Anti-reflux surgery - children

Alternative Names: Fundoplication - children; Nissen fundoplication - children; Belsey (Mark IV) fundoplication - children; Toupet fundoplication - children; Thal fundoplication - children; Hiatal hernia repair - children; Endoluminal fundoplication - children

Anti-reflux surgery is surgery to tighten the muscles at the bottom of the esophagus (the tube that carries food from the mouth to the stomach). Problems with these muscles can lead to gastroesophageal reflux disease (GERD).

This surgery can also be done during a hiatal hernia repair.

This article discusses anti-reflux surgery repair in children.

Description of Procedure

The most common type of anti-reflux surgery is called fundoplication. This surgery usually takes 2 to 3 hours.

Your child will be give general anesthesia before the surgery. That means the child will be asleep and unable to feel pain during the procedure.

The surgeon will use stitches to wrap the upper part of your child's stomach around the end of the esophagus. This helps prevent stomach acid and food from flowing back up.

A gastrostomy tube (g-tube) may be put in place if your child has had swallowing or feeding problems. This tube helps with feeding and releases air from your child's stomach.

Another surgery, called pyloroplasty may also be done. This surgery widens the opening between the stomach and small intestine so the stomach can empty faster.

This surgery may be done several ways, including:

• Open repair: The surgeon will make a large cut in the child's belly area (abdomen).
• Laparoscopic repair: The surgeon will make 3 to 5 small cuts in the belly. A thin, hollow tube with a tiny camera on the end (a laparoscope) is placed through one of these cuts. Other tools are passed through the other surgical cuts.

The surgeon may need to switch to an open procedure if there is bleeding, a lot of scar tissue from earlier surgeries, or if the child is very overweight.

Endoluminal fundoplication is similar to a laparoscopic repair, but the surgeon reaches the stomach by going through the mouth. Small clips are used to tighten the connection between the stomach and esophagus.

Risks of Anti-reflux surgery - children

Anti-reflux surgery risks include:

• Damage to the stomach, esophagus, liver, or small intestine. This is very rare.
• Gas and bloating that makes it hard to burp or throw up. Most of the time, these symptoms slowly get better.
• Gagging.
• Painful, difficult swallowing , called dysphagia. For most children, this goes away in the first 3 months after surgery.
• Rarely, breathing or lung problems, such as a collapsed lung.

Risks for anesthesia include:

• Reactions to medicines
• Breathing problems, including pneumonia
• Heart problems

Risks for any surgery include:

• Bleeding
• Infection

Review Date: 3/17/2011
Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Department of Pediatric Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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