A fundoplication is a surgical procedure in which the upper part of the stomach is wrapped around the lower part of the esophagus. This prevents the reflux of stomach contents into the esophagus and out of a child's mouth.
This surgery is usually only done for children with acid reflux who have not responded to medical treatments, including acid reducers, positioning (staying upright after meals and/or using a Tucker Sling), and eating frequent and small meals, etc.
These children continue to have severe reflux symptoms, such as:
- Poor weight gain or weight loss
- Choking epidsodes or recurrent pneumonia
- Frequent irritability and trouble sleeping
A pediatric surgeon and a pediatric gastroenterologist can help to determine if your child needs a fundoplication.
What is a fundoplication?
A fundoplication is an operation used to treat gastroesophageal reflux (GER). During fundoplication, the surgeon wraps the upper part of the stomach — called the fundus — around the lower esophagus to narrow the esophagus.
Why is fundoplication necessary?
Fundoplication is recommended for children who have complications or persistent symptoms related to gastroesophageal reflux (GER) that are not improved by medication. Symptoms of gastroesophageal reflux include vomiting, esophagitis (heart burn) gastroesophageal stricture, recurrent pneumonia, breathing problems, and inadequate growth. Before an operation is performed your child may have one or more tests confirming GER, such as a pH probe study or esophogram.
When to call your child's health care provider
You may notice some minor swelling around the incision. This is normal. However, call your health care provider if your child has:
- A fever
- Excessive swelling
- Increasing pain
How is a fundoplication performed?
Fundoplication is performed in two to three hours with a two to three day hospital stay following surgery. Postoperative, during your child's hospitalization, he/she will receive intravenous fluids and pain medication. As soon as your child feels well enough he/ she will be allowed to eat, drink and take pain medication by mouth (usually 1-2 days after surgery). In some patients a gastrostomy tube is placed into the stomach to allow feedings to be administered and air to be released.
Air release is called "venting". It may be hard for your child to burp for many weeks after a fundoplication. Venting allows air to leave the stomach, which decreases bloating and keeps your child comfortable. During your child's hospital stay, the bedside nurse will teach you how to vent, care for and use the gastrostomy tube.
In most fundoplication operations, there is very little blood loss. You child will receive blood only in the rare case of an extreme emergency. If you wish to provide a directed donation of blood, contact our office, 1-2 weeks in advance of the operation.
- Your child's esophagus, stomach, liver, bowel, blood vessels, or nerves may get injured while having the surgery. This may cause him to lose a large amount of blood and need more surgery. He could have trouble breathing or get an infection during or after surgery. His stomach may be wrapped to his esophagus too tightly or loosely. He may have trouble swallowing, and bloating (stomach swelling) may occur. Even after having this surgery, your child's signs and symptoms may come back or become worse.
- Without treatment, your child's symptoms of GERD may keep on and get worse. The lining of his esophagus may be damaged and cause ulcers (sores) to form. These may heal into scars that can make his esophagus narrower. When this happens, your child may have sudden severe (very bad) chest pain and trouble eating. In infants, severe GERD can cause their breathing to stop, or heart rate to slow. Damage to the esophagus may lead to serious medical problems. Ask your child's caregiver if you are worried or have questions about your child's surgery, medicine, or care.
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