Transoral Incisionless Fundoplication (TIF)

The goal of antireflux surgery is to restore the normal functions of the junction between the esophagus and the stomach by creating a new antireflux valve. This is carried out by wrapping the upper portion of the stomach (the fundus) around the esophagus, either partially or totally. Both the TIF procedure and traditional antireflux surgery have the same goal. 

Benefits of the TIF procedure include:

• No scars, due to incisionless approach
• Faster recovery, since there is no internal cutting of the natural anatomy
• Fewer adverse events and complications than conventional surgery
• Can be revised if required (doesn't limit any of your future treatment options)

The purpose of the surgery is to:

• Reduce a small hiatal hernia (2 cm or smaller if present). If you have a larger hiatal hernia (greater than 2 cm), we can laparoscopically repair the enlarged opening in the diaphragm prior to performing the TIF procedure all in the same anesthesia session.
• Ensure proper positioning of the stomach and esophagus below the diaphragm
• Restore the angle at which the esophagus enters the stomach 
• Increase the pressure of the LES (lower esophageal sphincter) to prevent reflux and restore one-way valve operation 

The TIF procedure (exclusive of any hiatal hernia repair) is performed under general anesthesia and usually takes less than an hour to perform, but may vary from patient to patient. If a hiatal hernia repair is performed immediately before the TIF procedure, it adds more time; however, you are still under general anesthesia for a relatively short time overall. 

The strength of the new antireflux valve is largely determined by how well it heals; to aid healing, patients are asked to be on a short-term liquid diet followed by a mashed and soft food diet as the valve heals. 

The fasteners stay permanently in the body, but they are too small to be noticed and do not disrupt any bodily functions. The fasteners are very small and are made of the same material that surgeons have used for decades to sew tissue inside the body. Once in place, the body acclimates to the fasteners and often grows tissue around them.

A simple way to describe how the fasteners are applied is to imagine how a plastic price tag attaches to a piece of clothing. The fasteners are like that, but a much smaller version. The fastener rides along a very small needle that glides through two layers of tissue – stomach and esophagus. The fastener opens forming an "H" shape on either side of the two layers. The center of the "H" holds the tissue together while the body knits the two layers together. The knitting process is known as serosal fusion. The body needs about 6-8 weeks to complete this process. To help the body heal, we instruct you to eat foods with graduating texture, from clear liquids, full liquids, soft foods, up to normal texture foods. 

The TIF procedure has an excellent safety profile. To date, the TIF procedure has been performed on more that 25,000 cases worldwide with minimal complications and a serious adverse event rate under 0.5%. Clinical studies demonstrate that properly selected TIF patients rarely experience long-term side effects commonly associated with traditional antireflux surgery, such as chronic trouble swallowing, gas bloat syndrome, and increased flatulence.