Pediatric Nissen Fundoplication

What is gastroesophageal reflux disease?

Gastroesophageal reflux disease (GERD) is a digestive disorder that affects the lower esophageal sphincter (the muscular ring connecting the esophagus with the stomach). The sphincter normally prevents food from moving out of the stomach and back up into the esophagus.

A Nissen fundoplication is a surgical procedure that corrects GERD by creating an improved valve mechanism at the bottom of the esophagus. It is meant to prevent the flow of acids upward. Depending on your child’s situation, this surgery may be performed laparoscopically, using a camera and several tiny incisions (cuts), or with an “open” technique, through a regular surgical incision in the skin. Sometimes a gastrostomy tube will also be placed in the stomach to allow for feeding after the surgery.

A gastric emptying study (GES) may be performed to determine if the stomach is emptying properly or if it is delayed. If delayed gastric emptying is found, a surgical procedure called a pyloroplasty may be necessary. This widens the muscular channel between the stomach and the small intestine, allowing the stomach to empty normally.

During the surgery

  • An anesthesiologist (a physician who specializes in sedation and pain relief) gives your child general anesthesia, which brings about sleep.
  • The surgeon makes the required incision(s) for the open or laparoscopic approach.
  • The surgeon wraps the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter so that food will not reflux back into the esophagus.
  • The surgery takes about two hours, with additional time for a gastrostomy and/or pyloroplasty.

After the surgery

  • Your child may be in the hospital for three to five days after the surgery.
  • Occasionally, a nasogastric (NG) tube will be placed through your child's nose and into the stomach.
  • An intravenous (IV) line will be placed in your child's arm or hand to deliver fluids until feedings are resumed. When your child begins to pass gas or has a bowel movement, his or her diet will gradually be advanced. This process usually takes a few days.
  • Pain medications will be given to your child as needed.
  • After your child has started eating again, has had a bowel movement, and is feeling more comfortable, he or she will be discharged from the hospital. If your child is using a gastrostomy tube for feedings, the feedings will be advanced to their desired rate before discharge.

Caring for your child after surgery

  • Usually, your child will be able to resume light activity within a few days of surgery. Your child should avoid heavy lifting and strenuous activity for three weeks after surgery.
  • Generally, children can return to school within a few days after being discharged from the hospital.
  • You may give your child a sponge bath the day after surgery. Tub baths are permitted four to five days after surgery.
  • The small pieces of tape covering your child's incisions (called steri-strips) will gradually fall off on their own. If the strips do not fall off on their own, your healthcare provider will remove them at your child's follow-up appointment.

When to call your child's healthcare provider

You may notice some minor swelling around the incision. This is normal. However, call your health care provider if your child has:

  • A fever
  • Excessive swelling
  • Redness
  • Bleeding
  • Increasing pain
  • Vomiting

Follow-up appointment

A follow-up appointment will be scheduled three to four weeks after your child's surgery. Your child's healthcare provider will check on the wound sites and his or her recovery.

References:

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This information is provided by the Cleveland Clinic 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. This document was last reviewed on: 11/22/2016...#4200