Transoral Incisionless Fundoplication (TIF)
Transoral incisionless fundoplication (TIF) is a minimally invasive surgical procedure used to treat gastroesophageal reflux disease (GERD).
GERD is a chronic (long-term) digestive problem. It occurs when the stomach contents reflux (flow back up) into the esophagus (food pipe), causing significant discomfort or symptoms.
Fundoplication is a surgical procedure that involves wrapping the upper part of the stomach (fundus) around the lower esophagus to strengthen the lower esophageal sphincter (LES), the muscle that normally prevents the backflow of stomach acid into the esophagus.
Unlike traditional fundoplication surgery, which requires incisions in the abdomen or chest, TIF is performed entirely through the mouth (transorally) without making external incisions, using an endoscope and a special device, reducing the risk of complications that would be associated with open surgery.
Indications
Transoral incisionless fundoplication is typically considered for patients who have not responded well to medications or lifestyle changes for GERD symptoms such as heartburn, regurgitation, and chest pain, and are seeking a minimally invasive alternative to traditional surgery.
Preparation
Preoperative preparation for transoral incisionless fundoplication may include:
- A thorough medical evaluation, including a review of your medical history, current medications or supplements, and any allergies
- Routine blood work, imaging, and other tests specific to your condition
- Your physician may instruct you to avoid certain medications and supplements - especially those that can affect blood clotting
- You should not consume solids or liquids for at least 8 hours prior to surgery
- You will sign an informed consent form after the pros and cons of the surgery have been explained
Surgical procedure
Transoral incisionless fundoplication (TIF) is performed using a special TIF device along with an endoscope. The TIF device is equipped with grippers and fasteners, which help the doctor repair or re-create the valve, so it becomes a better barrier against acid reflux. An endoscope is a thin, flexible tube-like instrument with a camera and light source that allows doctors to see inside the body.
In general, transoral incisionless fundoplication surgery may involve the following steps:
- You will typically be given general anesthesia to ensure you are completely asleep and pain-free during the surgery.
- You will be positioned on the procedure table in a supine (face-up) position.
- Once you are under anesthesia, your surgeon inserts a special TIF device along with an endoscope through the mouth and into the esophagus.
- Using the endoscope and the special TIF device, the surgeon begins to create a new valve mechanism at the junction of the esophagus and stomach. This involves wrapping and fastening tissue to form a tight seal that prevents stomach acid from flowing back into the esophagus.
- Once the valve mechanism is successfully created and tested, the instruments are carefully removed through the mouth
Postoperative care
After the procedure, you will be monitored in a recovery area until you are fully awake and stable. Most patients can go home the same day as the surgery or after a short observation period, depending on their recovery and any specific post-operative instructions. Your healthcare team will provide you with detailed instructions, including dietary recommendations, activity restrictions, and medications to manage any discomfort or potential complications. Follow-up appointments will also be scheduled to monitor your progress and ensure the effectiveness of the TIF procedure in managing your GERD symptoms.
Risks and Complications
Potential risks and complications associated with transoral incisionless fundoplication surgery include:
- Bleeding
- Infection
- Sore throat
- Bloating or gas
- Shoulder pain
- Chest pain
- A tear or perforation
Benefits
Benefits associated with transoral incisionless fundoplication surgery over traditional open surgery include:
- No scars, as a result of the incisionless approach
- Fewer complications and adverse events
- Faster recovery
- Shorter hospital stay
- Revisable if needed
Summary
Transoral incisionless fundoplication (TIF) surgery is usually considered when lifestyle changes and medications have not adequately controlled GERD symptoms, or when complications of GERD, such as esophagitis or Barrett's esophagus, are present. Overall, TIF offers a less invasive alternative to traditional fundoplication surgeries, with a reduced recovery time and potentially improved outcomes for GERD patients.