Incisionless Reflux Surgery – EsophyX Transoral Incisionless Fundoplication (TIF)
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.