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Is TIF procedure advisable while having motility issues with improper sphincter contraction?

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Posted on Thu, 7 Mar 2019
Question: If one suffers with motility issues can the TIF procedure still be performed? Is the TIF like the nissen Fundoplication in respect to being able to do a partial wrap 180-240 ?
Do you know of the best surgeons for the TIF procedure in Long Island New York area ? Also, what would you personally do? TIF or Nissen? Thanks
doctor
Answered by Dr. Ramesh Kumar (12 hours later)
Brief Answer:
You are a candidate for fundoplication.

Detailed Answer:

Hello,

Motility issues with improper sphincter contraction are a contraindication to TIF.

No fundoplication is much better as concerned to TIF especially in 180-240.

I would have performed Fundoplication on you. It would give much better results in your case.

Lastly, limited or slow mobility is a contraindication for this procedure.

Go for Fundoplication.

Hope I have answered your query. Let me know if I can assist you further.

Thanks!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar (10 hours later)
One more question...

If your sphincter is lax or not closing properly, does that automatically mean you need surgery? Do all people with Gerd have sphincter problems and some can control this with just medication?

Thanks!
doctor
Answered by Dr. Ramesh Kumar (13 hours later)
Brief Answer:
Surgery is done when medicines are not successful.

Detailed Answer:

Hello again,

Surgery means intervention and usually as a rule of thumb interventions are done only when the patient is not relieved despite maximal medical therapy.

So ask your gastroenterologist to start you on PPI-antacids like Esomeprazole. It can be used in the dosage as high as 80 mg twice daily. Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone or Levosulpiride (both are prokinetic). This will slow down the reflux of acid back.

An antacid containing local anesthetic (Mucaine gel) should be taken.

Acotiamide is a wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.

All these drugs can be considered by your gastroenterologist to provide you with symptomatic relief in your problem. All these medications can be used at a time also by your primary. If you have tried all of them orIf not relieved despite this then go for surgery.

Yes, the sphincteric problem is always there as GERD means reflux of acid back into the esophagus.

Hope I have answered your query.

Regards,
Dr. Ramesh Kumar, Gastroenterologist
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2844 Questions

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Is TIF procedure advisable while having motility issues with improper sphincter contraction?

Brief Answer: You are a candidate for fundoplication. Detailed Answer: Hello, Motility issues with improper sphincter contraction are a contraindication to TIF. No fundoplication is much better as concerned to TIF especially in 180-240. I would have performed Fundoplication on you. It would give much better results in your case. Lastly, limited or slow mobility is a contraindication for this procedure. Go for Fundoplication. Hope I have answered your query. Let me know if I can assist you further. Thanks!