Fundoplication

fundoplicationThe goal of a fundoplication is to prevent stomach contents from returning to the esophagus. This operation is a accomplished by wrapping the upper portion of the stomach around the lower portion of the esophagus, tightening the outlet of the esophagus as it empties into the stomach. After a fundoplication, food and fluids can pass into the stomach but are prevented from returning to the esophagus and causing symptoms of esophageal reflux. A large skin incision may not be required. In most cases, a fundoplication can be performed by a pediatric surgeon using a small telescope and miniaturized instruments placed through three to four band-aid sized incisions on the abdomen.

Why is fundoplication necessary?

Fundoplication is recommended for children who have complications or persistent symptoms related to gastroesophageal reflux (GER) that are not improved by medication. Symptoms of gastroesophageal reflux include vomiting, esophagitis (heart burn) gastroesophageal stricture, recurrent pneumonia, breathing problems, and inadequate growth. Before an operation is performed your child may have one or more tests confirming GER, such as a pH probe study or esophogram.

How is a fundoplication performed?

Fundoplication is performed in two to three hours with a two to three day hospital stay following surgery. Postoperative, during your child's hospitalization, he/she will receive intravenous fluids and pain medication. As soon as your child feels well enough he/ she will be allowed to eat, drink and take pain medication by mouth (usually 1-2 days after surgery). In some patients a gastrostomy tube is placed into the stomach to allow feedings to be administered and air to be released. Air release is called "venting". It may be hard for your child to burp for many weeks after a fundoplication. Venting allows air to leave the stomach, which decreases bloating and keeps your child comfortable. During your child's hospital stay, the bedside nurse will teach you how to vent, care for and use the gastrostomy tube.

In most fundoplication operations, there is very little blood loss. You child will receive blood only in the rare case of an extreme emergency. If you wish to provide a directed donation of blood, contact our office, 1-2 weeks in advance of the operation.

How long will my child remain in the hospital after the operation?

Most children are ready to go home in two to three days after the operation.

Homecare

Most children are ready to go home in two to three days after the operation. Your child's diet may be restricted for some time and they may be required to use a gastronomy tube.

Eating By Mouth

If your child is to resume his or her usual diet, it is best to start slowly. Begin with liquids, advance to soft foods, and then to a regular diet. It may take several weeks for the postoperative swelling to subside and for solid foods to pass easily into the stomach. Foods that cannot pass into the stomach will be vomited up. It is not unusual for this to occur from time to time in the first few weeks after surgery. For questions about your child's dietary tolerance, view our Diet Recommendations After Fundoplication or call our office.

Gastrostomy Tube and Supplies

If your child leaves the hospital with a gastrostomy tube, a replacement tube of the same size will be sent home with you at discharge. If your child will be receiving feedings by gastrostomy, supplies will be ordered by the surgical nurse practitioner from a home care company. The home care company will ship supplies directly to your home. A nurse may come to your home, for a few visits, to help you learn to deliver feedings and take care of the gastrostomy tube. Long-term management of feedings and ordering of supplies will generally be the responsibility of your child's gastroenterologist.

For more info read our Homecare Guidelines for Gastrostomy Tubes

Pain Management

Prescription pain medication is not routinely required after hospital discharge. Most children only need Acetaminophen (Tylenol®) or Ibuprophen (Motrin®) once they are at home. Follow the dosage directions on the label. If your child is still uncomfortable, call our office and we may prescribe something stronger.

Care for Dressings

Gauze and clear plastic dressings, placed over the incisions, may be removed two days after surgery. Over the incision, there will be pieces of tape called Steri-strips®. On the Steri-strips®, there may be a small amount of blood. This is normal. Your child can bathe with the Steri-strips® in place. These can be removed one week after the operation. The skin surrounding the incision may be red and bruised, and the incision may be slightly swollen. This can last several weeks. There will be no visible stitches to remove because they are under the skin. The stitches will dissolve after several weeks.

In most operations, the wound is closed with dissolvable suture (stitches). These stitches are under the skin and do not have to be removed. In some children these stitches may come through the incision about 4 weeks postoperatively. This may be associated with a little local redness and pus and it may involve an end of the incision or a larger portion. This is normal and is best treated by gently cleansing the area with soap and water and waiting. When the suture falls out or completely dissolves, the wound will heal. If your child has worsening redness, swelling pain of the incision and a fever within 2weeks of the operation, please call our office.

Healing Ridge

After the incisions are healed you will be able to feel a firm ridge just underneath. This is called a healing ridge and it is normal to find this after surgery. The healing ridge usually lasts for several months before it softens and disappears.

Bathing Restrictions

Your child may bathe or shower as soon as two days after surgery. Once your child is feeling better, before discharge or at home, he or she may bathe or shower without restriction.

Activity Restrictions

There are no specific activity restrictions following surgery. Your child can return to school as soon as he or she feels well enough. If you need a letter sent to your child's school regarding the operation and recovery, please contact our office.

Do I see the surgeon again after the operation?

If all is going well, a visit to our office is not required. Our pediatric nurse practitioner will call you to check on your child's recovery. A visit with your child's Primary Provider and Gastroenterologist at one to two weeks after the discharge is recommended. Fundoplication may have long term complications including gas bloat, difficulty swallowing, and unwrapping or slipping. If you think your child is experiencing problems because of the fundoplication, call our office.

When do I call the surgeon's office?

Call our office at 415-476-2538 for the following:

  • Any concerns you have about your child's recovery
  • A temperature of 101°F or higher
  • A red incision
  • Increasing pain and tenderness at the incision
  • Any liquid coming out of the incision

Diet After Fundoplication

It will take time for your child to recover from this operation and for food to pass comfortably into his or her stomach. To make the first 3 months more comfortable, we have developed diet suggestions to help your child.

The First 2 Weeks

After the operation it is best to offer liquids only. Your child may not be able to burp or vomit after the operation therefore avoid carbonated beverages or gum. These increase air in the stomach, which can be very painful.

Suggested Diet:

Liquids include water, juice, milk, milkshakes, ice cream, jello, pudding, and pureed soups; pureed baby food and yogurt

The 3rd And 4th Weeks

After surgery it is much easier for your child to eat more textured foods but we recommend going slowly. You can begin by offering soft foods.

Suggested Diet:

Soft foods include mashed potatoes, pasta, rice and bread, fish, crackers, cereal, ground beef, cheese, and peanut butter.

The Next 2 Months

If eating goes well, your child can slowly resume his or her usual diet with some exceptions listed below.

Suggested Diet:

Your child may eat most foods but should avoid hotdogs, steak, chicken, pizza and nuts. These are foods that can get stuck in your child's esophagus and may not pass into the stomach. If this happens, your child may vomit the piece of food to clear the esophagus or he or she may need to be hospitalized to remove the food. This is uncomfortable and sometimes frightening. It is best to prevent this situation, by avoiding potentially problematic foods, for the first 3 months after the operation.

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