Hi Ollie --
What will help in determining which procedure is best for you is evaluating your symptoms. The manufacturer of the EsophyX device used in the TIF procedure offers it as a "bridge" surgery between those who can not or will no longer use PPIs, and the more radical Nissen. The TIF has the advantage in that it may completely solve reflux in some patients, or offer a transition to the Nissen at a later date. The Nissen, in and of itself, must be considered pretty final...as there is no further step beyond it, and adjustments are discouraged.
If your symptoms are pretty much GERD/heartburn, and not severe, then I think you would be a candidate for the TIF. If your symptoms are more LPR/NERD, then it may not offer you the complete relief you seek, since LPR is a special complication.
Make sure you have a complete battery of tests beforehand, especially the 48-hour Bravo. Manometry can be helpful, but be advised that the results of this test can be inconclusive. Mine came back negative, even though there must be something weak in my LES. The GI mentioned that this test is not always helpful.
I had moderately worse LPR symptoms than I do now, before my TIF in August. My DeMeester score was around 25, and now it's in the "normal" range...however, since LPR is all about a weakened pharyngeal sphincter in addition to the LES, those reflux spikes, in addition to the aeresolized acid vapor and non-acid components of reflux, are enough to still give me symptoms. The most troubling are continued dysphagia and asthmatic conditions, as well as subtle hoarseness/laryngitis that prevent me from speaking for long periods, or singing. Even with a "normal" DeMeester score, I'm still getting 25-30 reflux spikes per day.
Everyone is different, of course, and there may be those whose throats are tougher than mine. But given my experience with the procedure, I would say that the TIF is less appropriate for LPR/NERD patients than GERD patients who are mainly experiencing heartburn (which I do not).
If you need to evaluate it on a cost basis, the Nissen may actually be cheaper for you than the TIF. I found out afterwards, as I struggled with the payments after my insurance, that the EsophyX is a single-use device, and hospitals really try to gouge and make up some of their losses by overcharging special instruments. Since the Nissen is performed with basic equipment that is reusable, you may not have quite the expense. Be sure and check this out thoroughly.
Since I am not free from my symptoms, I am now faced with considering the Nissen, which scares me. There are many on this messageboard who have been helped immensely by this procedure, and once past the recuperation, do fine. Since the TIF was the first major surgery I'd ever faced, I'm understandably less enthusiastic about this sort of thing, and tend to focus on the negatives instead of the positives.
Best of luck with your decision. I tried to come up with a flow chart to help me decide what to do, but wasn't successful in coming up with anything useful. In the end, I leaned towards the TIF because I needed to do something, and the TIF seemed the "lesser of two evils".
Age may help in your decision. If you're 50+, then maybe that might be a tick or two in the Nissen column, because it's the peer-reviewed standard for reflux surgery. The TIF still lacks long-term studies. If you're younger, then the easier TIF may give you good results for a few years before having to consider something more radical.
Best wishes.
-Bruce