Date Joined Nov 2011
Total Posts : 417
| Posted 12/24/2011 12:53 AM (GMT -6)
I know we discussed this a bit in another thread. One thing that might factor in your decision is the cost. I discovered that my health insurance doesn't cover the full cost of "medical equipment", and by far the most expensive portion of the TIF surgery is for the EsophyX device -- which can only be used once. The hospital where I had the surgery done really tried to gouge for this, and apparently make some profit...even though they are a non-profit entity. I protested, and I'm not sure where the final bill stands at this point, four months later.
I called the manufacturer, and they confirmed what my surgeon told me -- that the device costs around $5,000 (confirming that I should've pursued a different course of study in college!). Anyway, the point I'm trying to make is that a Nissen surgery might actually be cheaper, because it uses laparoscopic tools that may be reusable, etc.
Depending upon what you learn with your pH test, and the severity of your symptoms, may also influence your decision. If your DeMeester score is 25 with 50 episodes per day, then the TIF may not be such a good option.
Don't be afraid to reject a surgeon. I didn't get a good feel for the first one I contacted, and he was reluctant to take on my case since it involved eosinophilic esophagitis too. That was a stupid reason, though, because the EoE is treatable. I ended up choosing a surgeon who was three hours away, and it's a pain to have to drive back and forth, but so it goes...
P.S. I was just re-reading your post, and I caught your words, "...similar in principle to Nissen." This isn't entirely correct. The TIF works more by extending the esophagus slightly into the stomach, than tightening the LES. Yes, it does make the LES somewhat narrower, too, but I'm not sure how long-lasting this particular benefit might be. This was the case with me -- the first 2-3 weeks post-op I was entirely symptom-free, presumably because of swelling at the surgical site. As I healed, the symptoms returned.
Picture the TIF procedure like turning a sock halfway inside-out, then sewing through both the outside and inside fold. (There are four "rings" of four fasteners each, spaced about a total of 1.5cm, and in/up 1cm from the lowest extension of the esophagus into the stomach.) By extending the esophagus into the stomach, the LES works less like a "funnel" for stomach contents to either "tip" or be ejected into the esophagus. I believe this is the main function of the TIF surgical site...but this is my opinion.
The Nissen, on the other hand, works primarily by actively squeezing the LES closed by peristalsis, mimicing the manner in which the musculature of the LES is supposed to work. This in addition to the sutures making for a tighter LES.
If the LES is in a weakened state, indicating the source of the reflux and need for surgery, then there is no such muscular contraction following the TIF to clamp down on the LES.
Post Edited (bcfromfl) : 12/24/2011 12:33:33 AM (GMT-7)