cTIF – Concomitant hiatal hernia repair and transoral incisionless fundoplication

What is cTIF?

Concomitant hiatal hernia repair and transoral incisionless fundoplication (cTIF) is a pioneering minimally invasive procedure for people with a hiatus hernia and GORD. It combines two established techniques to offer optimum benefit to the patient.

A hiatus hernia occurs when part of the stomach squeezes or slides upwards through the diaphragm into the oesophagus (food pipe) and causes unpleasant digestive symptoms (such as heartburn, acid reflux, regurgitation, pain after eating, bad breath, bloating and/or difficulty swallowing)

Hiatus Hernia

Questions and Appointments

For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams.

Why cTIF?

Anti-reflux surgery has been the traditional method for treating all sizes of hiatus hernia. It involves surgically bringing the hernia back down below the diaphragm and then wrapping the top of the stomach around the lower part of the food pipe (oesophagus), stitching it in place.

One major drawback of surgery is that the wrap is a full circle (360 degrees) and is quite tight, so belching/regurgitation is restricted (this can lead to swallowing issues and/or bloating). Furthermore there is a chance (1 in 10) of the surgery being converted from key hole to an open operation, which can mean a lengthy recovery period.

A newer less invasive alternative to anti reflux surgery is transoral incisionless fundoplication (TIF), which is performed via endoscope (a thin flexible tube down the throat). During the 30 minute procedure the bottom of the food pipe is pushed into the stomach and stitched into place creating a new valve that prevents stomach contents leaking up. The shape of the wrap is 270 degrees and patients report they can still burp/belch and they have a lower incidence of swallowing issues. However TIF can only be used to correct a hiatus hernia of up to 2cm.

As such cTIF offers patients with a larger hiatus hernia (over 2cm) a way to bring the hernia back down, but also create a less restrictive valve which is shown to deliver better patient outcomes. The recovery time is far less than conventional surgery and the success rate very pleasing.


Have a question?

If you have a question and would like to find out more, please contact Dr. Haidry’s secretary

What happens during cTIF?

In this procedure, Dr Rehan Haidry and his surgical colleagues will first address the hiatus hernia (repaired via keyhole surgery) bringing the stomach down under the diaphragm. Then, while under the same general anaesthetic, the TIF procedure is completed. This creates a new flap valve that is less restrictive than traditional surgery (270 degrees rather than full 360 degrees wrap). It is this difference that is associated with less side-effects like gas/bloating and swallowing problems.

cTIF is still a relatively new procedure, but as it combines two techniques (that have been used for many years independently) it can be considered very safe. Early data shows it is as effective and safe as TIF, with 70-80% of patients being able to come off medications over one year, and complications in <1%.

While longer term outcomes are being investigated, cTIF has dramatically expanded the number of eligible patients able to undergo TIF to prevent GORD symptoms (without the troubling side-effects of a traditional surgical wrap).




In The Press

Sixty-minute stomach operation could banish heartburn in weeks.

Read the full article in the Daily Mail – here.


Get In Touch

For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams on:

Tel: 0203 423 7609  |  Email: rhaidrymedsec@ccf.org