toupet (partial Nissen) vs. TIF

Met another surgeon today and asked his opinion on Esophyx TIF vs. Nissen.

He said I am comparing apples and oranges. He is of the opinion that in terms of the risks of possible side effects (dysphagia, bloating) - TIF should not be compared directly with the full Nissen but with the partial (Toupet) Nissen. He said that the partial (Toupet) gives the same benefits in this respect as TIF over the full Nissen.

He is of the opinion that the success rate with Toupet is much higher and he has other surgeon friends who have stopped doing the TIFs. He also said that doing incisionless surgery is not necessarily a good thing since in the case of Esophyx one does not have full control and view of the surgical site (he said that Medigus is much better in this respect as it allows better view of the surgical site).

He says that the incisions will heal quickly and in terms of the post-operation healing, TIF has some benefit but he does not think that - that alone should be the reason why I should choose the type of the surgery and that I should be looking at the final benefit I will see at the end of the healing - and I agree with him.

Another factor here is - Toupet will be fully covered by the insurance while the TIF will not be.

We did talk about LINX as well and he was generally positive about it based on the data he has studied from Europe - but cautioned about the lack of long term data. I am also uncomfortable about a foreign object sitting inside of me - so, I'd like to avoid that - if possible.

Comments, thoughts are welcome!
Thanks

Post Edited (PPI-LESS) : 8/17/2012 1:59:09 PM (GMT-6)

No - I did not ask him specifically about LPR.

However, yes in general the success rate of any type of fundoplication (nissen, toupet or tif) is lower for patients with LPR-only symptoms.

As you know - the etiology of LPR is not clearly understood and there is no universal consensus even for its definition.

I used to have more LPR like symptoms last year and less GERD (heartburn) like symptoms. But - now I have more GERD symptoms than LPR symptoms. Since I have both types of symptoms - I am assuming that the surgery will help me.

My symptoms these days without any medications are:
- heartburn (uneasy, rising of the acid feeling around the les area)
- sometimes bitter burning taste in the mouth/tongue/throat area

With aciphex 20mg/day and sometimes gaviscon at night - I am able to control these symptoms - but my body starts to ache if I stay on aciphex for more than a few days. So, I tend to go on and off of it.

Food does not seem to have any correlation to my symptoms. I can have pizza, beer and have no change in symptoms. I was on a restricted / Koufman diet last year for several months when my throat was really fried and hurting all the time. So, I could not eat anything that would hurt/burn it even more. So, the diet / food then was mostly about not eating anything acidic that would hurt on it way down. But, the food does not seem to 'trigger' it, so now that my throat has healed, I eat pretty much whatever in moderation.