Esophageal Hiatal Hernia Repair In St. Petersburg, FL

See a foregut specialist when reflux keeps breaking through medication, or when imaging shows a hiatal hernia larger than 3 centimeters. At that size, the hernia almost always drives reflux mechanically, and no pill can close a stretched opening in the diaphragm.

Get an objective evaluation if any of these fit you:

• Heartburn or regurgitation that continues on a once-daily proton pump inhibitor, or that needs twice-daily dosing to stay controlled.
• Reflux at night: a sour taste, coughing, or waking from sleep, often worse when you lie flat.
• Throat symptoms with little or no heartburn, such as chronic throat clearing, hoarseness, a nagging cough, or a lump-in-the-throat feeling. Those often trace back to silent reflux (LPR), which standard testing frequently misses.
• Trouble swallowing, or a feeling that food sticks.
• Complications already found on endoscopy: severe esophagitis, a stricture, or Barrett’s esophagus.
• A wish to stop taking acid-suppressing medication for the rest of your life.

Not every one of these is reflux. That’s the whole reason for testing, and it’s covered below.

Acid-suppressing medication lowers the acid in your reflux. It doesn’t fix the mechanical failure causing the reflux. A hiatal hernia is a stretched or weakened opening in the diaphragm that lets the stomach slide up into the chest, which pulls apart the two structures that normally hold reflux back.

Think of the reflux barrier as a two-part door. One part is the lower esophageal sphincter, the muscular valve at the bottom of the esophagus. The other part is the diaphragm, which supports that valve every time you bend, lift, or strain. If one part fails, reflux happens. If both fail, reflux is close to unavoidable. A hernia breaks the diaphragm side of that door, and a pill can’t rebuild it.

Proton pump inhibitors block acid for roughly 12 to 16 hours a day and make the refluxed material less acidic. They do nothing to strengthen the valve or repair the diaphragm, so reflux events keep happening. Bile, pepsin, and other digestive enzymes still travel up and can still irritate tissue, even when heartburn eases. As Dr. Grandhige puts it, medication turns down the burn but doesn’t stop the leak.

Dr. Grandhige confirms reflux with objective testing before he recommends any procedure. Many patients who arrive expecting surgery leave with a non-surgical plan, because the testing showed their symptoms were coming from something else.

Each test answers a different question:

• Upper endoscopy (EGD) looks for damage, such as inflammation, a stricture, or Barrett’s esophagus. A normal endoscopy doesn’t rule out reflux. It only tells you whether reflux has caused visible harm.
• Esophageal pH monitoring is the gold-standard test for reflux. Over 48 to 72 hours of normal daily life, it records how often reflux happens, how long it lasts, and whether it lines up with your symptoms.
• Esophageal manometry measures how well the esophagus squeezes and coordinates. Motility decides which operation is safe, and whether operating is safe at all. Skipping it is how patients end up with trouble swallowing after surgery.
• A barium swallow shows how the esophagus behaves in real time, which helps when food seems to stick or after a prior operation.

For silent reflux, standard testing is often not enough, so Dr. Grandhige uses a custom 24-hour dual-channel pH-impedance probe that measures reflux both above the lower esophageal sphincter and up at the throat. That difference matters. With careful selection, LPR symptom improvement runs near 80%, well above the roughly 50% quoted when patients are chosen on symptoms alone. In LPR, only about 50 to 60% of patients have testing that actually justifies surgery, and the rest are protected from an operation that wouldn’t help.

This test-first standard lines up with national guidance. The 2025 SAGES guideline for the surgical treatment of hiatal hernias puts objective evidence of reflux and shared decision-making at the center of the decision to repair.

The patients Dr. Grandhige turns down are sometimes the most frustrated. He’s honest that they’d be far unhappier after an operation that left their symptoms in place. As he tells patients, “The operation is the last step. The decision-making is the surgery.”

There is no single best reflux operation. The right one depends on your anatomy, your esophageal motility, your symptom pattern, and your goals. Dr. Grandhige is the only board-certified surgeon in the Tampa Bay area who performs all three established anti-reflux procedures with regularity, and with RefluxStop added in 2026, the practice now offers all four. That range is the reason the procedure gets matched to the patient, instead of the patient being fit to the one procedure a surgeon happens to do.

• Fundoplication wraps the upper stomach around the lower esophagus to rebuild the valve. It’s the most durable option, it handles large hernias, and it has decades of outcome data. The trade-off is that some patients notice more gas and bloating, and depending on the wrap, a limited ability to burp or vomit. Dr. Grandhige tailors the wrap (Nissen, Toupet, Dor, or Watson) to your motility.
• The LINX system is a ring of magnetic titanium beads placed around the lower esophagus. It resists reflux when the stomach is under pressure and opens to let food through. Most patients keep the ability to burp and vomit, bloating tends to be milder, and it can be removed if needed. It requires good esophageal motility, and current devices are MRI-compatible up to 1.5 Tesla.
• TIF (EsophyX) rebuilds the valve from inside, through the mouth, with no incisions. It’s the best endoscopic option available, and it suits patients with mild-to-moderate reflux and little or no hiatal hernia who aren’t obese. Because it works through the mouth, it can’t repair the hernia or the diaphragm, so it’s less durable. Dr. Grandhige quotes a failure rate near 2% per year and presents it as a strong option for years, not a permanent fix.
• RefluxStop is the newest addition. It combines a hiatal hernia repair with a partial fundoplication and a small implant that helps restore the barrier without fully encircling the esophagus.

He has performed over 600 fundoplications, over 600 LINX procedures, and over 200 TIF procedures. Volume like that is why he can read borderline test results and pick the operation that fits, or advise against all of them.