Possible to miss a hiatal hernia after many tests?

My husband had exploratory surgery yesterday to find out the cause of his pre-prandial stomach pain. Originally, one of the goals of the surgery was to free the celiac artery from constriction by the median arcuate ligament (due to a diagnosis of celiac artery compression syndrome), which the surgeon did. Once he got in there, the surgeon found a lot of scar tissue from my husband's fundoplication surgery in 2002. He cleared the scar tissue away, and re-did the fundoplication. Finally, he saw a very large hiatal hernia (not sure which type), which he repaired. The surgeon said afterward that he now thinks the hernia (rather than celiac compression syndrome) may have been the cause of the excruciating abdominal pain my husband has had for the last ten years. The pain started in 2000, and the surgeon thinks it may have been present before the fundoplication surgery in 2002 and grown larger after.

1) If there was a hernia at the time of the original fundoplication surgery, wouldn't the original surgeon have noticed it and repaired it?
2) Is it possible to miss a hiatal hernia during several barium x-rays, ultrasounds, and many other imaging tests? He's had them all, and no one has ever mentioned the existence of a hernia.

Thanks.

[Paderla Anitha, DNB]

Hello and hope you are doing well.

It's possible that it could have been missed in the earlier surgery, as hiatal hernia is movement of the stomach into the thorax. If the movement is minimal, it can be missed. It can be detected by barium studies and endoscopy.

Hope this helped and do keep us posted.