From the Guidelines
The TIF procedure is recommended for patients with mild to moderate GERD and small or no hiatal hernias, while hiatal hernia repair with Toupet fundoplication is preferred for patients with larger hiatal hernias or severe GERD symptoms, as evidenced by recent clinical practice updates 1.
Comparison of TIF and Hiatal Hernia Repair with Toupet Fundoplication
The TIF procedure and hiatal hernia repair with Toupet fundoplication are both effective options for treating gastroesophageal reflux disease (GERD), but they differ in their approach and indications.
- TIF is a less invasive endoscopic procedure that creates a partial fundoplication without incisions, making it suitable for patients with mild to moderate GERD and small or no hiatal hernias.
- Hiatal hernia repair with Toupet fundoplication is a laparoscopic or open surgical procedure that addresses both the hernia and reflux by repairing the diaphragmatic defect and creating a 270-degree posterior wrap of the stomach around the esophagus.
Key Considerations
When choosing between these procedures, the following factors should be considered:
- Size of the hiatal hernia: TIF is suitable for small or no hiatal hernias, while hiatal hernia repair with Toupet fundoplication is preferred for larger hiatal hernias.
- Severity of GERD symptoms: Patients with severe GERD symptoms may benefit from hiatal hernia repair with Toupet fundoplication.
- Patient's overall health: The patient's overall health and medical history should be taken into account when selecting a procedure.
- Surgeon's expertise: The choice of procedure may also depend on the surgeon's expertise and experience with each procedure, as noted in recent clinical practice updates 1.
Outcomes and Recovery
Both procedures have different outcomes and recovery periods:
- TIF offers quicker recovery with minimal complications but may be less durable long-term.
- Hiatal hernia repair with Toupet fundoplication requires general anesthesia and has a longer recovery period, but provides more durable long-term results, especially for complex cases.
Dietary Modifications
Patients should expect dietary modifications after either procedure, starting with liquids and progressing to soft foods over several weeks. Ultimately, the choice between TIF and hiatal hernia repair with Toupet fundoplication should be based on individual patient factors and recent clinical evidence 1.
From the Research
Comparison of TIF Procedure and Hiatal Hernia Repair with Toupet Fundoplication
- The TIF procedure is a minimally invasive technique used to treat gastroesophageal reflux disease (GERD) [(2,3)].
- Hiatal hernia repair with Toupet fundoplication is a surgical procedure used to treat hiatal hernias and GERD [(4,5,6)].
- A study comparing the long-term efficacy of laparoscopic Nissen and Toupet fundoplication for types III and IV hiatal hernias found similar long-term postoperative symptom control between the two procedures 4.
- The TIF procedure has been shown to be a safe and effective alternative to redo laparoscopic surgery in symptomatic patients with appropriate anatomy and objective evidence of persistent or recurrent reflux 2.
- Concomitant hiatal hernia repair with TIF (cTIF) has been proposed as an alternative to conventional anti-reflux surgery (ARS) for patients with hiatal hernias > 2 cm 3.
Key Findings
- The median rate of discontinuation of proton pump inhibitors (PPIs) after cTIF was 73.8% 3.
- Significant improvements were observed in disease-specific, validated GERD questionnaires after cTIF 3.
- The median rate of complications after cTIF was 4.4% 3.
- Laparoscopic Toupet fundoplication has been shown to be an effective treatment for GERD and hiatus hernia, with a low rate of side effects 6.
Outcomes
- Patient-reported symptoms and satisfaction did not vary significantly between patients receiving laparoscopic Nissen and Toupet fundoplication 4.
- The TIF procedure has been shown to improve GERD-related quality of life and reduce symptoms of GERD [(2,3)].
- Hiatal hernia repair with Toupet fundoplication has been shown to be a safe and effective procedure with a low incidence of complications [(5,6)].