Revisional Laparoscopic Antireflux Surgery After Transoral Incisionless Fundoplication

Transoral incisionless fundoplication (TIF) is increasingly accepted as an effective management strategy for refractory gastroesophageal reflux, especially in patients with minimal or no hiatal hernia. All antireflux procedures have a failure rate, however, and TIF is no exception. Nevertheless, it has significant advantages and likely will continue to gain widespread adoption.

One concern about the procedure that is commonly expressed is the potential for a challenging dissection at the hiatus during reoperative surgery. The authors’ program includes TIF as a treatment option, and one of their earliest patients required conversion to a laparoscopic fundoplication. This video demonstrates the expected anatomy during reoperation. It is helpful to consider the transoral procedure as having much in common with a Belsey fundoplication; much of the adhesion encountered during dissection will be at the left crus. Conversion to a conventional fundoplication when indicated is effective, safe, and should not preclude a more widespread adoption of the TIF procedure.

Suggested Reading

1. Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S. Long-term efficacy of transoral incisionless fundoplication with Esophyx (Tif 2.0) and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc. 2015;29(9):2770-2780.
2. Witteman BP, Kessing BF, Snijders G, Koek GH, Conchillo JM, Bouvy ND. Revisional laparoscopic antireflux surgery after unsuccessful endoscopic fundoplication. Surg Endosc. 2013;27(6):2231-2236.