Gastroesophageal Reflux and FundoplicationWhat is gastroesophageal reflux or GER?Gastroesophageal reflux (GER) is the movement of food and acid from the stomach back into the esophagus. Gastroesophageal reflux disease (GER) is a common cause of failure to thrive in infants and vomiting in children. Newborns with GER may present as a fussy, colicky infant and may burp up or vomit frequently. These symptoms may be relieved by elevating the infant's head after feedings or by thickening the formula. It is normal for newborns to have some reflux and most outgrow reflux by 6-8 months of age. Children with GER often complain of pain or burning in the chest or upper abdomen, gagging, or vomiting. Many children with reflux can be treated with medication to reduce acid and improve stomach emptying. There are some children whose reflux is significant enough to interfere with growth or cause frequent severe respiratory infection. For children with significant reflux who are not responsive to medication, surgical treatment of the reflux is usually recommended. This anti-reflux procedure is called a gastric fundoplication. How is a fundoplication done?Fundoplication is done under a general anesthesia. The procedure can be done either laparoscopically or open. If the surgeon uses a laparoscope there will be 4-5 small incisions (less than ? inch) on the abdomen. If the surgeon uses an open technique there will be one much larger incision (3-4 inches). During the procedure the fundus or upper portion of the stomach is brought around the esophagus from behind and then sutured to create a wrap, like a collar fits around a neck. This wrap works like a valve on the esophagus to keep stomach contents from flowing back into the esophagus. In infants and children with feeding or growth problems, a gastrostomy tube will also be placed during this same procedure. The gastrostomy tube can be used for feeding, fluids, medications, and venting or burping.
How long is the hospital stay after surgery?Most children are in the hospital 2-3 days after surgery. If your child has a gastrostomy tube you will be instructed in the care and use during your hospital stay. Will there be much discomfort?Children are usually most uncomfortable in the first 24-48 hours after surgery. Intravenous medications may be used for pain control during that time. Most children are able to switch to oral pain medications in 24 hours. The abdomen may be generally sore for up to one week after surgery. Initially some patients report tightness in their chest. It feels difficult or impossible to burp. It may occasionally feel as though food is not passing through the wrap. There may be some discomfort with gas bloating and the stomach may feel tight and hard. It may take as long as four weeks for the swelling to decrease after surgery and for these feelings to subside. Are there diet restrictions after surgery?A full liquid or soft diet is usually recommended for a minimum of two weeks after surgery. The child's diet may then be slowly advanced to include more textured foods. The following dietary changes may help decrease discomfort in the first 2-4 weeks after surgery:
Are there activity restrictions after surgery?After surgery the child should not participate in vigorous physical activity or heavy lifting for 1-2 weeks. Are there bathing restrictions after surgery?Incisions should be kept clean and dry for 48 hours after surgery. After that time the child may shower or sponge bathe and pat the incisions dry. One week after surgery or when the incisions appear well healed the child may bathe or swim. When should we call the surgeon?
If you have a problem or question during regular business hours call our office directly. Office Hours: Monday-Friday 8am-4pm Office Phone: (734) 764-4151 EMERGENCY NUMBER: (734) 936-6267, ASK FOR THE PEDIATRIC SURGEON ON-CALL This information is provided by the University of Michigan Department of Surgery, Section of Pediatric Surgery and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider or our offices. |
