273 - Transoral Incisionless Fundoplication (TIF): A Novel Approach to treat Gastroesophageal Reflux Disease (GERD)
Clinical Issue: Gastroesophageal reflux Disease (GERD) is a chronic condition where acid from the stomach persistently and regularly flows backward up into the esophagus. The stomach acid in the esophagus causes heartburn which is the main symptom of GERD. If untreated GERD may lead to further tissue damage. The American College of Gastroenterology states at least 15 million Americans or 20 percent of the American Population experience heartburn every day. Description of Team:Transoral incisionless fundoplication (TIF) is an endoscopic procedure designed to relieve symptoms of Gastroesophageal reflux disease (GERD). The procedure is performed by our surgical team which includes the thoracic surgeon, thoracic surgical resident, anesthesia team, circulator and scrub nurse. As this procedure is a relatively new treatment option available to our surgical patients our team is assisted by our healthcare partner on the day of surgery. Preparation and Planning:The primary issue in patients with GERD is that their esophageal sphincter is too short or too loose. Preparation and planning for the TIF procedure involves a preop EGD, evaluation of the patient’s Hill Grade, integrity of the esophageal tissue for pathology, stricture and ulceration while maintaining NPO status on the day of surgery. The nursing team prepares the TIF device prior to the patient’s arrival to the operating room.
Assessment: TIF is one of the less know anti-reflux surgeries, but it is a great option for patients. Our surgeons have fully evaluated the patient and assessed their symptoms of GERD are not at the more severe spectrum. For further assessment, after intubation an EGD is performed to measure the axial and transverse dimension of the esophagogastric junction (EGJ). A measurement of < 2cm is appropriate for a TIF procedure. Implementation:The TIF procedure differs from a traditional fundoplication procedure because it is performed through the mouth rather than through a laparoscopic or open abdominal incision approach. While under general anesthesia the TIF device is used with a flexible endoscope and gently introduced into the stomach under constant visualization. The fundus of the stomach is folded up and around the distal esophagus. Metal fasteners and 3-0 sutures are used to anchor the repair. Outcome: Our TIF trained surgeons are able to restore the natural shape, location and effectiveness of the patient’s esophageal valve and thus halt the GERD symptoms. Implications for perioperative nursing: The TIF procedure takes advantage of the advancements of minimally invasive procedures. Perioperative nursing always seeks to ensure the best outcomes for our patients. This procedure reduces the need for large skin incisions, decreased risk for infection, decreased negative long-term side effects and faster recovery time. This leads to a more optimal quality of life for our patients.