TIF Surgeon Skills

I've spoken with a couple of surgeons regarding TIF. One thing they both seem to say that was new information to me: TIF surgery also requires considerable skills. Experience with the instrument can only be gained by doing more of them. One of them in fact said that he feels more comfortable doing the Nissens than the TIFs since he has done about 12 TIFs as opposed to close to 500 Nissens. The other surgeon said that it is only after about 10 or so that one starts to get better at doing the TIFs. Creating a thick valve with a twist at the end is important according to one of them.

One question that I have about the surgeons:
Some surgeons who do Nissens/TIFs are cardiothoracic surgeons doing different kinds of surgeries (lungs, hearts, thorax etc.). However, others are focussed on GI (bariatrics being a good part of their experience/business) - and yet others are specialists of the minimally invasive surgery only. I'll be curious to know what you all think - which types of surgeons are good (or get good at) doing Nissens/TIFs. Another related question here is - is it important that the TIF surgeon also be a good Nissen surgeon?

Thanks!

Remember those old commercials..."I'm not an expert, but I DID stay at a Holiday Inn Express last night..." ;-)

I'm not sure I would necessarily comdemn a surgeon just because he hasn't done a lot of TIFs. Of course the surgeons are going to say that in order to do the surgery takes considerable skill. First of all, they have big egos and want to come across like they're the BEST at doing something, but they also hope to differentiate themselves from others by the same claim of skill.

If you think about what's actually being done, though, there's nothing about a TIF that's extraordinarily complicated. And in truth, I think most of the technology/skill is built into the EsophyX instrument. It's basically an awkward, oversized EGD instrument, with a staple gun. If the surgeon is reasonably intelligent (perhaps measured by the number of successful Nissens), and knows, for example, not to overinflate the stomach because it puts too much tension on the fundus, etc., I see no reason why an experienced surgeon can't be qualified to do a good TIF.

I think the surgeon who did mine had done fewer than ten. The fact that it hasn't helped my symptoms is no fault of the procedure, or the surgeon who did it. The results can be considered "excellent", were it not for my LPR.

One thing you mentioned -- the "twist" at the end of the valve -- I've never heard of. Perhaps this involves some skill. But the thickness of the valve is due to the thickness of the tissue already present. A surgeon can't create a thick valve with a TIF if the esophageal tissue is thin to begin with.

I can't contribute to the discussion about the relative skills of different types of surgeons. The only measure I would use to rate an individual's skill is the number of procedures per year, and total. That, and maybe the number of gray hairs on his head. I don't think I'd trust a kid fresh out of medical school!

-Bruce

Max,
I seem to have mild (early) disease. My symptoms are not that severe - they are there pretty much all the time though and cause more of a discomfort, annoyance - and sometimes they do cause aches and pains. Unfortunately, I just can not stay on any of the acid reducers except for antacids like Tums etc. Therefore, I am leaning towards a TIF at this time. I have heartburn but I also get the symptoms in the mouth (sour, bitter taste) and in the throat. So - yes - there is a 1 in 4 chance that it may not solve my problem - but I am willing to take that chance given that a Nissen can be done on top of TIF.

Bruce,
Regarding the skills of using the esophyx equipment, I agree that most experienced surgeons can do it well. However, as you may know - the esophyx endoscope - if not handled well - can cause such problems as misfiring, perforations etc. and you are right that as long as a novice is not doing it, it should be ok. But, I still want to probe various aspects before I take my final decision.