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Endoscopic Anti Reflux Surgery or Transoral Incisionless Fundoplication

Anatomy and Reflux surgery
 
The esophagus is a muscular tube that allows food to pass from the mouth to the stomach.  When you eat or drink, the muscles at the top of the esophagus (Upper esophageal sphincter – UES) relax and allow food or liquid to be pushed through the rest of the esophagus through a process called peristalsis until it passes through the lower esophageal sphincter (LES) into the stomach.  When any part of the esophagus malfunctions, it can greatly inhibit a person’s ability to eat and drink and can cause moderate to severe discomfort. 
 
Gastroesophageal Reflux Disease (GERD)
 
Although occasional heartburn is common, especially after a heavy meal, more than 60 million Americans suffer from severe and persistent symptoms of gastroesophageal reflux disease or GERD.  GERD is a painful and often serious disease in which the acid in our stomach flows back up into your esophagus and throat causing a burning feeling in the middle of your chest.  This is due to a weakened lower esophageal sphincter (LES) which is a one way valve at the top of your stomach that usually prevents reflux into your stomach. 
 
Symptoms include :

If gastroesophageal reflux is left untreated for a long period of time, the sensitive tissue in the esophagus will become inflamed (esophagitis) and can cause pain.  Extended exposure can lead to sores or ulcers in the esophagus which may lead to bleeding.  You may also develop scar tissue which may lead to a stricture which will narrow the esophagus and make it difficult to swallow.
 
Chronic irritation can also lead to the growth of abnormal cells in the esophagus, called Barrett’s esophagus.  This can be linked with an increased risk of cancer and requires close surveillance, discussion with your gastroenterologist and discussion about possible surgery. 
 
GERD Treatment and anti-reflux surgery procedures
 
Lifestyle changes and medications can significantly reduce the severity of GERD symptoms.  Because smoking, caffeine, alcohol, chocolate, citrus and fatty foods can all trigger GERD, the first step is to avoid these agitators.  Losing weight, eating smaller meals, eating more slowly and using pillows at night can all offer some relief. 
 
Over the counter and prescription drugs such as Maalox, Mylanta, Tums, Tagamet, Pepcid, Zantac and Prilosec can all alleviate GERD symptoms.  There are also prescription strength variants such as Prevacid, Protonix or Nexium which may be prescribed. 
 
Recent warning have been issued about long term usage of proton pump inhibitors (PPI’s) as they may lead to an increased risk of fractures of the hip, wrist and spine. By lowering stomach acid levels, PPI’s might affect the body’s absorption of calcium, which in turn could lead to osteoporosis and the above mentioned fractures. There seems to be a dose-response relationship between PPI’s and osteoporosis. B12 levels also have been noted to be lower in those on long term PPI’s.

PPI’s are also associated with increased pneumonias as bacteria proliferate in the less acidic environment created by PPI’s.

There has been a connection between PPI’s and Clostridium difficile, a bacterium capable of causing life-threatening diarrhea.

Transoral Incisionless Fundoplication / Esophyx

Recent advancements in Europe and now in the United States over the past five years have shown promising results to a novel incisionless therapy for reflux.

For those patients who have mild to moderate reflux, this incisionless procedure allows a majority of patients to discontinue usage of PPI’s. This procedure is performed by introducing an instrument and a camera into a patients mouth and directing it under visual guidance into the patients stomach. The EsophyX device is used to construct a durable antireflux valve and tighten the LES (lower esophageal sphincter), thus reestablishing a barrier to reflux by restoring the competency of the gastroesophageal junction.

For those patients that have a hiatal hernia greater than 2 centimeters, the TIF procedure produces sub-optimal results. For these patients, we still recommend laparoscopic hiatal hernia repair and Nissen fundoplication in order that we can fix the hiatal hernia and cure a patients reflux simultaneously.

Given that this is an incisionless procedure, patients experience little to no discomfort. The procedure takes one to two hours to perform and it is performed under general anesthesia. Patients are kept in the hospital overnight.

TIF is gaining acceptance as a revolutionary approach to reflux. Suncoast Surgical Associates is proud to be the only group to perform this procedure at Brandon Regional Hospital and one of only a handful of surgeons to offer it on the Gulf Coast.

After Transoral Incisionless Fundoplication

Patients are watched overnight in the hospital.

Patients are slowly advanced from a liquid to a soft diet. Please look at the Post-TIF Procedure Diet form on our forms page for a detailed explanation of our post-operative recommendations.

After four to six weeks, most patients have discontinued all antacid medications and are tolerating all foods. Including those foods that used to cause them reflux !

As with all surgery, patients should avoid strenuous activity for four to six weeks. It is important to recognize that although incisionless, it is important to allow the body to internally heal. Most patients have little to no pain so feel ready to resume full activity sooner than recommended.

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