Fundoplication
What is a fundoplication?
Who needs this operation?
About the operation
After the operation
Pain after the operation
Eating after the operation
Caring for your child at home
When to call the doctor
What is a fundoplication?
A fundoplication is an operation used to treat gastroesophageal reflux (GER). During fundoplication, the surgeon wraps the upper part of the stomach — called the fundus — around the lower esophagus to narrow the esophagus.
Who needs this operation?
The lower esophagus normally narrows to keep swallowed food and liquids in the stomach, but in children with severe GER, it's not narrow enough, so food comes up from the stomach up into the esophagus.
If your child has GER, her doctor will try to treat it first with thickened feedings, upright positioning after feedings and medications, but if those treatments fail, he may recommend fundoplication.
About the operation
Once your child is asleep and in the operating room, the surgeon will place a nasogastric (NG) tube through your child's nose and into his stomach to serve as a guide for wrapping the fundus around the esophagus. The surgeon makes an incision in your child's abdomen, then wraps the fundus around the lower part of the esophagus and stitches it in place. This procedure may be done open, through an incision, or laparscopically.
The surgeon may also place a gastrostomy tube — also called a "G-tube" at the same time. This tube, which is placed directly into the stomach through the abdominal incision, helps vent or "burp" air from the stomach, since the fundoplication may prevent air from escaping through the normal route — the mouth. Some infants and children may also need the gastrostomy tube for feedings.
After the operation
After your child's surgery is over, she'll go first to a recovery room, then to a regular hospital room — or, if she has other medical problems — to the intensive care unit. Older children will be out of bed the evening of the operation. Activity will help prevent respiratory (breathing) problems and help get her stomach and intestines working again.
The incisions may be covered with STERI-STRIPS, or temporary glue called DERMABOND. These strips stay in place until they fall off, or you can remove them when the edges start curling up and lifting up. Your child's stitches will dissolve under the skin.
Children are usually in the hospital about three to five days. Infants, as well as children with other medical conditions, may need to be in the hospital longer.
Pain after the operation
Your child will get pain medicine through an intravenous (IV) line. Once your child is tolerating feedings by mouth or through the G-tube, he'll get his pain medications that way, too.
Eating after the operation
The anesthesia your child received for surgery temporarily puts her bowel "to sleep," so at first, she'll get her necessary hydration (salts, sugars and fluids) from the IV.
Babies and children with a gastrostomy tube will have the G-tube to gravity to drain excess fluids from the stomach. The following day, the surgical dietician will work with you to establish a feeding regimen that works well for your child.
Older children without a gastrostomy tube may start to drink clear liquids the day after surgery. If tolerated, your child will advance to a soft, slippery diet for the first four weeks until you are seen by your child’s surgeon.
Once your child passes gas or stool, and the NG tube drainage decreases or turns clear, the NG will be removed. At this point, older children will start taking in liquids first, then solids. Babies with a G-tube and a J-tube will get feedings first through the J-tube, then will gradually be switched to the G-tube. Once a baby is getting all her feedings through the G-tube, the J-tube will be removed.
Caring for your child at home
Before your child leaves the hospital, the staff will show you how to vent the G-tube and give him tube feedings. You'll also have a home care nurse who will review the procedures with you once your child is home.
While the surgery will prevent reflux, your child may still gag during the first few weeks after surgery. If your child is a baby, venting the G-tube during gagging episodes may help. If your child is older, encourage him to eat smaller, more frequent meals — and eat them slowly.
Children should stay out of school for a few days after coming home from the hospital, and don't allow them to participate in physical education classes or sports until after the postoperative follow-up visit.
When to call the doctor
Be sure to call your child's doctor (at Children's Hospital, you should call 215-590-2730) if:
- Your child:
- Shows any signs of infection, including redness, swelling or green or yellow discharge from the incision
- Is gagging a lot
- Not tolerating feed
- Has any difficulty swallowing
- Is vomiting
- Has a fever greater than 101 degrees F under the arm or 102 degrees F rectally
- The G-tube comes out
- Your child's belly becomes very swollen, even after you've vented the G tube
- You have any questions or concerns
Reviewed by: Surgical Advanced Practice Nurses
Date: November 2008
Contact Us
- 215-590-2730
