Combined Laparoscopic and Endoscopic Procedure: Hiatal Hernia Repair with TIF (Loose Gastroesophageal Valve Repair)
While TIF is a great endoscopic option for patients with the appropriate anatomy, many patients, unfortunately, have a hiatal hernia that is too large or a gastroesophageal valve that is too loose to qualify for this procedure alone. While TIF may be technically feasible in these patients, they are less likely to get long-term relief of symptoms. We know that it can be very disappointing for patients with debilitating reflux to hear that they are not a candidate for endoscopic therapies including TIF. Traditional anti-reflux surgery (laparoscopic Nissen fundoplication) is an option for these patients. Fear of long-term side effects such as difficulty swallowing, gas-bloat syndrome, or increased flatulence, however, often understandably prevents people from pursuing a more invasive intervention.
For such patients, one important option that we do offer is a combined laparoscopic and endoscopic procedure. When we perform this procedure, a surgeon will laparoscopically repair the hiatal hernia and then we will endoscopically perform the fundoplication. The hiatal hernia is repaired by moving the stomach back down into the abdomen, and then repairing the defect in the diaphragm that allowed it to occur. The diaphragm hiatus – the opening the esophagus pass through just before it connects to the stomach – is thus re-tightened preventing hernia recurrence. After the hernia is repaired, we will then immediately perform endoscopic fundoplication to restore the gastroesophageal valve that acts as a barrier to reflux. Because the surgical portion of this procedure is laparoscopic and minimally invasive, patients still generally only need to stay in the hospital for one night after the procedure. Because the fundoplication portion is performed endoscopically, the long-term side effects of a surgical fundoplication can be avoided.
A recent study published in the Journal of the Society of Laparoendoscopic Surgeons demonstrated that this combination procedure results in safe and effective reflux relief with significant reduction acid reflux symptom scores.1 During follow-up evaluation 22 of 29 patients had persistent intact Hiatal repair and fundoplication. Among these patients, 95% had complete normalization of the acid levels in their esophagus. This combination procedure is an important technique that we can employ in providing our patients with a minimally invasive and safe end to their acid reflux.
We can help!
If you suffer from acid reflux, you have options. Give us a call. We can work together and see if this combined procedure may be right for you. The majority of health insurance companies cover hiatal hernia repair along with the TIF when the procedures are performed together. As always, it’s important to check with your insurance company to verify coverage.
Your IES Doctors.
- Ihde, GM et al. pH Scores in Hiatal Repair with Transoral Incisionless Fundoplication. JSLS. 2019 Jan-Mar; 23(1): e2018.00087.