Hiatal Hernia Specialists In St. Petersburg, FL

A hiatal hernia is a weakening or enlargement of the hiatus, the opening in the diaphragm the esophagus passes through on its way to the stomach. When that opening stretches, the stomach slips up into the chest, the lower esophageal sphincter is displaced, and the reflux barrier fails mechanically. About 90% of people with GERD have a hiatal hernia, even when it is small enough to be missed on endoscopy.

Acid-suppressing medications reduce how acidic the refluxed material is. They do not strengthen the sphincter, repair the diaphragm, or stop reflux events from happening. As Dr. Grandhige puts it, medications turn down the burn but do not stop the leak. That is why so many patients stay symptomatic on daily or twice-daily proton pump inhibitors, and why bile and digestive enzymes can keep refluxing and damaging tissue even after acid is controlled.

Hiatal hernias are not something you did wrong. They come from normal pressure on the diaphragm over time: pregnancy, weight changes, chronic coughing, straining, heavy lifting, and core-intensive work or exercise. A deeper explanation of the anatomy and hernia types is on the hiatal hernias condition page.

Hiatal hernia repair is a subspecialty, not general surgery. The outcome is decided before the operation begins, by how well the disease is understood and how accurately the procedure is matched to the patient.

Most general surgeons repair hiatal hernias only occasionally and refer the complex reflux cases out. Among the few who do perform anti-reflux surgery, decisions are often based on symptoms and medication history rather than objective testing. That is where outcomes go wrong, because reflux-like symptoms can also come from esophageal motility disorders, esophageal hypersensitivity, or non-reflux causes that surgery does not fix and can worsen.

A surgeon who sees foregut disease every day develops pattern recognition that occasional exposure cannot produce: which patients will do well, which are at risk for side effects, and which should not have surgery at all. Dr. Grandhige is a board-certified general surgeon who performs his procedures regularly and at volume, and because he offers multiple procedures, the decision is driven by what fits your body, not by the one operation a surgeon happens to be comfortable with. You can confirm any surgeon’s active license and disciplinary history through the Florida Department of Health before you book. For St. Petersburg residents, the question is rarely distance. It is whether you want a focused specialist or a generalist for a functional operation you live with for decades.

A normal endoscopy does not rule out a hiatal hernia or reflux. Endoscopy looks for damage; it does not measure whether reflux is happening, how often, or why. This is the single most common reason St. Petersburg patients are told “nothing is wrong” while their symptoms continue.

Dr. Grandhige bases every decision on objective testing, and he personally reviews all prior studies and notes from your gastroenterologist, ENT, pulmonologist, and primary care doctor before you walk in. The workup uses the right test for the right question:

• Esophageal pH monitoring confirms whether reflux is actually occurring, how often, and whether it lines up with your symptoms. It is the test that proves GERD.
• Esophageal manometry measures whether the esophagus is strong and coordinated enough to handle a given repair. Skipping it is how patients end up with dysphagia after surgery.
• Upper endoscopy evaluates anatomy and complications like esophagitis or Barrett’s esophagus.
• Barium swallow shows how the esophagus behaves during a real swallow. Worth knowing: where a patient feels food stick matches the true location only about 60% of the time.

For throat symptoms, cough, or hoarseness, Dr. Grandhige uses a customized 24-hour dual-channel pH impedance probe that measures reflux above both the lower and the upper esophageal sphincter, and detects non-acid reflux like bile and pepsin that standard testing misses. This testing is technically demanding and not routinely performed in most practices. It matters because of what it does to outcomes, covered in the silent reflux section below.

When repair is appropriate, the right procedure depends on your anatomy, your esophageal function, the size of the hernia, and your goals. There is no single best reflux operation. Dr. Grandhige is the only board-certified surgeon in the Tampa Bay area who performs all three of the main anti-reflux procedures with regularity, and a fourth, RefluxStop, is planned for 2026.

• Fundoplication wraps the upper stomach around the lower esophagus to rebuild the reflux barrier. It is very durable, has decades of outcome data, and can address large hiatal hernias. Dr. Grandhige performs Nissen, Toupet, Dor, and Watson configurations, chosen by your esophageal motility. Read more about fundoplication.
• LINX is a ring of magnetic titanium beads placed around the sphincter. It preserves normal anatomy, and most patients keep the ability to burp and vomit once early swelling settles, which lowers the risk of gas-bloat. It needs adequate esophageal motility. Read more about LINX.
• TIF (transoral incisionless fundoplication) is done through the mouth with no incisions, for carefully selected patients with mild to moderate reflux and minimal or no hiatal hernia. It cannot repair the diaphragm, so it is not a substitute for surgery when a hernia needs fixing. Dr. Grandhige is direct that it is the best endoscopic option available but is not permanent; he quotes a failure rate of about 2% per year. Read more about TIF / EsophyX.

Hiatal hernia repair itself is the longest and most demanding part of any anti-reflux surgery: the stomach is brought back into the abdomen tension-free, the diaphragm opening is repaired to the size of the esophagus, and one of the procedures above is added because most hernia patients also have reflux. Crucially, not every patient needs surgery, and many leave the consultation with a non-surgical plan instead.

The decision is never made because a procedure exists or because a patient was referred for surgery. Dr. Grandhige tells patients, “The operation is the last step. The decision-making is the surgery.” Here is the process he runs every time:

1. Confirm reflux is truly present. Objective pH testing and symptom correlation come first. If reflux is not proven, surgery is not recommended, no matter how typical the symptoms sound.
2. Understand the anatomy. Hernia size, esophageal length, and the relationship between stomach, diaphragm, and esophagus determine which repairs are even feasible and how durable they will be.
3. Evaluate esophageal function. Manometry shows whether a full or partial wrap is safe, whether LINX is appropriate, or whether surgery should be avoided. Ignoring motility leads to dysphagia and regret.
4. Match symptoms to physiology. Dr. Grandhige states plainly which symptoms he expects to improve, which may improve partially, and which are unlikely to be reflux at all.
5. Weigh your priorities. Durability, getting off medication, the ability to burp and vomit, reversibility. Preferences refine the choice, but never override anatomy or safety.
6. Choose a procedure, or choose none. Only after the first five steps does procedure selection happen, including the option of observation or continued medical management.

This is why offering multiple procedures matters. A surgeon limited to one operation tends to fit every patient to it.

Patients travel to the practice from across Pinellas County and the wider region, including St. Petersburg, Clearwater, and as far as Orlando, Sarasota, Naples, and Jacksonville. The drive from St. Petersburg is roughly 25 minutes across the bay.

For patients coming from out of town, the team coordinates scheduling to minimize trips, and whenever testing can be done closer to home, they arrange it there first so your visit is efficient. The goal stated throughout the practice is to move from consultation to a clear plan, and to surgery only when it is warranted, usually within about four to eight weeks depending on what testing is already done.

The office is at 1315 South Howard Avenue, Suite 101, Tampa, FL 33606. You can get directions or call 813.922.2920.