Anti-reflux surgery - children
Alternate 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
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.
Overview & Description
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. - During this surgery, the surgeon will use stitches to wrap the upper part of your child’s stomach around the end of the esophagus. This helps prevent stomach acid and food from flowing back up.
- A g-tube (gastrostomy tube) may be placed to help with feeding and to release air from your child’s stomach. The surgeon may use a g-tube if your child has had swallowing or feeding problems.
- The surgeon may do another procedure called a pyloroplasty. This procedure widens the opening between the stomach and small intestine so that the stomach can empty faster.
Ways the doctor may do this surgery are: - Open repair. The surgeon will make a large incision (cut) in your child’s belly area (abdomen).
- Laparoscopic repair. The surgeon will make 3 to 5 small incisions in the belly. The surgeon will insert a laparoscope (a thin, hollow tube with a tiny camera on the end) through one of these incisions and other tools through the other incisions. The surgeon may need to switch to an open procedure if there is bleeding, a lot of scar tissue from earlier surgeries, or if the child is very overweight.
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
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: - Your child has symptoms of heartburn that get better with medicines, but you do not want your child to continue taking these medicines. Symptoms of heartburn are burning in their stomach, throat, or chest, burping or gas bubbles, or problems swallowing food or fluids.
- Part of your child’s stomach is getting stuck in their chest or is twisting around itself.
- Your child has strictures (a narrowing of the esophagus), bleeding in the esophagus, is not growing well, or has failure to thrive.
- Your child has aspiration pneumonia (a lung infection caused by breathing contents of the stomach into the lungs), a chronic cough, or hoarseness.
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