By Michelle Oleson

It’s being called the next step in the evolution of surgery. Surgery without an incision doesn’t even sound like surgery, but for the 60 million people in the United States who suffer from Gastroesophageal Reflux Disease (GERD) or chronic acid reflux, it’s a new treatment option they can get excited about.

GERD is caused by a defect in the gastroesophageal valve (GEV), which is located at the point where the esophagus meets the stomach. If the valve doesn’t close properly after a person swallows, stomach fluids back up, or “reflux,” into the esophagus, exposing it to gastric acids. This causes heartburn, but more importantly, it causes damage or eroding to the lining of the esophagus. In a small percentage of patients, it can develop into esophageal cancer. Some reflux is normal, but anyone who experiences it more than two times per week may want to see a doctor.

“Patients with GERD typically try a variety of treatments before opting for surgery,” said David Hayes, MD, board certified surgeon at Emory Johns Creek Hospital. “They start with diet changes, then progress to over-the-counter and prescription medications. When those methods don’t work, they look to surgery to fix the problem. More and more often, they’re choosing Transoral Incisionless Fundoplication, or TIF surgery instead of laparascopy,” he said.

The TIF procedure is surgery without an incision. It reconstructs the body’s natural physical barrier to reflux; or, in simpler terms, it builds or strengthens the GEV valve. Here’s where the incisionless part comes in. When a patient is under general anesthesia, the surgeon inserts a special EsophyX device through the patient’s mouth and into the stomach. With a camera attached to the device, the surgeon uses the guidance of a monitor to mold tissue, creating a new valve or strengthening an existing one. The entire procedure takes less than an hour and because patients don’t have incisions, they get the benefits of faster recovery time, less discomfort and fewer adverse post-surgery effects.

“While drug therapy is effective for the majority of patients who don’t have severe reflux, those that require ongoing, long term prescription use or can’t tolerate the side effects of the medications may want to talk to their doctors about this type of surgery,” said Dr. Hayes. “Drug therapy masks the underlying root of the problem, and some medicines can lead to inadequate absorption of minerals, such as calcium, which can then cause osteoporosis.”

However, it’s not only patients with obvious GERD symptoms that can be candidates for TIF surgery. People with chronic sinus infections, chronic hoarseness or reactive airway disease may also benefit from the procedure.

“We’re finding that reflux can also be the basis for chronic sinus or asthma-like symptoms,” said A. L. Jackson Slappy, MD, board certified surgeon at Emory Johns Creek Hospital. “People who have these symptoms or a combination of these and reflux symptoms should talk to a specialist, such as an ear, nose and throat doctor or pulmonologist to see if reflux could be the cause. This procedure could potentially help them.”

Dr. Hayes said that TIF incisionless reflux surgery provides almost immediate relief from GERD. He said it eliminates heartburn in 85 percent of patients, and almost 80 percent can stop taking proton pump inhibitor medication within two years of surgery. In fact, 60 to 80 percent of patients can eat whatever they want two years after the procedure is done without fear of heartburn.

Wouldn’t it be great if all surgeries could be that easy?