Expert Hiatal Hernia & Reflux Surgery in Miami, FL

Hiatal hernia repair is usually done laparoscopically or robotically. The surgeon returns the stomach to the abdomen, removes the hernia sac, frees the esophagus so enough of it sits below the diaphragm without tension, and closes the enlarged opening in the diaphragm with sutures, sometimes reinforced with mesh. A fundoplication (Nissen or Toupet) is usually added to prevent reflux, or a gastric bypass in patients with obesity. Most patients go home within one to two days.

Most patients experience significant improvement or complete resolution of reflux after a well-planned operation. Results are best when reflux is confirmed by objective testing and the cause — such as a recurrent hiatal hernia or a failed wrap — is clearly identified. For patients with obesity or multiple prior failures, gastric bypass is often the most reliable anti-reflux option.

No. Mesh is used selectively based on the size of the hernia and the quality of the tissue. The foundation of hiatal hernia repair is closing the diaphragm opening with sutures and getting enough esophagus into the abdomen without tension. Mesh reinforcement may reduce early recurrence in large hernias, but long-term benefits are less clear (Oelschlager et al., Journal of the American College of Surgeons, 2011), so the decision is individualized.

Laryngopharyngeal reflux (LPR) occurs when stomach acid or digestive enzymes reach the throat and voice box. Unlike GERD, many patients don’t feel heartburn. Instead, LPR causes symptoms such as chronic throat clearing, cough, hoarseness, globus sensation (a “lump in the throat”), or difficulty swallowing. Diagnosis often requires laryngoscopy, pH testing, or evaluation by a reflux specialist.

LPR symptoms are usually throat‑based rather than chest‑based. The most common include chronic throat clearing, persistent cough, hoarseness, post‑nasal drip, excessive mucus, sore throat, and a sensation of something stuck in the throat. These symptoms often worsen after meals, talking for long periods, or lying down.

Treatment focuses on reducing reflux exposure to the throat. First‑line therapy includes dietary changes (avoiding acidic, spicy, and fatty foods), weight optimization, elevating the head of the bed, and avoiding late‑night eating. Medications such as PPIs or H2 blockers may help, but many patients require targeted evaluation for structural issues like hiatal hernia or esophageal motility disorders. Severe or persistent cases may benefit from surgical or endoscopic reflux management.

A complete foregut workup is essential and improves outcomes: upper endoscopy to examine the esophagus and rule out other problems, esophageal manometry to confirm normal muscle function and exclude achalasia, ambulatory pH monitoring to objectively confirm acid reflux, and usually a barium esophagram to map the anatomy and hernia (Maret-Ouda et al., JAMA, 2020; Yadlapati et al., AGA Clinical Practice Update, 2022; Andolfi & Fisichella, JOMI). These tests confirm the diagnosis and determine which operation is best for you.

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For most patients, yes. Anti-reflux surgery provides durable relief and allows the large majority of patients to stop daily acid-suppression medication, with patient satisfaction above 90% at 10 years (Thrumurthy et al., JAMA, 2026). Surgery controls regurgitation far better than continued medication — a randomized trial found a successful outcome in 67% of surgical patients versus 28% treated medically for refractory heartburn (Fass, New England Journal of Medicine, 2022). However, GERD is a chronic disease: more than 25% of patients resume some PPI use over long-term follow-up, and up to 20% have symptom recurrence within 10 years (Fass, New England Journal of Medicine, 2022; Thrumurthy et al., JAMA, 2026). Careful patient selection and matching the operation to your physiology maximize the chance of staying medication-free.

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cTIF combines a laparoscopic hiatal hernia repair with a transoral incisionless fundoplication performed in the same session (Jaber et al., Surgical Endoscopy, 2024). It exists because standard TIF does not fix a hiatal hernia, so patients with a hernia larger than 2 cm — who would otherwise be excluded from TIF — can have the hernia repaired first and then receive the incisionless valve (Choi et al., Journal of the American College of Surgeons, 2021). The results are strong: a prospective multicenter study of 188 patients reported clinical success in 92%, discontinuation of daily PPIs in 84%, and normalization of esophageal acid exposure in 84%, with a median stay of about 23 hours and serious adverse events in only 1.6% (Kolb et al., Journal of the American College of Surgeons, 2026). Systematic review confirms high PPI-discontinuation rates with low rates of new dysphagia (~5.3%) and bloating (~6.9%) (Jaber et al., Surgical Endoscopy, 2024).

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No. The overwhelming majority of people with reflux never develop esophageal cancer. However, chronic, frequent reflux — especially long-standing, severe, erosive reflux — raises the risk and can lead to Barrett's esophagus, the precursor to esophageal adenocarcinoma. That is why persistent reflux should be evaluated rather than simply self-treated indefinitely (Thrift, Nature Reviews Gastroenterology & Hepatology, 2021; Xie, Smyth & Lagergren, New England Journal of Medicine, 2026).

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