Transoral Incisionless Fundoplication (TIF) is a medical procedure for chronic acid reflux, also known as gastroesophageal reflux disease (GERD). It can also manage minor hiatal hernias. The TIF procedure is performed endoscopically, meaning it involves no external incisions. Specialists use an endoscope, a flexible tube with a camera, inserted through the mouth to access the affected area.
Understanding GERD
Gastroesophageal Reflux Disease (GERD) is a chronic digestive condition where stomach acid or contents flow back into the esophagus. This backward movement occurs due to a weakened or improperly functioning lower esophageal sphincter (LES), a ring of muscle at the junction of the esophagus and stomach. Normally, the LES opens to allow food into the stomach and then closes tightly to prevent reflux.
When the LES is compromised, stomach acid can irritate the esophageal lining, leading to various symptoms. Common indicators of GERD include heartburn, a burning sensation in the chest, and regurgitation, where stomach contents return to the throat or mouth. Other symptoms can involve chest pain, difficulty swallowing, chronic cough, hoarseness, or a sensation of a lump in the throat.
Persistent acid exposure can lead to complications such as inflammation of the esophagus (esophagitis), narrowing of the esophagus, or precancerous changes to the esophageal lining.
How the Procedure is Performed
The TIF procedure is an endoscopic, incisionless approach performed under general anesthesia, typically lasting less than an hour. During the procedure, a specialist inserts an endoscope and a specialized device called EsophyX through the patient’s mouth. This device is guided down the esophagus to the gastroesophageal junction, where the esophagus meets the stomach.
The EsophyX device reconstructs the anti-reflux valve by folding the upper part of the stomach, the fundus, around the lower esophagus. This process involves creating a series of tissue folds, or plications, secured with small, durable fasteners. The goal is to form a new, tighter valve that prevents stomach acid from flowing back into the esophagus.
This reconstruction typically creates a 270 to 300-degree wrap around the esophagus, restoring the natural barrier against reflux. The precision of the EsophyX device allows for the creation of a stable, functional valve directly through the oral pathway.
Advantages and Recovery
TIF surgery offers several benefits compared to more invasive anti-reflux operations. Its incisionless nature leads to less post-operative pain and a reduced risk of complications like infection or scarring. This minimally invasive approach generally translates to a faster recovery process.
Patients typically return home the same day or after an overnight hospital stay. Discomfort after the procedure is usually mild, primarily consisting of a sore throat or some chest and shoulder discomfort, which often resolves within a few days to a week. Most individuals can resume non-strenuous daily activities within a few days.
A modified diet, initially consisting of liquids and gradually progressing to soft foods, is usually recommended for a few weeks to allow the newly formed valve to heal. Many patients experience significant relief from GERD symptoms, often leading to a reduced need for daily acid-suppressing medications within a month.
Who Can Benefit
The TIF procedure is suitable for individuals experiencing chronic GERD symptoms not adequately controlled by medication, such as proton pump inhibitors (PPIs). It offers an alternative for those seeking to reduce or eliminate reliance on daily medication or avoid more extensive traditional surgery.
Candidates often include patients with a small hiatal hernia, typically 2 centimeters or less, as the procedure can also address this condition. A comprehensive evaluation by healthcare providers is necessary to determine eligibility. This assessment includes a detailed review of medical history, an analysis of symptoms, and diagnostic tests.
Diagnostic tests, such as endoscopy, pH monitoring, and manometry, help confirm the severity of reflux and assess the structural integrity of the esophagus and its valve.