Jason from North Houston sent us this question: TIF vs. Toupet fundoplication: how is that decided?? Thanks so much.
I am not sure in what context you are asking this question. Comparing TIF to fundoplication surgery for acid reflux is like comparing oranges to apples. TIF, short for transoral incisionless fundoplication, is not actually a fundoplication. Fundoplication entails mobilizing the upper part of the stomach, gastric fundus, then wrapping the fundus around the distal esophagus to re-create the anti-reflux barrier. This can only be achieved using laparoscopic or open surgery. TIF is an endoscopic procedure that does not allow an acid reflux surgeon to mobilize the gastric fundus. Furthermore, TIF procedure does not include hiatal hernia repair and distal esophageal dissection. These two steps are crucial aspects of anti-reflux surgery. Hiatal hernia repair and distal esophageal mobilization restore normal anatomy and bring down the most distal esophagus and upper stomach from the chest into the abdominal cavity.
TIF procedure is limited to placating limited amount of gastric tissue around the distal esophagus. It is presumed that this simple technique restores the anti-reflux barrier and reliably stops heartburn.
Toupet or Nissen fundoplication, on the other hand, entails hiatal hernia repair, distal esophageal mobilization, complete gastric fundus mobilization to wrap around distal esophagus.
Nissen fundoplication is the preferred procedure at Houston heartburn and Reflux Center because of its high success rate and very low complication rate. Toupet fundoplication is primarily offered in cases of a gastric fundus too small to loosely wrap around the entire esophageal circumference. Consequently, the gastric fundus is partially wrapped around the posterior esophagus to prevent narrowing of distal esophagus.
The short answer to your question “TIF vs. Toupet fundoplication: how is that decided?” is simple. A properly performed Toupet fundoplication is a more reliable and durable solution for acid reflux when compared to TIF.