Concomitant Transoral Incisionless Fundoplication (cTIF)

cTIF is an advanced minimally invasive treatment that combines hiatal hernia repair with transoral incisionless fundoplication to restore the body’s natural barrier against reflux—without traditional open surgery.

At UC Health, gastroenterologists and minimally invasive surgeons work together to evaluate each patient's anatomy, symptoms and treatment goals to determine whether advanced options like cTIF are appropriate. 

Related Conditions

- Acid Reflux & Gastroesophageal Reflux Disease (GERD)

ABOUT THIS TREATMENT

Understanding cTIF

For many people living with chronic acid reflux or GERD, medications and lifestyle changes can help manage symptoms. But when symptoms persist or reflux is caused by structural changes such as a hiatal hernia, additional treatment may be needed.

Concomitant Transoral Incisionless Fundoplication (cTIF) is an advanced minimally invasive procedure designed to address both reflux and the underlying anatomy contributing to symptoms.

The procedure combines robotic hiatal hernia repair with transoral incisionless fundoplication (TIF) to rebuild the anti-reflux valve and reduce stomach acid from flowing back into the esophagus.

At UC Health, patients benefit from a collaborative approach between gastroenterology and thoracic surgery specialists to evaluate treatment options and develop personalized care plans.

What Is cTIF?

cTIF is a minimally invasive treatment performed in two parts.

First, the surgeon repairs the hiatal hernia using small laparoscopic incisions. A hiatal hernia occurs when part of the stomach moves upward through the diaphragm and can weaken the body’s natural protection against reflux.

After the hernia repair is completed, a gastroenterologist performs transoral incisionless fundoplication (TIF) using specialized equipment inserted through the mouth. No additional abdominal incisions are required for this portion of the procedure.

During TIF, tissue at the top of the stomach is reshaped to recreate the valve between the stomach and esophagus, helping reduce reflux episodes.

By treating both the anatomy and the reflux mechanism together, cTIF offers an alternative to more traditional anti-reflux surgery for select patients.

Who Can Benefit from cTIF?

cTIF may be an option for patients who:

  • Experience chronic GERD symptoms
  • Continue to have symptoms despite reflux medications
  • Have a hiatal hernia that contributes to reflux
  • Want to reduce long-term dependence on medications
  • Experience regurgitation, chronic cough or throat symptoms
  • Prefer a minimally invasive treatment approach

Candidates for cTIF undergo a comprehensive evaluation that may include endoscopy, pH testing, esophageal manometry and imaging studies to confirm the diagnosis and determine the best treatment approach.

Benefits of cTIF

cTIF is designed to improve reflux symptoms while minimizing recovery time and preserving normal anatomy.

Potential benefits may include:

  • Reduced heartburn and regurgitation
  • Improved quality of life
  • Reduced reliance on acid-reducing medications
  • No large abdominal incision
  • Minimally invasive recovery
  • Restoration of the body’s natural anti-reflux barrier
  • Improved control of reflux-related symptoms

Results vary based on anatomy, severity of reflux and individual health factors.

What to Expect

From your initial evaluation through recovery, your care team will guide you through each step of the cTIF treatment process.

Before Treatment

Your care team will perform a complete reflux evaluation and review prior treatments, symptoms and diagnostic testing.

Testing may include:

During Treatment

cTIF is performed under general anesthesia.

The procedure includes:

  • Repair of the hiatal hernia performed robotically
  • Reconstruction of the anti-reflux valve performed endoscopically

Most patients stay overnight for observation and go home the next day, depending on their recovery and treatment plan.

After Treatment

Recovery recommendations vary but may include:

  • Temporary dietary modifications
  • Gradual return to activity
  • Follow-up appointments
  • Medication adjustments

Most patients return to normal daily activities over the following weeks.

cTIF Compared with Traditional Anti-Reflux Surgery

Both cTIF and traditional anti-reflux surgery aim to reduce reflux and improve symptoms, but treatment recommendations depend on anatomy and individual goals.

cTIF

  • Minimally invasive approach
  • Combines hernia repair and incisionless fundoplication
  • Designed to preserve anatomy
  • Smaller incisions and shorter recovery
  • Less reports of bloating, inability to belch and vomit afterwards

Traditional Fundoplication

  • More extensive surgical reconstruction
  • May be preferred for more complex anatomy
  • Long history of clinical use

Your care team will discuss which option is most appropriate based on your evaluation.

