This animation goes over how reflux surgery can be accomplished without any incisions. Known as Transoral Incisionless Fundoplication (TIF), this surgical …
The lower esophageal sphincter or LES is a 
one-way valve that separates the esophagus from  
the stomach. When food or liquid is swallowed, 
the LES opens transiently to allow passage into  
the stomach. Otherwise, the sphincter remains 
closed to prevent stomach contents from flowing  
back up into the esophagus. However, for patients 
who suffer from reflux, the LES abnormally remains  
open allowing stomach secretions and contents to 
reflux up into the esophagus causing symptoms.
Should conservative management with medications 
as well as diet and lifestyle changes not resolve  
reflux symptoms, such patients may be a candidate 
for surgical intervention which typically involves  
physically tightening the LES. Traditionally, 
a Nissen Fundoplication or stomach wrap is the  
standard approach to surgically tighten the LES 
and requires small incisions over the abdomen.
However, there is a procedure that can 
tighten the lower esophageal sphincter  
without any incisions called transoral 
incisionless fundoplication or TIF.
There are several ways of performing TIF.  
The method shown here is via a device called 
EsophyX made by Endogastric Solutions.
Under sedation, the EsophyX device is introduced 
into the mouth under endoscopic guidance and  
threaded down into the stomach. The endoscope is 
then angled so complete visualization of the LES  
site is maintained at all times. The device 
jaws are then folded into its active state.  
The stomach wall is then retracted 
into the jaws of the device.  
If a small hiatal hernia is present, 
suction provided by the endoscope can  
be used to reposition the hernia below 
the diaphragm before device activation.
Once the stomach wall is positioned correctly, the 
device can be activated like a stapler resulting  
in fasteners being deployed to hold the stomach 
wall in place and secure the fold. The stapling  
is the repeated in multiple specific locations 
to recreate a natural functional sphincter.  
With healing, scar tissue develops which 
further secures the newly formed valve.

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