Seriously considering TIF

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Regular Member

Date Joined Apr 2011
Total Posts : 377
   Posted 12/23/2011 11:52 PM (GMT -6)   
I am managing my symptoms every day without the meds ... however, I constantly have to deal with the GERD symptoms that occur quite randomly: bitter taste in my mouth, chest pain and throat sensation/achiness while swallowing. I haven't been able to find cause and effect with respect to the diet or any other lifestyle triggers so far. My symptoms have certainly gotten better in the last 6 months or so (and certainly since Feb of 2011 when all this started) .. but these symptoms are not quite going away. I saw a couple of big jumps in improvements (the most recent one after I started the yoga breathing exercises). However, the improvements have tapered off. It seems to me that the symptoms now wax and wane. Some of the days I feel better, the other days I don't.

I am going to see my GI (who will give me another pH impedance test) and then a TIF surgeon next month. I am seriously considering TIF. Reading about TIF .. it appears that it'll be a good bridge for someone like me who has milder GERD symptoms - and since TIF is similar in its principle as Nissen, I feel better about it than Linx. Linx seems more invasive to me than TIF (magnetic beads sitting on the esophagus). At worst - TIF won't provide adequate relief and I'll have to live with a stapled LES valve.

If I do have GERD and if GERD in all likelihood is chronic and progressive, I don't see any reason why I should not give TIF a try - and at least give myself a chance to get to a normal life ...

Comments, suggestions welcome ...

Regular Member

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)

Tandem Rider
Regular Member

Date Joined Jun 2011
Total Posts : 122
   Posted 12/24/2011 7:36 AM (GMT -6)   
I had a TIF in April. My DeMeester was 28 with over 100 episodes a day. After my TIF my DeMeester was 5.8 and I don't know about episodes. Because of the taste and burning in my mouth I was drinking something constantly and brushing my teeth frequently. After the TIF I have to remind myself to drink to keep from becoming dehydrated. My insurance paid for the TIF like any other surgery. Good luck with your decision.

New Member

Date Joined Nov 2011
Total Posts : 14
   Posted 12/24/2011 9:20 AM (GMT -6)   
I too was seriously considering the TIF, but my insurance considers the procedure "experimental and investigative". Not sure I want to take the chance of getting a huge bill. Not sure if the total cost of procedure is under 10K or higher ??.  In my case, even though I have been battling with night time reflux, upset stomach, gas/belching,  my demeester was only 8 with 62 events - which has me confounded and makes me wonder if I should proceed with a wrap or not. A couple of years ago, I did have a scope that confirmed esophogitis, so again, very confused.

Regular Member

Date Joined Apr 2011
Total Posts : 377
   Posted 12/24/2011 2:39 PM (GMT -6)   
Bruce -

Yes, you are correct about the difference between the mechanisms for Nissen and TIF. Nissen clamps from the outside while TIF lengthens and funnels the end of the esophagus in.
TIF literature however states that the TIF mechanism is similar to Nissen .. and which is why it is also a type of "fundoplication" .. I guess because the upper tissue of the stomach is used and is plicated to create a stronger valve is probably why it is claimed to be similar. However, you are right that the way the two work are quite different. However, they both are very much different from Linx which does not plicate or use the stomach fundus tissue at all.
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