Laparoscopic Nissen Fundoplication (Pedriatic)
Gastro-esophageal reflux disease (GERD) is the movement of food and acid from the stomach back up into the esophagus. GERD may cause symptoms such as throwing up, gagging, chest pain, and breathing problems. Children with severe reflux may have frequent ear, nose, and throat infections. These children may also have poor weight gain. Children whose reflux does not improve may require a surgery called a fundoplication.
You and your doctors feel that surgery is the best choice for treating your child’s reflux. Your child will receive general anesthesia during the operation. Three to four small incisions will be made to allow the scope and instruments used for the surgery to go into the abdomen. The abdomen will be filled with air to create space for the instruments to move. The surgeon will then wrap a portion of your child’s stomach around the bottom of the esophagus, making a one-way valve. This valve will allow food and drink to go down into your child’s stomach but stops stomach contents from flowing back up into the esophagus.
Your child may need a gastrostomy tube (G-tube). A G-tube is a small tube placed through the skin and stomach wall into the stomach. It is placed during surgery. A G-tube can be used for feedings, giving medicines, and letting extra air or fluid out of the stomach. You and your surgeon will discuss this before surgery.
After surgery, your child will recover in the hospital for 2-4 days before going home. Your child will return to see the doctor in clinic 2-3 weeks after that.
Incision Care
- Your child’s incisions should heal in 1-2 weeks. The stitches will dissolve.
- Do not put ointments, powders, or creams on the incision sites.
- Your child may shower 3 days after surgery and may tub bathe after 7-10 days.
- Check for signs of infection daily.
-Red and/or hot incision site
-Pus-like drainage
-Increased swelling or bleeding
- For 1 year after the incisions are healed, apply SPF 30 sunscreen to the scars when out in the sun.
Activity
- For the first 4 weeks, your child should not lift any objects greater than 10 pounds. This includes heavy backpacks. Lifting puts extra strain on the incisions and may increase the chance of problems.
- Your child should not ride a bike, skateboard, rollerblade, or perform any activity that poses a risk of falling. Your child may swim after 2 weeks.
- After 4 weeks, your child may increase the level of activity and play. If you are not sure if it is safe, check with your doctor.
- Check with your doctor before your child returns to gym class and recess.
- Your child may return to school when she feels up to it.
It is normal for your child to have some pain. Pain medicine will be prescribed for your child. Your child may have some aching in his neck and shoulders from the air put into the abdomen during surgery. For relief, have your child lie down flat and put pillows under the hips. Lie flat for 5-15 minutes and the pain should slowly go away.
Diet
During the first 2-3 weeks after having the Nissen done, there will be lots of swelling at the site of the surgery. This can make the size of the esophagus much smaller. Your child will be on a full liquid or soft diet until returning to see the doctor (about 2-3 weeks). It is vital that she eats slowly and chews food well. Have your child drink slowly and in small amounts. Do not let your child use a straw to drink.
If your child has not had a bowel movement in 3 days, you may want to use a stool softener (DocusateÒ, ColaceÒ), a bulk fiber laxative, or glycerin suppository. They can be purchased at your local drug store without a prescription.
When to Call the Doctor
- Constipation not relieved by stool softener or glycerin suppository
- Fever above 100.4° F (by mouth) for 2 readings taken 4 hours apart
- Excess swelling
- Increased redness at the incision site or warm to touch
- Excess bloody or pus-like drainage
- Increased pain not controlled by pain medicine
- Rapid increase of bruising. (Some bruising is normal.)
Phone Numbers:
If you have questions or problems, please call:
Monday-Friday 8:00am-4:30pm: (608) 263-9419
After hours, holidays and weekends call (608) 262-2122. This is the hospital paging operator. Ask for the pediatric surgery resident on call. Leave your name, your child’s full name, and your phone number with the area code. The doctor will call you back.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 02/26/2010
Copyright © 02/26/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6110
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