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Pediatric Laparoscopic Nissen Fundoplication

WHAT YOU NEED TO 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.

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. It may also be used to give liquids, food, and medicine to your child after surgery.

During your child's surgery:

  • Your child is placed on his back or in a semi-sitting position with his legs bent. His chest and abdomen are cleaned with soap and water. A small incision (cut) is made above your child's belly button to put the laparoscope through. Caregivers insert tools through 4 or more smaller incisions going into his abdomen. Your child's abdomen is filled with a gas (carbon dioxide) to make it swell. This lifts the abdominal wall away from his internal organs to give caregivers more space to work in.
  • Caregivers move other body organs, such as the liver and diaphragm, out of the way. The table where your child lies is tilted to raise his head and upper body. The upper part of your child's stomach is loosened from his abdomen. A special tube is placed from your child's mouth into his stomach to hold his esophagus open. The upper part of your child's stomach is wrapped around his esophagus, and stitched in place. Caregivers remove the tube holding your child's esophagus open, and a gastrostomy tube may be placed. The gas inside your child's abdomen is released. The incisions are closed with stitches or surgical tapes and covered with bandages.

After your child's surgery:

Your child is taken to a room until he is fully awake. Caregivers 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.

  • Diet:
    • Your child may be able to eat when bowel sounds (stomach growling) are heard. Your child's caregiver will listen to his abdomen using a stethoscope. Water or liquids are usually given a few hours after the surgery. Milk may be given 12 to 15 hours after. If your child does not have problems after drinking liquids, caregivers may let him eat soft foods. Some examples of soft foods are puddings, applesauce, and mashed potatoes.
    • Your child may have a gastrostomy tube. Ask caregivers 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.

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.

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.

© 2015 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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