Why Choose UC Health for cTIF?

UC Health offers specialized expertise in advanced reflux care through a multidisciplinary team of gastroenterologists and minimally invasive surgeons.

Patients benefit from:

  • Advanced reflux diagnostics
  • Access to minimally invasive treatment options
  • Collaborative GI and surgical expertise
  • Personalized treatment planning
  • Academic medicine and innovation
  • Comprehensive follow-up care

Our goal is to help patients reduce symptoms, improve comfort and return to daily life with confidence.

Help Along the Way

Answers to Your Questions About cTIF

cTIF is a minimally invasive treatment that combines two approaches: repair of a hiatal hernia and transoral incisionless fundoplication (TIF) to restore the body’s natural barrier against reflux.

Compared with traditional anti-reflux surgery, cTIF is designed to reduce reflux symptoms while minimizing disruption to surrounding anatomy. Because the fundoplication portion is completed through the mouth rather than additional abdominal incisions, some patients experience a smoother recovery and fewer side effects associated with more extensive surgical reconstruction.

Your provider will recommend the treatment approach that best matches your anatomy, symptoms and long-term goals.

cTIF is designed to provide long-term relief from reflux symptoms and improve quality of life for appropriately selected patients.

Many patients experience meaningful improvement in heartburn, regurgitation and reliance on acid-reducing medications after treatment. However, results vary based on factors including symptom severity, anatomy, lifestyle and underlying digestive conditions.

While cTIF can significantly improve GERD symptoms, no procedure can guarantee permanent elimination of reflux for every patient.

cTIF may be considered for patients who:

  • Have chronic GERD symptoms
  • Continue to experience reflux despite medications
  • Have a hiatal hernia contributing to symptoms
  • Want to explore alternatives to long-term medication use
  • Are candidates for minimally invasive treatment

Determining eligibility requires a comprehensive evaluation that may include upper endoscopy, pH testing, esophageal manometry and imaging.

Before recommending cTIF, your care team may perform specialized reflux and esophageal testing to better understand the cause of symptoms and confirm whether this treatment is appropriate.

Testing may include:

  • Upper endoscopy (EGD)
  • Bravo™ pH monitoring
  • Esophageal manometry
  • Imaging studies
  • Medication review and symptom assessment

This evaluation helps ensure treatment is tailored to each patient’s anatomy and digestive health needs.

Recovery timelines vary, but most patients return home the same day or after a short hospital stay.

Patients can generally expect:

  • Temporary dietary modifications
  • Gradual return to normal activities
  • Follow-up visits with their care team
  • Temporary medication adjustments

Your provider will give individualized guidance for activity, eating progression and recovery expectations.

Diet plays an important role in healing after cTIF.

Most patients transition through phases beginning with liquids and soft foods before gradually returning to regular meals. Your care team will provide detailed instructions based on your recovery progress.

Following dietary recommendations supports healing and helps protect the newly restored anti-reflux valve.

Many patients are able to reduce or eliminate reflux medications following treatment, but this varies from person to person.

Your provider will review medications during follow-up appointments and determine whether adjustments are appropriate based on symptoms and recovery.

If reflux symptoms return over time, your care team will perform additional evaluation to determine the cause.

Treatment options depend on factors such as anatomy, symptom severity and previous treatment history. In some cases, additional medical therapy or other interventions may be considered.

About this page:

About this page:

Content is written in plain language in collaboration with UC Health clinicians to reflect current evidence‑based care. If your plan differs from what’s described here, follow your care team’s instructions.

Page updated: 7/21/2026

Medical review by: Neha Wadhwa, MD &  Robert M. Van Haren, MD, MSPH

Read cTIF Patient Story Featuring Medical Reviewers
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