Hiatal Hernia Doctor Specialist In Wesley Chapel, FL

Procedure selection is the actual work. Dr. Grandhige puts it plainly to patients: the operation is the last step, and the decision-making is the surgery. He runs the same six steps every time, in order.

Step 1. Prove reflux is present. Objective pH testing, correlation of reflux events with symptoms, and a determination of whether the reflux is acid, non-acid, or bile-related. If reflux is not objectively proven, no operation is recommended regardless of how convincing the symptoms sound.

Step 2. Read the anatomy. Presence and size of a hiatal hernia, esophageal length and position, and the relationship between stomach, diaphragm, and esophagus. Anatomy sets which repairs are technically possible and how durable each is likely to be.

Step 3. Test esophageal function. Manometry measures contraction strength, swallow coordination, and spasm. This is the most frequently skipped step and the most consequential. Motility findings decide whether a full or partial wrap is safe, whether a magnetic device is appropriate, and whether surgery should be avoided.

Step 4. Match symptoms to physiology. Typical symptoms, atypical symptoms, and symptoms unlikely to be reflux at all get sorted separately. You are told which ones are expected to improve, which may improve partially, and which will not change.

Step 5. Weigh what matters to you. Durability, getting off medication, keeping the ability to burp and vomit, minimizing side effects, reversibility. Preference refines the choice once medical appropriateness is settled. It never overrides anatomy or motility.

Step 6. Choose a procedure, or choose none. Observation and medical management remain on the list through the final step.

There is no best reflux operation. There is a right one for a given anatomy and a given esophagus, and matching them is what the six steps are for.

The wrap uses the top of your own stomach to reinforce the failing valve, and the diaphragm is repaired at the same time. Four configurations are in regular use: Nissen at 360 degrees, Toupet as a posterior 270, Watson as an anterior 270, and Dor as an anterior partial. The configuration is chosen before surgery from your manometry, not in the room. Operative time runs about 1.5 to 2 hours, it is outpatient, and most patients go home the same day. Diet advances over two to three months.

The trade-off is real. Because the wrap makes it harder for acid to come up, it can also make it harder for air and food to come up. Bloating and limits on burping or vomiting are the common complaints, and depending on the configuration these may be temporary or permanent. Patients with untreated severe motility disorders are not candidates. Dr. Grandhige has performed over 600 fundoplications.

A ring of magnetic titanium beads placed around the lower esophagus. It does not raise the resting pressure of the sphincter. It resists opening when stomach pressure rises, and it opens when you swallow, which is why most patients keep the ability to burp and vomit once the early inflammation settles. Anatomy is preserved and the device can be removed.

A widespread misconception is worth correcting: hernia size does not disqualify you from LINX. Patients with no hernia, small hernias, and moderate to large hernias can all be candidates, provided the hernia is repaired during the same operation. What LINX does require is good esophageal motility, because your esophagus has to push food through the device. Weak motility means a higher risk of lasting swallowing difficulty, and those patients do better with a partial wrap. Current devices are MRI compatible up to 1.5 Tesla.

One observation from years of these cases that does not appear in the manufacturer literature: patients who could feel their Bravo pH capsule while it was in place often report sensing the LINX device afterward. People who are highly attuned to internal sensation are worth flagging before implant, not after. Over 600 LINX procedures have been performed here.

Performed entirely through the mouth with no abdominal incisions, under general anesthesia, in about 45 to 60 minutes. It rebuilds a partial internal valve and lengthens the reflux barrier.

It also cannot repair your diaphragm. That is the limitation everything else follows from. Dr. Grandhige quotes a failure rate of about 2 percent per year, roughly 20 percent per decade, and describes it to patients as the best endoscopic option available rather than a permanent fix. It is not offered to patients with severe esophagitis, Barrett’s esophagus, peptic strictures, a moderate or large hiatal hernia, or obesity. Expect chest, left shoulder, and upper abdominal discomfort afterward from the swelling and fasteners, sometimes muscle spasms that are treated with medication, and a six-week restriction on heavy lifting and core strain. Over 200 TIF procedures have been performed at this practice.

The FDA granted premarket approval for RefluxStop on August 20, 2026, opening the U.S. market for the first time. The device restores the natural anatomy of the gastroesophageal junction without encircling the esophagus or applying pressure to the food passageway, and the approval followed review of five-year clinical data. Dr. Grandhige plans to add it, which would make all four current anti-reflux procedures available from one surgeon. It is not yet in use at this practice. Ask at your consultation where that stands.

A meaningful number of consultations here end without a surgical plan, and that is the point of the testing rather than a failure of it.

If pH testing does not prove reflux, no operation is recommended, no matter how severe the symptoms feel. Several conditions produce reflux-like symptoms and respond badly to anti-reflux surgery: esophageal hypersensitivity, functional chest pain, rumination, esophageal motility disorders, and achalasia, which needs a completely different operation. Some throat and cough complaints turn out to be ENT, pulmonary, or allergic in origin, and those patients get referred to colleagues Dr. Grandhige works with directly so the handoff does not duplicate care.

The second honest limit: surgery fixes reflux, not every symptom you arrived with. Patients naturally want one diagnosis to explain everything. Heartburn and regurgitation may resolve completely while bloating or abdominal pain persist through a separate mechanism. You will be told which symptoms are expected to improve and which are not, before you decide anything.

Dr. Grandhige is direct about the cost of this. The patients he declines to operate on are often the least happy people leaving the office. They would be considerably less happy after an operation that did not change anything.

Foregut disease is the whole scope of this practice: the esophagus, diaphragm, and stomach, and benign conditions only. Esophageal and gastric cancers, and problems outside the foregut, are referred elsewhere.

If you have been on daily acid suppression for years, been told your endoscopy was normal while your symptoms continued, or been handed a hernia measurement without an explanation of what it means, the next step is objective testing rather than another medication trial. Send your records ahead, come once if your workup is complete, twice if it is not.