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Transoral Incisionless Fundoplication (TIF) Procedure

Medically Reviewed by Dany Paul Baby, MD on November 07, 2022

The transoral incisionless fundoplication, or TIF, procedure is a relatively mild surgical technique. It was developed to treat a particular medical condition called gastroesophageal reflux disease (GERD).  

What Is GERD? 

Gastroesophageal reflux disease (GERD) is a fairly common condition in America. The most common symptom of GERD is acid reflux, or heartburn.  

Your doctor will first try to treat your GERD symptoms with medication before moving on to surgery. Doctors typically prescribe both antacids and proton pump inhibitors (PPIs) to treat the symptoms of GERD. 

Preliminary research suggests that PPIs could lead to health complications with long-term use. Researchers need more data to confirm these early results. Ask your doctor for the most up-to-date information on these findings.

Who Needs TIF? 

You may qualify for the TIF procedure if you have GERD and: 

  • Haven’t responded to other forms of treatment
  • Have had a related procedure — called a Nissen procedure — in the past that needs to be corrected
  • Have had a TIF procedure in the past, and it needs to be repeated 

Ideally, the TIF procedure will reform and stabilize the valve that connects your stomach to your esophagus. This should provide enough support in the area to stop or significantly reduce the rate of acid reflux into your esophagus.

How Do You Prepare for the TIF Procedure? 

Your doctor may require a number of tests to determine whether or not the TIF procedure is right for you. This includes: 

  • A bravo capsule test. Your doctor will use an endoscope to place a chip near the base of your esophagus. This chip will measure the pH in the region and determine how frequently you experience acid reflux over a 48- or 96-hour period. The chip wirelessly communicates information to a device that you wear on your belt. 
  • An esophageal motility test. This is a way to determine how much pressure you generate when you swallow. This information can help your medical team. 
  • An X-ray video endoscopy. This is a way to get more imaging data on the area where the surgery will take place. The main point of this is to look for the presence of a hiatal hernia. This is when your stomach is pushing up through your diaphragm, into your esophagus. It can make all of your GERD symptoms worse and determine the kind of procedure that you qualify for. If your hernia is smaller than 2 centimeters, then you can still qualify for the TIF procedure. If your hernia is larger than 2 centimeters, then your surgeon will have to use another procedure called a cTIF. This stands for TIF with concomitant hernia repair. 

Once you’ve been approved for surgery, you’ll need to take a few more steps to prepare for the procedure. This includes not eating or drinking during the 12 hours before surgery. Also, make sure to tell your medical team about any allergies that you have.

What Equipment Is Used in the TIF Procedure? 

To perform the surgery your doctor will use two main pieces of equipment — an endoscope and a special TIF device. An endoscope is a thin, flexible tube that can be inserted into your mouth. It allows doctors to see the inside of your body. 

The TIF device was developed specifically for procedures like this one. It attaches to the endoscope and contains a variety of grippers and fasteners. These are used to hold and manipulate the tissues at the bottom of your esophagus.

What Is the TIF Procedure? 

As the name implies, TIF doesn’t require any cuts to enter your body — that’s what incisionless means. Instead, your surgeon will go in through your mouth — which is the meaning of the word transoral. 

Fundoplication is a technical term for the process of folding your fundus. Your fundus is a unique tissue at the top of your stomach. During the TIF procedure, this tissue is folded up around the area between your stomach and esophagus in a tube- or donutlike shape. 

A full fundoplication creates a ring around the bottom of your esophagus. Any ring that’s less than 240° is considered a partial fundoplication.  

The surgery should only last a total of 30 to 45 minutes and is typically done under general anesthesia. The steps are as follows: 

  • Your doctor will insert the endoscope and TIF device down your throat and into your stomach.
  • If you have a hiatal hernia, the doctor will correct this first with the use of suction and repositioning.
  • Then the TIF device will grasp and pull down the tissue of your esophagus and wrap it in the tissue at the top of your stomach.
  • The folded tissue is secured with plastic fasteners that will remain in your body.
  • The TIF device and endoscope are removed by traveling back up your throat.

Possible TIF Procedure Complications

Complications are rare with the TIF procedure. According to multiple studies, there’s approximately a 2% chance of developing a serious complication either during or after the procedure. Serious complications include tears to tissues in the area and internal bleeding. 

Temporary side effects of TIF procedure can include: 

The TIF Procedure Recovery Process

After the procedure, you may need to stay the night in the hospital so your medical team can monitor your recovery. But you might be able to go home on the same day. 

You’ll have to stick to an all-liquid diet for one week after the procedure. Then you’ll need to eat only soft foods for several weeks. You may also need to limit strenuous activities until your doctor says that you’re okay. 

Your doctor should schedule a follow-up appointment for about two weeks after your surgery.

TIF Procedure Success Rate

The TIF procedure is able to reduce acid reflux in approximately 99% of cases. About 89% of people are able to stop taking PPIs for a number of years. Hiatal hernias are reduced in about 91% of cases. 

But studies differ slightly on these statistics. For example, one study found that about 69% of patients were still satisfied with their surgery six months after it took place. 

But the effects of this surgery will wear off over time. The symptom relief tends to last for about eight to 10 years. After this, you’ll need to resume taking your old medications or repeat the surgery.

TIF Procedure vs. Nissen Procedure

These days most experts are recommending the TIF procedure over the traditional Nissen procedure. The Nissen procedure is a type of minimally invasive laparoscopic surgery. It requires making a cut in your abdomen and accessing your fundus from there. This tends to create more complications than the TIF procedure.  

The resulting structure that’s created with the TIF procedure is normally longer and less narrow than the one created using the Nissen procedure. There are fewer side effects with this shape.  

Both surgeries stop working within a decade.  

Always talk to your doctor if you have any questions or concerns about these surgeries or if you think that the TIF procedure is right for you.

Show Sources

SOURCES: 
Antunes, C., Aleem, A., Curtis, S. StatPearls, “Gastroesophageal Reflux Disease,” StatPearls Publishing, 2022.  
Johns Hopkins Medicine: “Transoral Incisionless Fundoplication (TIF).” 
Massachusetts General Hospital: “Transoral Incisionless Fundoplication.” 
Surgical Endoscopy: “Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis.”
Therapeutic Advances in Gastroenterology: “The evolution of TIF: transoral incisionless fundoplication.”

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