Pediatric Laparoscopic Nissen Fundoplication

What you should know

A laparoscopic Nissen fundoplication is surgery to treat your child's gastroesophageal reflux disease (GERD). During this surgery, the top part of your child's stomach is wrapped around the lower part of his esophagus. This prevents stomach acid from moving up into your child's esophagus.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

Risks

  • Problems may happen during your child's laparoscopic surgery that may lead to an open surgery. Your child's esophagus, stomach, liver, bowel, blood vessels, or nerves may be hurt during the surgery. This may cause bleeding and a large amount of blood loss. He could also have trouble breathing or an infection during or after surgery. His stomach may be wrapped to his esophagus too tightly or loosely. He may have trouble swallowing, and his stomach may swell. Even after he has this surgery, your child's signs and symptoms may come back or get worse.

  • Without treatment, your child's symptoms of GERD may continue and worsen. 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 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 have questions about your child's surgery, medicine, or care.

Getting Ready

The week before your child's surgery:

  • If your child is staying in the hospital after his surgery, pack the things that he will need. These include his clothes, toothbrush, feeding supplies, and toys.

  • Your child's caregiver may ask that you give him antibiotic medicine. This medicine prevents and treats infection.

  • Your child may need to have a barium swallow, esophageal pH monitoring, esophagoscopy, or upper gastrointestinal (GI) series. He may also need a 12-lead echocardiography (ECG), chest x-ray, and blood tests. Ask your child's caregiver for more information about these tests. Write down the date, time, and location of each test.

The night before your child's surgery:

  • Your child's caregiver may ask you to give him medicine to help him sleep.

  • Ask caregivers about directions for eating and drinking.

The day of your child's surgery:

  • Write down the date, time, and location of your child's surgery.

  • Ask your child's caregiver before giving any medicine on the day of your child's surgery. Bring all the medicines your child is taking, including the pill bottles, to the hospital.

  • Dress your child in loose, comfortable clothing. Have him wear socks to help him stay warm.

  • Caregivers will insert an intravenous tube (IV) into your child's vein. A vein in the arm is usually chosen. Through the IV tube, he may be given liquids and medicine.

  • An anesthesiologist may talk to you before your child's surgery. This caregiver may give your child medicine to make him sleepy before surgery.

  • You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your child's caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

  • Your child will be taken to the operating room. His chest and abdomen will be cleaned with soap and water. Caregivers may give him general anesthesia to keep him asleep during surgery. Small incisions (cuts) will be made into your child's abdomen. The laparoscope and other tools will be put into these incisions.

  • Using the tools, caregivers will free the upper part of your child's stomach from other structures attached to it. The upper part of your child's stomach will be wrapped around his esophagus and secured in place. A tube may be put through your child's abdomen and into his stomach to feed him through. The incisions are closed with stitches or surgical tapes and covered with bandages.

After your child's surgery:

Your child will be taken to a room until he is fully awake. Caregivers will watch him closely for any problems. You may be able to come in and sit with your child. Do not let your child get out of bed until his caregiver says it is OK. When caregivers see that your child is OK, he will be taken back to his hospital room.

Waiting area:

This is an area where family and friends can wait until your child is able to have visitors. Leave a phone number or other means of contact where you can be reached if you leave the area.

Contact a caregiver if

  • You cannot make it to your child's surgery on time.

  • Your child is irritable and crying more than usual.

Seek Care Immediately if

  • Your child has a fever.

  • Your child has trouble breathing.

  • Your child is not able to eat or drink.

  • Your child has sudden severe chest pain.

  • Your child's signs and symptoms are getting worse.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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