The Principles of Antireflux Surgery*

Benefits of TIF:

  • Incisionless approach means no scars
  • Constructed over a shaft that prevents overly tight fundoplication that can affect natural abilities to swallow, belch or vomit
  • Partial fundoplication—a more physiologic repair
  • No internal cutting or dissection of the natural anatomy—faster recovery
  • Comparable results to conventional antireflux surgery
  • Better safety profile than conventional antireflux surgery
  • Can be revised if required
  • Does not limit future treatment options

The goal of a fundoplication is to restore the normal functions of the gastroesophageal junction by wrapping the upper portion of the stomach (the fundus) around esophagus either partially (e.g., Hill, Toupet and Dor procedures) or totally (e.g., Nissen) in order to:

  • Reduce a hiatal hernia (if present) by properly positioning the distal esophagus and stomach below the diaphragm.
  • Restore the angle at which the esophagus enters the stomach
  • Increase the pressure of the lower esophageal sphincter (LES) to prevent reflux and recreate a one-way valve

Transoral Incisionless Fundoplication (TIF)

The TIF procedure, using the EsophyX device, is closely based on the well-established principles of conventional antireflux surgery and delivers similar results. The main differences between TIF and conventional surgery are:

  • Incisionless Approach: Conventional antireflux surgery involves accessing the anatomy via 3-5 abdominal incisions. TIF does not require any incisions and is performed through the patient’s mouth. TIF’s incisionless approach means less discomfort, faster recovery and no abdominal scars.
  • No Dissection: Laparoscopic surgery requires the surgeon to dissect, or cut around, relative anatomy which can increase the risk of complications and adhesions as well as recovery time.
  • Hiatal Hernia Repair: The TIF procedure is best suited for patients with hiatal hernia <2 cm. Hiatal hernia size is assessed via EGD.
  • Strong Safety Profile: To date, worldwide over 14,000 TIF procedures (12,500 in the U.S.) have been performed with fewer adverse events and complications than conventional antireflux surgery

Due to the unique approach of the TIF procedure, patients typically experience less discomfort, faster recovery and fewer adverse effects. Most patients are able to return to work and normal activities within a few days after their TIF procedure. Results to date for TIF are comparable to those of conventional antireflux surgery.

If you have GERD and are interested in learning more about TIF, consult aTIF specialist near you.

[1] Jobe, B.A., et. al. Endoscopic Appraisal of the Gastroesophageal Valve After Antireflux Surgery. Am J of Gastro 2004.
[2] Little, A., et. al. Mechanisms of Action of Antireflux Surgery: Theory and Fact. World J of Surg. 1992;16:320-5.
[3] Nissen R, The Treatment of Hiatal Hernia and Esophageal Reflux by Fundoplication. Hernia 1964;30:488-496.
[4] Adler, R.H., et. al. A valve mechanism to prevent gastroesophageal reflux and esophagitis. Surgery 1958;44:63-75.