TIF Procedure

Understanding Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a chronic condition caused by changes in the valve between your esophagus and stomach that allow stomach acid to flow back into the esophagus. GERD can have a significant impact on quality of life and can result in both typical symptoms such as heartburn or regurgitation or more unusual symptoms such as chest pain, trouble swallowing or food sensitivity. Your doctor may do a series of tests to diagnose GERD.

Gastroesophageal reflux disease can cause symptoms such as:

• Heartburn
• Chest pain
• Regurgitation
• Trouble swallowing
• Food sensitivity

Your doctor will do a series of tests to diagnose Gastroesophageal Reflux Disease. Learn more about the symptoms, causes and other treatment options for Gastroesophageal Reflux Disease (GERD).

Understanding Hiatal Hernia

Hiatal hernias are a common finding that may contribute to reflux symptoms. A hiatal hernia occurs when a portion of the stomach moves upwards into the chest cavity. The hernia makes it easier for reflux of stomach contents to pass into the esophagus and cause symptoms like heartburn. However, some patients with GERD do not have these hernias. 

Most patients with GERD are successfully treated with medications to suppress production of stomach acid. Medications may not work in all patients, particularly those with larger hiatal hernias. Some patients with GERD may also want to consider options to get off the medications they require to control their disease.

How are the TIF and cTIF Procedures performed?

The TIF procedure is a minimally invasive endoscopic procedure that can help treat symptoms of GERD in select circumstances. This procedure can be done in patients without a hiatal hernia or in those whose hernia is two centimeters or smaller. During the procedure the esophagus is first lengthened. Then the top of the stomach is gently folded and partially wrapped around the lower esophagus (i.e. fundoplication). The wrap is held in place with fasteners. No cutting on the skin is needed. The procedure takes about one hour to perform and is done under general anesthesia.

When a hiatal hernia is larger than 2 centimeters, a cTIF (concomitant transoral incisionless fundoplication) is required. During these procedures a surgeon uses laparoscopy where the hernia is pulled out of the chest cavity and secured in place. Endoscopy is then used to create the fundoplication around the lower esophagus. The laparoscopic surgery and the cTIF each take about one hour and are performed under the same general anesthesia setting.

After Your TIF Procedure

Do I have to stay the night in the hospital?

Yes. Most patients are admitted overnight for observation after the procedure.

What happens when I go home? Going back to work?

All patients who have a cTIF will be admitted for one or two nights in the hospital to ensure any pain is adequately controlled and you successfully restart oral intake for diet and medications. Some patients getting a TIF alone may be discharged the same day as the procedure. Your diet will progress from a liquid diet to a regular diet over 8 weeks. Your activity (such as lifting heavy objects) will be limited for about 2 months after the procedure as well. You will resume all home medications when you go home unless otherwise instructed by your doctor. Along with your home medications, you will be given a prescription for acid reflux medication. You and your doctor will determine a time that you may safely return to work. If you require documentation for your profession, please ask your doctor.

Will I need to come back for additional procedures?

Yes. TIF and cTIF patients may be asked to return one month after the procedure for follow-up with the GI and surgical team. At six months, you will come back for the following procedures:

• An upper endoscopy (EGD)
• Endoflip
• Bravo esophageal pH wireless monitoring OR Esophageal pH and impedance monitoring