When a hiatal hernia actually needs surgery
Not every hiatal hernia needs surgery. Dr. Grandhige recommends repair mainly in four situations: a hernia larger than 3 centimeters, reflux that continues despite daily medication, a need for more than once-daily medication, or complications such as severe esophagitis or Barrett’s esophagus.
Size drives a lot of this. A hernia over 3 centimeters almost always contributes mechanically to reflux, medication rarely manages it well, and it tends to grow over time. Large hernias also carry a rare but dangerous risk called gastric volvulus, where the stomach twists inside the chest. Smaller hernias can still cause major symptoms when the sphincter is also weak, especially regurgitation.
Just as important is when not to operate. Many people with reflux-like symptoms are better off without surgery, because their symptoms come from esophageal hypersensitivity, a motility disorder, functional chest pain, or an ENT or lung cause rather than mechanical reflux. Operating on those patients doesn’t help and can make swallowing worse. That’s why the decision starts with proving the diagnosis, not with the fact that a hernia exists.
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How we confirm the cause before operating
Dr. Grandhige doesn’t operate based on symptoms. He proves reflux with objective testing first, then matches the procedure to your anatomy and how your esophagus actually works. This test-first approach is the single biggest reason modern reflux surgery, done correctly, performs far better than its old reputation.
Each test answers a different question. Esophageal pH monitoring is the gold standard for diagnosing GERD, because it measures whether reflux is happening, how often, how severe it is, and whether it lines up with your symptoms over 24 to 72 hours of normal life. Esophageal manometry measures the strength and coordination of your esophagus, which decides whether a full or partial wrap is safe and catches disorders like achalasia that reflux surgery would make worse. Upper endoscopy checks anatomy and complications and lets him place a pH probe. A barium swallow gets added when swallowing itself is in question.
Silent reflux is where this pays off most. Standard reflux testing usually only looks above the lower esophageal sphincter, so it misses reflux reaching the throat and voice box, and patients with silent reflux (LPR) get told their test is normal or that surgery has only a coin-flip chance of helping. Dr. Grandhige uses a customized 24-hour pH-impedance dual-channel probe that measures reflux above both the lower and the upper esophageal sphincter, including non-acid reflux like bile and pepsin. By selecting the right patients this way, he raises the odds of symptom improvement in LPR from the roughly 50% these patients are often quoted to about 80%. It means he operates on fewer people, but on the right people.
Which repair fits you: your four options
There’s no single best reflux operation. The right one depends on your anatomy, your esophageal motility, how severe the reflux is, and your own priorities like durability, reversibility, or keeping the ability to burp. Dr. Grandhige is the only board-certified surgeon in the Tampa Bay area who performs fundoplication, LINX, and TIF with regularity, and he’s adding RefluxStop as a fourth option. Because he does all of them, the choice is driven by fit, not by the one procedure a surgeon happens to be comfortable with.
Fundoplication wraps the upper part of your stomach around the lower esophagus to rebuild the barrier, and it repairs the hiatal hernia at the same time. It comes in several configurations (Nissen, Toupet, Dor, Watson) chosen from your motility testing. It’s the most durable option, it handles large hernias and weaker esophageal function through partial wraps, and it has decades of outcome data behind it. The tradeoff is that, depending on the wrap, it can limit burping and vomiting and cause some gas and bloating.
The LINX system is a ring of magnetic titanium beads placed around the lower esophagus. It preserves your normal stomach anatomy, usually keeps your ability to burp and vomit, tends to cause less bloating, and can be removed if needed. It requires good esophageal motility to work well, current devices are MRI compatible up to 1.5 Tesla, and it carries a slightly higher risk of early swallowing difficulty.
TIF, or transoral incisionless fundoplication, is done entirely through the mouth with no external incisions, using the EsophyX device to build a partial valve from the inside. Because it can’t repair the diaphragm, it fits a narrow group: minimal or no hiatal hernia, mild to moderate reflux, no severe esophagitis or Barrett’s, and not obese. Recovery is faster, but it’s less durable, and Dr. Grandhige quotes a failure rate of about 2% per year. He describes it as the best endoscopic procedure available and a solution that works for years rather than a permanent fix, and he won’t offer it to patients who fall outside those criteria.
RefluxStop is a newer device being added to the practice as a fourth choice. It widens the range of anatomy and physiology that can be matched to the right repair.
Why St. Petersburg patients cross the bay for this
For hiatal hernia and reflux surgery, patient selection and surgical volume drive results more than how close the office is. That’s the reason St. Petersburg patients regularly make the roughly 25 to 30 minute drive across the Gandy or Howard Frankland Bridge to South Tampa instead of choosing the nearest general surgeon.
Dr. Grandhige focuses almost entirely on the esophagus, diaphragm, and stomach. He isn’t doing a gallbladder one day and a reflux repair the next, and the volume shows: over 600 fundoplications, over 600 LINX procedures, and over 200 TIF procedures. He also operates at a single hospital, HCA South Tampa, with the same anesthesia team, the same nurses, and his own physician assistant in every case. That consistency shortens operative time, helps recovery, and means someone who knows your exact operation is reachable afterward.
