Anti-reflux surgery - children

Definition

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.

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

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:

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.

Why the Procedure Is Performed

Anti-reflux surgery is usually done to treat GERD in children only after medicines have not worked or complications develop. Your child's doctor may suggest anti-reflux surgery when:

Risks

Anti-reflux surgery risks include:

Risks for anesthesia include:

Risks for any surgery include:

Before the Procedure

Always make sure your child's health care team knows about all the medicines and supplements your child is taking, including those you bought without a prescription.

A week before surgery, you may be asked to stop giving your child any products that affect blood clotting. This may include aspirin, ibuprofen (Advil, Motrin), vitamin E, and warfarin (Coumadin).

Your child's doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

How long your child stays in the hospital depends on how the surgery was done.

Your child can start eating again about 1 to 2 days after surgery. Liquids are usually given first.

Some children have a g-tube placed during surgery. This tube can be used for liquid feedings, or to release gas from the stomach.

If your child did not have a g-tube placed, a tube may be inserted through the nose to the stomach to help release gas. This tube is removed once your child starts eating again.

Your child will be able to go home once they are eating food, have had a bowel movement and are feeling better.

Outlook (Prognosis)

Heartburn and related symptoms should improve after anti-reflux surgery. However, your child may still need to take medications for heartburn after surgery.

Some children will need another operation in the future to treat new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the esophagus too tightly or it loosens.

The surgery may not be successful if the repair was too loose.

References

Brant K. Oelschlager BK, Eubanks TR, Pellegrini CA. Hiatal Hernia and Gastroesophageal Reflux Disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 42.

Khan S, Orenstein S. Gastroesophageal reflux disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 315.

Lobe TE. The current role of laparoscopic surgery for gastroesophageal reflux disease in infants and children. Surg Endosc. 2007 Feb;21(2):167-74.

Saedon M, Gourgiotis S, Germanos S. Is there a changing trend in surgical management of gastroesophageal reflux disease in children? World J Gastroenterol. 2007 Sep 7;13(33):4417-22.