Transoral incisionless fundoplication (TIF)
If you experience a digestive concern such as gastroesophageal reflux disease (GERD) or hiatus hernia, the gastroesophageal (GE) junction valve (connecting the oesophagus and the stomach) can become loose. TIF is a non-surgical endoscopic procedure that aims to tighten the valve by creating a stronger, more supportive band of tissue around the area where the stomach meets the oesophagus.
It is recommended as an alternative treatment to more invasive procedures that help treat conditions such as GERD and esophagitis.
This procedure tends to cause fewer complications than other GERD treatment surgeries, so it can offer relief from GERD regardless of whether you’re eligible for more invasive surgery or not.
‘Endoscopic’ means this procedure will use an endoscope. An endoscope is a long, thin tube with a small camera on the end that passes through your mouth and down your gullet. No incisions are involved, so TIF is less invasive than surgery.
Why might I need TIF?
This procedure is an option for those who have a minor hiatus hernia and mild to moderate GERD. It is an option for those who don’t want/can’t have invasive surgery for these conditions. It is often seen as the middle ground between long-life prescriptions for proton pump inhibitors (PPIs) and surgery.
Some patients may not respond well to PPI treatment or develop side effects or complications, in which case TIF can help patients ease off PPIs and eventually stop taking medication altogether.
Before the procedure
If you are interested in having TIF, you will have to speak to a medical professional to assess whether you are a good candidate.
You may have to have tests such as:
- Endoscopy – this involves an endoscope passed through your throat, down your gullet and into your stomach to look for any signs of concern
- Wireless 96 hour pH capsule (BRAVO or Alpha) or Esophageal pH test – this will test the acid reflux levels inside the oesophagus
- Esophageal manometry – this measures the muscle activity in your oesophagus and can confirm whether your muscles are working correctly
If your condition is suitable for TIF treatment, your specialist consultant and surgeon will prepare you for the procedure.
You must notify your doctor about any allergies and repeat prescriptions that may affect the procedure.
You must avoid food and drink 12 hours before the procedure. When you arrive, you will be given an IV drip with the medication needed for the procedure, which includes anaesthesia, muscle relaxers, antibiotics, antiemetics, and analgesics (painkillers).
During the procedure
The procedure should take 30 to 60 minutes to complete.
Your surgeon will operate on your GE junction valve using an endoscope and a special fundoplication device. This device will wrap the top of the stomach securely around the lower part of the oesophagus to create a tighter valve between them. The combination of tissue will be secured with either fasteners, surgical staples or stitches.
Each operation may differ slightly due to the type of medical device used with the endoscope during the procedure.
You should not feel any pain because you will be under general anaesthesia.
Recovery
You may be able to go home the same day after the procedure. However, if your surgeon believes that is necessary, you may need to stay overnight in the hospital.
It is normal to have minor discomfort after the procedure, and you will be given painkillers as needed.
You might experience nausea, stomach pain, or vomiting. Vomiting can cause damage to the operative site, so we will provide you with anti-nausea medication to prevent you from being sick.
Some key tips to help you recover from the procedure include:
- Avoid eating 2 hours before bedtime
- Avoid using straws
- Refrain from smoking
- Take small bites and chew thoroughly when eating solid foods
- Stay away from vigorous physical activity and heavy lifting for three weeks
Your surgeon may also recommend a particular diet plan to help you heal and keep up with nutrition after surgery.
Risks and complications
The TIF procedure is generally safe compared to other surgical procedures. Side effects are usually minor and temporary. They can include:
- Sore throat
- Shoulder pain
- Chest pain
- Problem swallowing
- Pleural effusion (when fluid builds up between your lungs and chest cavity)
Some people have also reported that the procedure hasn’t treated symptoms of GERD or hiatus hernia in the long term. Therefore, you may need additional treatment.
Benefits
TIF is a relatively new procedure compared to other treatments, so we aren’t aware of the full long-term effects of the surgery.
Early studies have shown that TIF has resolved symptoms for 80% of patients after 5 years, of whom two-thirds of patients did not need regular PPIs going forward. Many patients have noted that their symptoms have reduced or been resolved as a result of treatment.
Book an appointment
If you have reflux symptoms or hiatus hernia, you may be wondering whether you may need to repair the tissue with the help of the transoral incisionless fundoplication procedure.
Our gastroenterologist will thoroughly assess and monitor your condition to determine the most suitable treatment. We also offer a second opinion service.
Get in touch today to book an appointment with our gastroenterologist.