The large majority of patients that I see and treat are going to have both a hiatal hernia and reflux. And so most of those patients are going to undergo a combo hiatal hernia repair and TIF procedure. Typically the way that I perform hiatal hernia surgery is minimally invasive. I do a lot of robotic surgery. And som typically I repair a hiatal hernia robotically. What that means for a patients is there are going to be several small cuts in their abdomen for us to go internally. We're going to get things pulled back where they belong. Where the opening is, where stuff travels through, oftentimes needs to be narrowed down, typically with suture - to repair and reinforce that hernia. Once that portion of the procedure is complete we then will (with the scope) perform the TIF (the incisionless fundoplication). While they're still asleep, the scope will run down and we'll recreate that reflux valve to perform the TIF. Typically this procedure takes a couple hours for us to perform. And then, depending on how the patients feel when they wake up and recover, they may be able to go home same day. Worst case scenario, often times just an overnight stay. Changes in recovery process: so diet is one of the biggest things that we talk to folks about after surgery and after the procedure, because their diet will be modified. When we fix the hiatal hernia and perform the fundoplication, there's going to be some natural swelling and tightness in that area that occurs. And so, we'll start them on a very regimented diet. Typically, with very thin, what we call clear liquids, for several days. And then we'll advance to a little bit thicker consistency liquids for about 2 weeks. They will see me back during that timeframe and we'll check in on how they're doing and how their symptoms are and how they're tolerating their diet. And then we'll begin to very slowly advance back all the way to being able to eat the large majority of their normal diet. It's one of the great benefits in my opinion of the TIF procedure is that patients are able to eat more normally than in comparison to traditional fundoplications. They have less symptoms of difficulty swallowing, what we call dysphagia. They also have less problems with filling bloated because gas or air can get trapped if it can't come out. Patients do really well in comparison to the fundoplication procedures that are traditionally done surgically. Oftentimes that's about a 4-6 week process for patients to go through with their diet advancement. At the same time when they're recovering from their hiatal hernia, they'll be on some activity restrictions because we don't want that hernia to recur. We want to give time for things to heal and be strong so that they don't have this occur again. Typically, we'll have some weight restrictions on things that they can lift, various activities that we'll have them avoid during that same time period as well.
