Q: What do you think of the TIF (transoral incisionless fundoplication) procedure for relieving persistent gastroesophageal reflux disease? I've been on a double dose of proton pump inhibitors and have made lifestyle/diet changes. My symptoms, including hoarseness, sore throat and a sour taste in the back of my throat, are not improving. I'm 56 and never had heartburn until two years ago. — Fred G., St. Louis
A: The TIF procedure is well-accepted, and positive study results continue to support it. As the name implies, the procedure is through the mouth (transoral) and no laparoscope or other tools are used that puncture the skin (incisionless). This reduces the risk of infection and shortens recovery time.
GERD happens when stomach acid enters the esophagus because the door between the stomach and the esophagus — the lower esophageal sphincter or LES — won't shut all the way. The TIF procedure uses a device called the EsophyX to fasten together reformed and refolded tissue, so that you have a solid anti-reflux door, and GERD goes away. Open and laparoscopic surgical procedures are very effective, but they are more invasive and expensive. The results of the TIF procedure seem to be the same, if not better.
The procedure takes an hour or two, requires anesthesia, then there's a day in the hospital, and you'll be back at work a day or two after that. However, not all patients with medically resistant GERD are candidates for TIF. So go get checked out by a specialist and see if you qualify for the procedure. Most people who do can say goodbye to antacids and hello to garlic!
Q: I heard that sepsis is the No. 1 cause of hospital deaths. I'm headed in for a hernia operation. What is sepsis, and what are my chances of contracting it? Am I better off in an outpatient surgical center? — Tim J., Lafayette, Ind.
A: Even though most people have never heard of this condition, sepsis is the top cause of hospital mortalities. But you can catch it anywhere.
It's estimated there are about 1 million cases of sepsis annually in North America, resulting in 300,000 deaths. Worldwide, it accounts for 10 million deaths every year.
Sepsis (sometimes called systemic inflammatory response syndrome, or SIRS) strikes when the immune system becomes hyperstimulated as it fights an infection. This causes widespread inflammation that triggers formation of microscopic blood clots. This clotting can reduce blood and oxygen flow, and can cause vital organs to fail. Even though sepsis usually happens in reaction to a bacterial infection, it also can be triggered by a viral, parasitic or fungal infection.
People who have a weakened immune system, children, the elderly, people who are obese and those being treated for chronic conditions like type 2 diabetes, kidney disease and asthma are most at risk. In any case, your chances of developing sepsis are slim, but when people do, it is usually because of less-than-perfect sanitary conditions.
The most common sites of hospital-borne infections (that lead to sepsis) include intravenous lines, surgical openings (incisions and drains) and anywhere else the skin is compromised, as it is when bedsores develop.
Beating sepsis starts with a quick diagnosis and treatment, usually with IV antibiotics and fluids. Make no mistake; it is a medical emergency.
The best way to avoid getting sepsis? Get vaccinated against many of the infectious diseases that can cause sepsis or make it worse, such as pneumonia. And make sure when you're in the hospital your visitors and all health-care providers who come near you wash their hands with sanitizer before they touch you or any medical equipment.
Bonus tip: A surgical center may have fewer of the very bad germs hanging around. We almost always favor a lower-intensity site for many simple procedures, as long as the surgeon has admitting privileges to a high-powered center (a really good hospital) if something doesn't go just right.