TIF stands for Transoral Incisionless Fundoplication

TIF is the newest and least invasive surgical procedure to eliminate heartburn and esophageal reflux. The endoscopic procedure restores the natural valve between the esophagus and the stomach to prevent esophageal reflux. No incision is needed! No longer do you have to take the “purple pill” or suffer with acid reflux symptoms. As the long term side effects of the powerful acid reducing class of drugs known as PPI’s (Proton Pump Inhibitors) such as Nexium, Prilosec, Prevacid, ect. become recognized, it is clear that there needs to be a safer alternative. That alternative is now available here at New Braunfels Surgical Associates/Hill Country Vein Center with state of the art diagnostic equipment. Dr. Kneuper is very experienced in performing this revolutionary procedure as well as the older laparoscopic techniques that can end your dependence on daily medication for acid reflux.

About the TIF Procedure

TIF (transoral incisionless fundoplication) is the latest treatment for safely and effectively treating chronic acid reflux disease, or GERD. A completely incisionless procedure, TIF reconstructs the antireflux barrier to provide a solution to the anatomical root cause of GERD. The procedure is for patients who are dissatisfied with current pharmaceutical therapies or are concerned about the long-term effects of daily use of reflux medications. In clinical studies, 79% of patients remained off daily PPIs (proton pump inhibitors) and 93% experienced a total elimination of heartburn at two years after the procedure.

TIF was developed to emulate more invasive surgical techniques, but from within and completely without incisions and visible scars. TIF is performed endoscopically using the innovative EsophyX surgical device from EndoGastric Solutions.The procedure is completely incisionless and is performed through the mouth, rather than through an abdominal incision.

Typically lasting no more than 50-60 minutes, the procedure is performed under general anesthesia and reconstructs the antireflux barrier to restore the competency of the gastroesophageal junction. Most patients can go home the next day and return to work within a few days.

Our facility provides convenient and comprehensive evaluation of the vein anatomy and physiology utilizing the best duplex ultrasound technology available. This noninvasive imaging performed by Registered Vein Technologists, clearly pinpoints the area of venous incompetence and reflux. This knowledge allows us to treat the key area with surgical precision to ensure the best possible outcome.

Frequently Asked Questions:

Q: How is TIF performed?

A: It is performed with the patient under general anesthesia. The EsophyX device is slowly introduced into the body transorally (through the mouth) and advanced into the esophagus under visualization of a video camera inserted down the central shaft of the device. The EsophyX device is then used to form and fasten several tissue folds, or plications, to create a robust antireflux valve at the gastroesophageal junction.

Q: How long does the procedure take?

A: The procedure takes approximately 60 minutes.

Q: How long can I expect to be hospitalized?

A: The procedure is performed in the hospital setting. You will be required to spend the night after the procedure in the hospital.

Q: What is the recovery like?

A: Patients should expect to experience some discomfort in their throat and chest for the first few days to a week after the procedure. Patients will be asked to restrict physical activity for the first week and will be given dietary guidelines to help maximize their success while the tissue heals.

Q: How soon can I return to work?

A: Most patients will be able to return to work within 3-7 days after the procedure, or as recommended by their study doctor.

Q: Are there risks or side effects associated with the procedure?

A: The procedure has been generally proven safe in hundreds of surgeries performed worldwide. To date, most observed side effects or discomforts have been mild. Previous research studies have shown that the nature and the number of adverse events associated with the procedure are similar to other procedures that involve acid reflux surgery. Discuss with your study doctor all potential risks and side effects and whether you are the right candidate for the procedure.

Q: What results should I expect?

Two U.S. case series with 161 patients reported a significant improvement in symptoms and PPI discontinuation in 80-90% patients, and normal esophageal acid exposure in 70%.

Q: Is TIF using EsophyX FDA cleared?

A: The EsophyX device was cleared by the United States Food and Drug Administration (FDA) in 2007 for treatment of symptomatic chronic GERD after it had been proven safe and effective.

Q: What will my diet be after the TIF procedure?

A: After the procedure you will be on a diet of liquid foods for 2 weeks, soft foods for another 2 weeks, and then on a normal diet without fibrous vegetables and meet for 2 more weeks. You will advance to general diet after week 6.

Q: What is the expected follow-up after surgery?

A: Your follow-up will consist of routine office visits at week 2, month 1 and month 3 after the surgery, and two assessment visits at month 6 and month 12.

Q: Who will pay for the surgery?

A: The costs of TIF procedure and all study-related tests will be billed to your insurance company. You should ask your study doctor what costs will or will not be covered by your insurance.