Surgery for GERD is referred to as “anti-reflux surgery” and typically involves a procedure called a fundoplication, during which the lower esophageal sphincter is reinforced by wrapping a portion of the stomach around the bottom of the esophagus. The most common type of fundoplication is the Lap Nissen procedure, but there are also a number of partial fundoplication surgeries that are alternative options for patients as well. TIF is one of these partial fundoplications, a less invasive version of the Lap Nissen that’s done endoscopically (through the mouth) to treat GERD.
The primary issue in patients with GERD is that their esophageal sphincter is either too short or too loose. The TIF procedure allows surgeons to partially pleat the stomach around the esophagus in order to lengthen and tighten the patient’s sphincter, correcting their GERD and therefore reducing their symptoms. It’s a partial fundoplication procedure, meaning that rather than wrapping the stomach 360 degrees around the LES (lower esophageal sphincter) like they do during a Lap Nissen procedure, the stomach is used to create a 270-300 degree plication instead.
The effect it has on the sphincter is similar to taking a straight tube and turning it into a funnel. TIF helps lengthen and reinforce the LES, turning it into a funnel type object that has the ability to let things down but keeps them from splashing back up.
TIF is one of the less known anti-reflux surgeries, but it’s a great option for patients, especially those whose GERD isn’t incredibly severe. The concept is the same as the Lap Nissen, the only main differences are the degree to which the plication is performed and the invasiveness of the procedure.
Choosing which anti-reflux surgery is best for you can be difficult, and where these procedures vary the most significantly is in other areas like the pros, cons, recovery details, and cost. Here’s the breakdown for TIF:
- TIF has been around for a while, with over 10 years of proven effectiveness and study
- It’s the least invasive of all the anti-reflux procedures
- TIF is completely incision-less, so patients don’t have to worry about any lasting scars from the procedure
- The common side effects of anti-reflux surgery like dysphasia and bloating are minimal when it comes to the TIF procedure
- Effectiveness rates are pretty high, with about 80% of patients with heartburn able to stop their daily antacid medications after the procedure
- Any other procedure can still be performed down the line if necessary. In many cases, there’s no reason to jump to the most intense surgery before you know if an easier one could work. For many patients struggling with GERD, the more intense Lap Nissen may be unnecessary. It’s possible that the issue can still be solved by a more simple procedure like TIF.
- As a partial fundoplication procedure, TIF isn’t as tight or effective as the Nissen
- An overnight stay in the hospital is required after undergoing the TIF procedure
- The long-term durability of the TIF procedure is still relatively unknown
TIF is an outpatient procedure, but patients are still required to stay overnight in a hospital the day after their procedure. It’s mostly precautionary, if patients vomit from the anesthesia then they run the risk of loosening the procedure. Post-surgery, patients are placed on a semi-liquid diet for two weeks so that scarring can occur properly. They’re usually back to an unrestricted diet by four weeks after the procedure, though, and are also weaned off their daily antacids over the four weeks after the surgery. Doctors usually suggest that patients take one week off of work after undergoing the TIF procedure, a significantly better alternative than the two weeks required after the Lap Nissen procedure.
The cost of anti-reflux procedures can get a bit dicey, and most of it depends on the patient’s specific deductible, as well as what type of procedure they underwent. Generally speaking, TIF is covered by insurance the majority of the time. About 95% of private carriers typically cover the procedure, and there are cash pay options for patients whose carriers do not. The big thing for patients to note is that while Medicaid covers the Lap Nissen procedure, it doesn’t currently offer coverage for TIF.
Picking the right anti-reflux procedure for you is difficult, which is why it’s important to understand not only how each one works, but also the various pros, cons, recovery details and costs associated with each procedure. The great news for patients with GERD is that you don’t have to make these decisions alone. We’ve got a fabulous group of some of the most knowledgeable doctors in the southeast on staff, and they’re always available to walk you through your options. Contact us to schedule a consult, and be well on your way towards eliminating GERD from your life!