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tiff transoral incisionless funduplication is an incisionless surgical procedure that reconstructs the bodys natural physical barrier to reflux inserted through the mouth the esophax device is used to construct a durable anti-reflux valve reestablishing a natural barrier to reflux tiff is surgery without incisions or the complications associated with more invasive surgical procedures tiff is performed under constant visualization by the surgeon while the patient is under general anesthesia the esophagus device riding over the endoscope is gently glided down through the patients mouth into the stomach the stomach is inflated and the endoscope is advanced and turned so that it is looking up at the entrance to the stomach this is where the anti-reflux valve will be created the tissue mold is then advanced into the stomach the tissue retractor is engaged at the z line a line that marks where the esophagus and stomach come together the tissue is retracted into the tissue mold some patient