waxahachie, TX 75165
- Phone: 469-800-9832
- Hours: Monday through Friday, 8:00 AM – 5:00 PM[25]
Dr. Iskandar is multilingual, speaking English, French, and Arabic, making care accessible to diverse patient populations.[25]
Don’t let a complex hiatal hernia diminish your quality of life. With the right surgeon and specialized care, you can achieve lasting relief from symptoms and get back to the activities you love. Contact The Iskandar Complex Hernia Center today to schedule your consultation with Dr. Mazen Iskandar and take the first step toward feeling like yourself again.
References
- Nishimura S, et al. “Association Between Large Hernia Size and Severe Postoperative Complications After Type III/IV Hiatal Hernia Repair.” Cureus 16(11), November 2024. View source
- Nishimura S, et al. “Association Between Large Hernia Size and Severe Postoperative Complications After Type III/IV Hiatal Hernia Repair.” Cureus, 2024. View source
- Saleh Z, Verchio V, Ghanem YK, et al. “Optimizing outcomes in paraesophageal hernia repair: a novel critical view.” Surgical Endoscopy, Published online August 12, 2024. View source
- National Center for Biotechnology Information (NCBI) – StatPearls: “Hiatal Hernia”. View source
- Medscape Reference: “Hiatal Hernia Overview”. View source
- Medscape Reference: “Hiatal Hernia Imaging”. View source
- PMC Article: Type IV Hiatal Hernia. View source
- PMC Article: Hiatal Hernia Symptoms and Complications. View source
- Annals of Esophagus: Hiatal Hernia Management. View source
- Mayo Clinic: “Hiatal Hernia – Symptoms and Causes”. View source
- Cleveland Clinic: “Hiatal Hernia: What It Is, Symptoms, Treatment & Surgery”. View source
- Healthline: “What Size Hiatal Hernia Needs Surgery”. View source
- Cureus: Nishimura S, et al. Research Profile. View source
- PubMed: Research on hernia size and surgical complications. View source
- PubMed: Outcomes in large hiatal hernia repair. View source
- Cureus: “Feasibility of Anti-Reflux Gastric Bypass for Massive Paraesophageal Hernia in Obese Patients with Gastroesophageal Reflux Disease”. View source
- PubMed: Surgical complications classification systems. View source
- PMC: Full text of “Optimizing outcomes in paraesophageal hernia repair: a novel critical view”. View source
- German National Library: Study documentation on paraesophageal hernia repair. View source
- ResearchWithNJ: “Optimizing outcomes in paraesophageal hernia repair: a novel critical view” – Study fingerprints and citations. View source
- Annals of Esophagus: Revisional hiatal hernia surgery. View source
- Annals of Esophagus: Minimally invasive hiatal hernia repair outcomes. View source
- Video-Assisted Thoracic Surgery: Complex hiatal hernia management. View source
- The Iskandar Complex Hernia Center: Dr. Mazen Iskandar Profile. View source
- Baylor Scott & White Health: Dr. Mazen Iskandar, MD, FACS – Biography and Credentials. View source
- The Iskandar Complex Hernia Center: Official Website. View source
- EIN News: “Dr. Mazen Iskandar Earns Surgeon of Excellence in Hernia Surgery Accreditation from SRC”. View source
- Press Advantage: “Dr. Mazen Iskandar Selected to Contribute to Prestigious Surgical Journal”. View source
- The Iskandar Complex Hernia Center: For Surgeons and Physicians. View source
- Tallahassee.com: “The Iskandar Complex Hernia Center – One of Only Two Hernia Centers of Excellence in Dallas-Fort Worth”. View source
- Daily News Journal: “The Iskandar Complex Hernia Center – One of Only Two Hernia Centers of Excellence in Dallas-Fort Worth”. View source
- GlobeNewswire: “The Iskandar Complex Hernia Center Unveils a Revolutionary Approach to Complex Hernia Surgery Repair and Treatment”. View source
- Financial Content: “The Iskandar Complex Hernia Center Highlights the Advancements in Fundoplication Surgery for GERD and Hiatal Hernia Repair”. View source
- PMC: Hiatal hernia repair surgical techniques and outcomes. View source
- PMC: Hospital stay and recovery after hiatal hernia surgery. View source
- PMC: Long-term outcomes of hiatal hernia repair. View source
- Brigham and Women’s Hospital: “Hiatal Hernia”. View source
source https://iskandarcenter.com/hernia-surgery/studies-show-expert-surgeons-reduce-risks-in-large-hiatal-hernia-surgery-dallas-fort-worth-patients/
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