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Anti-reflux surgery - children

Contents of this page:

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

Definition    Return to top

Anti-reflux surgery is surgery to repair 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 repair a hiatal hernia.

Description    Return to top

A procedure called fundoplication is the most common type of anti-reflux surgery. Your child will be under general anesthesia during surgery. This will make your child unconscious and unable to feel pain. This surgery usually takes 2 to 3 hours.

Ways the doctor may do this surgery are:

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    Return to top

GERD is a condition that causes food or stomach acid to come back up from the stomach into the esophagus. This is called reflux. It can cause heartburn and other uncomfortable symptoms. Reflux occurs if the muscles where the esophagus meets the stomach do not close tightly enough.

A hiatal hernia occurs when the natural opening in the diaphragm is too large. The diaphragm is the muscle layer between the chest and belly. Your child’s stomach may bulge through this large hole into their chest. This bulging is called a hiatal hernia. It may make GERD symptoms worse.

Surgery is usually done to treat GERD in children only after medicines have not worked or problems develop. Your child’s doctor may suggest surgery when:

Risks    Return to top

Risks for any anesthesia are:

Risks for any surgery are:

Risks for this surgery are:

Before the Procedure    Return to top

Always tell your child’s doctor or nurse if your child is taking any drugs, supplements, or herbs you bought without a prescription.

A week before surgery, you may be asked to stop giving your child medicine and supplements that affect blood clotting. Some of these are aspirin, ibuprofen (Advil, Motrin), vitamin E, and warfarin (Coumadin).

On the day of your child’s surgery:

After the Procedure    Return to top

Children who have laparoscopic surgery usually spend 2 to 3 days in the hospital. Children who have open surgery may spend 2 to 6 days in the hospital.

Usually 1 to 2 days after surgery, your child can start eating again. Usually your child will be given just liquids at first.

If your child had a g-tube placed during surgery, it can be used for feeding and venting. Venting is when the g-tube is opened to release air from the stomach, similar to burping.

If your child did not have a g-tube placed, they may have a tube that goes from the nose to their stomach to help release gas. This tube will be 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 (poop), and are feeling better.

Outlook (Prognosis)    Return to top

Anti-reflux surgery repair is a safe operation. Heartburn and other symptoms should improve after surgery. But, your child may still need to take drugs 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.

References    Return to top

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.

Orenstein S, Peters J, Khan S, Youssef N, Hussain SZ. Gastroesophageal reflux disease (GERD). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 320.

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.

Update Date: 3/6/2009

Updated by: George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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