Fundoplication

What is GORD (gastroesophageal reflux disease)?

This is a medical condition where the content of the stomach (food, drink and acid) move back to the oesophagus (gullet). It is usually treated by medicines (anti-acids) but sometimes the if the symptoms persist, surgery is needed.

What are the symptoms of GERD?

Symptoms of gastroesophageal reflux include:

• being sick
• pain and heart burn
• inflammation of the oesophagus
• narrowing of the oesophagus (stricture)
• chest infections
• breathing problems
• inadequate growth

There can be damage to the teeth from the stomach acid, a bad taste in the mouth and bad breath.

What is fundoplication?

Fundoplication is an operation used to treat reflux by creating a valve at the top of the stomach. This stops the stomach contents from traveling back to the oesophagus. The stomach is used to make the valve (called a wrap) around the lower part of the oesophagus. After surgery food can go down to the stomach but not up again.

More about the surgery

In our hospital most of the fundoplications are done using keyhole (laparoscopic) surgery and your child will end up with 4 or 5 small cuts in their tummy. For this surgery your baby needs to have general anaesthesia.

Sometimes we do a complete valve wrap (called a Nissen fundoplication).

Nissen fundoplication

Sometimes we make a partial valve wrap (called a Toupet fundoplication).

Toupet fundoplication

Sometimes we find that the stomach has a tendency to slip up into the chest (called a hiatus hernia) and we repair this at the same time. The surgery takes between 2 to 3 hours and your child will need to stay for few days in hospital after that.

What are the complications of fundoplication?

• Bleeding and infection can happen with any operation, but they are low risks.
• The most common problem afterwards is difficulty swallowing due to the valve. This gets better with time. We will start your child on a soft diet for 2 weeks and then you can introduce more solid food after this. Usually swallowing is back to normal after 2 to 3 months but in some people, it can take longer or never back to normal.
• It is also quite common to bring back undigested food that gets stuck on the valve. This again gets better with time. Some people worry that this is the sick or reflux coming back but it is different and not usually a cause for concern.
• Trapped wind can happen because it is harder to burp after the operation.
• The stomach will be smaller after the operation and most people eat smaller amounts but more often to make up for this. Over time the stomach should stretch back to its usual size.
• The valve can become loose over time and the reflux can come back.
• The stomach can slip back up into the chest and this can also cause the reflux to come back.
• Some children keep on trying to be sick even after the fundoplication which can cause retching or gipping.
• Sometimes the keyhole surgery is not suitable for your child and the surgeon might decide to do a conventional operation with a larger cut.
• Very rarely the keyhole surgery may cause damage to the bowel, liver, spleen or other organs inside the tummy.

Feeding after surgery

The first 2 weeks

After the operation it is best to offer liquids or soft diet only. Avoid fizzy drinks. These increase gas in the stomach, which can be painful.

Suggested diet

Liquids include water, juice, milk, milkshakes, ice cream, jelly, pudding, and pureed soups, pureed baby food and yogurt. Soft foods include mashed potatoes, pasta, rice and bread, fish, crackers, cereal, ground beef, cheese, and peanut butter.

After 2 weeks

If eating goes well, your child can slowly resume their usual diet with some exceptions.

Your child may eat most foods, but some can get stuck in your child’s throat, and may not get down into their stomach. These include:

• sausages
• steak
• chicken
• bread
• nuts

If this happens, your child may sick up the piece of food to clear the oesophagus or be able to wash it down with a sip of water. Encourage your child to cut their food smaller than normal and chew foods thoroughly for the first 3 months after the operation.