Anti-reflux surgery - children

Definition

Anti-reflux surgery is surgery to repair 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 repair a hiatal hernia.

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

Description

A procedure called fundoplication is the most common type of anti-reflux surgery. Your child will be under general anesthesia during surgery. This will make your child unconscious and unable to feel pain. This surgery usually takes 2 to 3 hours.

• During this surgery, 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 g-tube (gastrostomy tube) may be placed to help with feeding and to release air from your child's stomach. The surgeon may use a g-tube if your child has had swallowing or feeding problems.
• The surgeon may do another procedure called a pyloroplasty. This procedure widens the opening between the stomach and small intestine so that the stomach can empty faster.

Ways the doctor may do this surgery are:

• Open repair. The surgeon will make a large incision (cut) in your child's belly area (abdomen).
• Laparoscopic repair. The surgeon will make 3 to 5 small incisions in the belly. The surgeon will insert a laparoscope (a thin, hollow tube with a tiny camera on the end) through one of these incisions and other tools through the other incisions. 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

Risks for any anesthesia are:

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

Risks for any surgery are:

• Bleeding
• Infection

Risks for this surgery are:

• Gas bloat, which makes it hard to burp or throw up. It also causes bloating after meals. These symptoms slowly get better for most people.
• Pain and difficulty swallowing, called dysphagia. For most children, this goes away in the first 3 months after surgery.
• Gagging, gas, and bloating
• Damage to the stomach, esophagus, liver, or small intestine. This is very rare.
• Breathing or lung problems, such as a collapsed lung. This is also rare.
• The repair may be too loose. This makes the surgery ineffective.