The practice runs on referrals. Gastroenterologists, ENT physicians, pulmonologists, and allergists send patients specifically because those patients come back educated and satisfied whether or not they had surgery. For patients coming from St. Pete and farther, the team consolidates testing, arranges for whatever can be done locally to be done near you first, and helps with scheduling so you make fewer trips.
About the surgeon
Gopal Grandhige, MD, is a board-certified general surgeon and the founder and medical director of Tampa Bay Reflux Institute. He earned a Bachelor of Science in Biology from Johns Hopkins University and his medical degree from the University of Michigan, then completed his general surgery residency, a fellowship in burn and critical care, and a fellowship in foregut and minimally invasive surgery, all at Yale-New Haven Hospital. He is a Fellow of the American College of Surgeons (FACS), a member of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and a founding member of the American Foregut Society. He has practiced foregut surgery in Tampa Bay since 2009 and performs all of his surgeries at HCA South Tampa Hospital. More on Dr. Grandhige’s background and philosophy is available on the practice site.
You can independently verify his standing through the American Board of Surgery physician lookup, the Florida Department of Health medical license lookup, and the American College of Surgeons directory.

FAQS
Visit the office
Tampa Bay Reflux Institute 1315 South Howard Avenue, Suite 101 Tampa, FL 33606 Phone: 813.922.2920 Hours: 9 AM to 6 PM, Monday through Friday
The office sits in a yellow brick building next to Sally O’Neill’s Pizza, with parking behind the restaurant. From St. Petersburg, it’s about a 25 to 30 minute drive across the Gandy or Howard Frankland Bridge.
An endoscopy cannot tell you if you have reflux. It can only tell you if you have complications of GERD.
If you are unhappy with your reflux symptoms, come in and we can discuss testing and treatments that can accurately diagnose your problem.
#reflux #gerd #hiatalhernia #gastroparesis #linx
CALL US AT 813-922-2920
www.tampareflux.com
If you have a hiatal hernia and fit one of these categories, you should know your options.
Dr. Grandhige is an expert in his field and performs 200 of these surgeries a year. He is the only surgeon in the Tampa Bay Area who offers all surgical options - LINX, Fundoplications, TIF and will be one of 20 surgeons in America introducing the latest procedure RefluxStop in 2026.
We accept most insurances but will verify yours before you come in. These procedures are considered medically necessary and covered by your insurance. You can expect to pay your in-network deductibles and nothing else.
#hiatalhernia #reflux #GERD #LINX #refluxstop
What causes reflux ?
1. Weak lower esophageal sphincter
2. Hiatal hernia
3. Flattening of the Angle of His
4. Poor esophageal motility
5. Gastroparesis (slow stomach)
NOT increased acid production
Don’t let GERD get in the way of living your life. Request your appointment with us today on the link below.
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https://tampareflux.com/contact-us/
Anyone can be victim to GERD and though weight loss can help reduce GERD symptoms. Many athletes with high impact workouts may continue to have these symptoms. This may be a symptom of a hiatal hernia or other issue. We are more then happy to assist you in finding your solution, just click the link below.
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https://tampareflux.com/contact-us/
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#nonsurgicalweightloss #ESG #gastricballoon #weightlossjourney #vsg #vsgjourney #spatz3 #orbera #orberaballoon #grandhige #DrG
#tampabayrefluxinstitute #guthealth #roboticsurgery
Heartburn may seem like an annoyance. But if you find yourself having symptoms on a daily basis, it may be time to to talk to Dr. Grandhige as it could be a symptom of something worse.
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#chronicheartburn #gerdsymptoms #heartburnrelief #reflux #PPIs #heartburn #LINX #fundoplication #TIF #GERD#tampaheartburn #linx #TIF #fundoplication #tampabayreflux #GERD #acidreflux #acidrefluxsurgery #stopreflux
#nonsurgicalweightloss #ESG #gastricballoon #weightlossjourney #vsg #vsgjourney #spatz3 #orbera #orberaballoon #grandhige #DrG
#tampabayrefluxinstitute #guthealth #roboticsurgery
If you are tired of avoiding your favorite foods or taking daily medications, we can help.
We are the Tampa experts in reflux ! With years of experience and thousands of patients treated successfully, we offer all FDA approved anti-reflux procedures.
Call 813-922-2920 to schedule your appointment
All major insurances accepted.
Not all patients need surgical intervention. Many patients are living a heartburn free life with their PPIs. However 40% of patients taking PPIs are not getting the relief they need. If you are one of those, you have options! Come in and find out more.
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#letushelpyou #medsnotworking #reflux #PPIs #heartburn #LINX #fundoplication #TIF #GERD#tampaheartburn #linx #TIF #fundoplication #tampabayreflux #GERD #acidreflux #acidrefluxsurgery #stopreflux
#nonsurgicalweightloss #ESG #gastricballoon #weightlossjourney #vsg #vsgjourney #spatz3 #orbera #orberaballoon #grandhige #DrG
#tampabayrefluxinstitute #guthealth #roboticsurgery
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