Fundoplication is a difficult decision for parents as well as pediatric specialists. There are many pros and cons. Here are some of the commonly asked questions.
FAQs for Fundoplications
Will the fundo interfere with him eating through his mouth? Not generally. Patients need to be on a â€œsmall bitesâ€ or Post-Nissen diet. They just have to avoid things that might get stuck if there is swelling at the bottom of the wrap.
Do you do this surgery often? Not as often as we used to. In the early 2000â€™s we would do this procedure on almost every developmentally delayed patient who aspirated and had GE reflux. Now we only do it on children that canâ€™t be managed medically and are not a candidate for continuous GJ tube feeds. All of the surgeons do many laparoscopic GI surgeries, so feel confident that your surgeon can do a laparoscopic fundoplication. All of our pediatric surgeons are fellowship-trained and either board certified or board-eligible in pediatric surgery.
What is the success rate of this surgery/ How well will it work? It really depends on the patient and their symptoms. National statistics suggest 70% do well enough to come off meds, 20% still need meds but are improved, and 10% are not improved. GE Reflux is not the same as vomiting. Reflux is a low-pressure movement of stomach contents into the esophagus. Vomiting is a high pressure, coordinated brain process that involves abdominal muscles as well as the stomach. The operation is very good for reflux, but less effective for vomiting.
Is it a laparoscopic surgery? Almost all children are candidates for laparoscopic surgery, but ask your surgeon.
What is a hiatal hernia and is the patient more likely to get one after procedure?The â€œhiatusâ€ is the normal opening of the diaphragm. The esophagus leaves the chest and enters the abdomen through the hiatus. A hiatal hernia is when the stomach comes up into the chest through that hiatal opening. It is possible to develop a hiatal hernia after the surgery, but less common with the recent modifications (not freeing the front of the esophagus).
How long is down time after surgery? Typical hospitalization is one night in the hospital. Most children can be back in school in a week.
Will patient have difficulty swallowing?It is very common to have food â€œstickâ€ during the first 3-6 weeks after the surgery. Difficulty swallowing can persist longer, but is less common.
Can the fundo come undone or rip? How likely? It is rare for the fundoplication to become completely undo. Often, over time it can become less effective, however. This is usually due to stretching of the wrap over time, making it less effective. Development of a hiatial hernia can also lessen the effectiveness of the wrap. The frequency varies by age and neurologic situation.
Will he be able to do therapy soon after? How long to heal?Generally in one week.
As patient grows will the fundo stretch? In some patients, the fundo works perfectly forever, but in others, they have return of symptoms. Patients who gag and wretch (dry vomit) seem to have more problems with failure than those that donâ€™t.
What happens if he gets air in his stomach? Can patient burp? Inability to burp is a common temporary side effect of the surgery. This causes a bloated, uncomfortable feeling. If it persists beyond 6 months and/or causes problems, options include dilating the esophagus or revising the fundo.