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Open Pediatric Nissen Fundoplication
WHAT YOU NEED TO KNOW:
An open 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 helps prevent stomach acid from moving up into his esophagus.
WHILE YOU ARE HERE:
Before your child's surgery:
- Informed consent is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.
- Emotional support: Stay with your child for comfort and support as often as possible while he is in the hospital. Ask another family member or someone close to the family to stay with your child when you cannot be there. Bring items from home that will comfort your child, such as a favorite blanket or toy.
- An IV is a small tube placed in your child's vein that is used to give him medicine or liquids.
- Preoperative care: Medicine may be given to help your child relax. Your child will be taken to the room where the procedure or surgery will be done.
- General anesthesia will keep your child asleep and free from pain during surgery. Anesthesia may be given through your child's IV. He may instead breathe it in through a mask or a tube placed down his throat. The tube may cause your child to have a sore throat when he wakes up.
- Nasogastric or orogastric tube: A nasogastric (NG) or orogastric (OG) tube may be put through your child's nose or mouth and down into his stomach. This tube keeps air and fluid out of his stomach during surgery.
During your child's surgery:
- Your child is placed on his back. His chest and abdomen are cleaned with soap and water. An incision may be made from the center of his upper abdomen to the belly button. The incision could be made across your child's abdomen, instead of up and down. The table where your child lies is tilted to raise his head and upper body, which moves his stomach and bowels lower.
- The upper part of your child's stomach is loosened from its place in his abdomen. A tube is placed from your child's mouth into his stomach to hold his esophagus open. The upper part of his stomach is wrapped around the esophagus and stitched in place. Healthcare providers remove the tube holding your child's esophagus open, and a gastrostomy tube may be placed. This tube is used to give liquids, food, or medicine. It may also be used to let air or fluids out of your child's stomach. The incision is closed with stitches or surgical staples or tapes and covered with a bandage.
After your child's surgery:
Your child is taken to a room until he is fully awake. Healthcare providers watch him closely for any problems. You may be able to come in and sit with your child. When healthcare providers see that your child is OK, he will be taken back to his hospital room.
- Activity: Your child's healthcare provider will tell you when it is OK for your child to get out of bed. Call his healthcare provider before letting him get out of bed for the first time. If he ever feels or looks weak, have him lie down right away and call your child's healthcare provider.
- Your child may be able to eat when bowel sounds (stomach growling) are heard. Your child's healthcare provider will listen to his abdomen for bowel sounds using a stethoscope. Water or liquids are given first. If your child does not have problems after drinking liquids, healthcare providers may then let him eat soft foods. Some examples of soft foods are puddings, applesauce, and mashed potatoes.
- Your child may need to have a gastrostomy tube. Ask healthcare providers to teach you how to care for your child's gastrostomy tube.
- Medicines: Your child may need any of the following:
- Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.
- Anti-nausea medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after surgery or taking pain medication.
- Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse. To prevent falls, stay with your child to help him get out of bed.
- Vital signs: Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.
- Your child's esophagus, stomach, liver, bowel, blood vessels, or nerves may get injured during 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 surgery, your child's signs and symptoms may come back or become worse.
- Without treatment, your child's symptoms may continue and get worse. The lining of his esophagus may be damaged and cause ulcers 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 healthcare provider if you have questions about your child's surgery, medicine, or care.
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.
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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.