Nissen fundoplication is a surgical procedure done to correct gastroesophageal reflux. Reflux occurs when stomach contents back up into the esophagus. The esophagus is the tube that connects the mouth to the stomach.
Your child's physician may recommend this operation if your child’s reflux symptoms do not improve with medicine and:
- he is not gaining weight due to vomiting
- he has frequent breathing problems
- reflux has caused severe, painful irritation in your child's esophagus
How does this procedure correct reflux?
The Nissen fundoplication is a 360-degree wrap of the top section of the stomach around the esophagus. This creates an area of high pressure that acts as a one-way valve. After the surgery, food and liquids should be able to easily pass down through the valve into the stomach, but should be less likely to back up into the esophagus.
Usually one incision is made in the middle of the abdomen for this operation. Sometimes the surgery can be done through a laparoscope. The way the procedure is done depends on your child's diagnosis, age, weight, and body shape.
If a laparoscope is used, several small incisions are made in the abdomen. A camera on the end of a small tube is placed through one of the small incisions. The surgeon can look on a video monitor to see the stomach and other organs while he operates. The surgeon places small surgical tools through the other incisions to perform the operation.
Many children who require this surgery also need to have a tract created from their skin into their stomachs during surgery. The tract is called a gastrostomy. The gastrostomy provides direct access to the stomach for tube feedings and to allow excess air to be released. The gastrostomy tract provides protection for the wrap as your child heals. Your child's nurse will give you other patient education handouts if your child has a gastrostomy.
What should we expect after surgery
The usual hospital stay for this procedure is 3-5 days after surgery. Usually a tube is placed down the nose into the stomach in the operating room, to keep the stomach empty for 24 - 48 hours after surgery. When the bowel begins to wake up again, usually 2-3 days after surgery, your child will receive a clear liquid diet.
The surgeon and nurses will work with you and your child to minimize the pain after the procedure. Your nurses will explain our pain scales and how you can help us keep your child's pain under control.
What should I expect when my child goes home
There is a moderate amount of swelling around the esophagus after this surgery. It may make it difficult for your child to eat or drink his regular diet for awhile. Provide plenty of liquids for your child to drink. If he eats solid food, start with soft easy-to-swallow foods at first and offer foods of his regular diet a little at a time.
If your child received a gastrostomy tube, his surgeon will let you know if he needs to continue to receive tube feedings at home.
Some children need to continue taking their reflux medications after the surgery. Your child's surgeon will give you a list of all the medications you need to use at home when your child is discharged from the hospital.
When should I call my child's surgeon?
- Your child has a fever of 101.50 Fahrenheit or greater
- The incision is red, swollen or has cloudy or foul-smelling drainage
- Your child vomits
- Your child has a gastrostomy tube and it comes out
- Your child continues to have pain even though you gave him the ordered medication
- If you have any questions or concerns
If your child had a gastrostomy tube placed at the time of surgery he needs to be seen in the G-Tube clinic in approximately 2 weeks.
If your child did not have a gastrostomy tube placed, he needs to see his surgeon in 2-3 weeks.
Please schedule follow-up appointments before your child is discharged from the hospital. The phone number is 668-7703 to schedule either type of follow-up appointment for your child.
This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.