Fundoplication procedure factsheet
Introduction
The Nissen’s fundoplication is used to help children with severe reflux and vomiting.
Reflux is when acid from the stomach comes back up the tube connecting it to the mouth, called the oesophagus. This can be very uncomfortable for children and can feel like burning in the mouth and throat. Reflux that happens regularly is called gastroesophageal reflux disease (GORD). GORD can make the oesophagus painful and inflamed.
Generally, your child will be treated for GORD with diet and lifestyle changes and medication. If these do not manage the GORD well, your child’s doctor may recommend a fundoplication procedure.
Fundoplication involves wrapping the upper part of the stomach, known as the fundus, around the oesophagus. This tightens the valve at the top of the oesophagus, lowering the risk of stomach acid travelling back up.
Before the procedure
The hospital will call you before your child’s procedure to let you know:
- what time you need to arrive
- when your child needs to stop eating and drinking
- whether it is a day procedure or whether they will stay overnight in the hospital.
During the procedure
Your child will be under a general anaesthetic for the procedure. This means they will be asleep and will not feel any pain.
Fundoplication is a laparoscopic procedure, also known as keyhole surgery. This means the surgeon makes small cuts in your child’s belly and uses long instruments to reach the organs inside. This helps your child recover more quickly.
Generally, the steps of the fundoplication are:
- the surgeon makes small cuts in your child’s belly
- the surgeon inserts surgical tools and a small camera to see inside
- the tools are used to wrap the top part of the stomach around the oesophagus
- the tools are removed, and the small cuts are closed with stitches.
G-tube
Some children will also have a gastrostomy or g-tube created at the same time as their fundoplication.
A g-tube is a tube that is inserted through the belly and into the stomach. This helps keep the stomach empty while healing. If your child cannot have keyhole surgery, their doctor will discuss other options with you.
After the procedure
When your child wakes up from surgery, they might feel sleepy and sick while the general anaesthetic wears off.
Your child will stay in the hospital for around five days to make sure they are recovering well and getting enough nutrition and fluids.
When your child is ready to go home, you will be given:
- pain medicine and instructions for dosage
- information about eating
- information about managing the gastrostomy tube.
Speak to the nurse or doctor if you have concerns or questions before going home.
Management
Managing gas build-up
Your child’s stomach will be smaller after the procedure, and they may have some trouble with gas buildup. This can include:
- vomiting
- burping
- bloating.
Gas build-up should improve over time but can be permanent in some children.
You can manage vomiting and gas build-up by:
- giving your child smaller amounts of food more frequently
- avoiding overfeeding
- making sure your child gets enough fibre and fluids to avoid constipation.
Constipation is when poo becomes hard and difficult to pass. It can be very uncomfortable and make vomiting and bloating worse.
Looking after the gastrostomy tube
If your child has a gastrostomy or g-tube, you can open the “button” to release gas or extra formula from the stomach. This must be done before each feed and when your child has discomfort and bloating from swallowing too much air.
Diet changes
After fundoplication, your child can swallow and eat as they did before. They might feel uncomfortable when eating solid food for a few weeks and should avoid foods like:
- scrambled eggs
- fresh bread
- large pieces of meat
Speak to your child’s doctor if you need support with diet changes for your child after fundoplication.
Children with neurological conditions
Neurological conditions affect the brain's ability to send messages to different body parts, including the oesophagus.
These conditions include:
- Cerebral palsy
- Muscular dystrophy
- traumatic brain injury.
Children with neurological conditions are at a higher risk of vomiting after the procedure. Vomiting after the procedure can mean the oesophagus will not heal properly, and the reflux will come back.
Speak to your child’s treatment team about specific recovery information for your child if they have a neurological condition.
Complications of fundoplication
Any procedure will have a risk of complications. Complications can be rare and include:
- bleeding
- infection
- leakage from the oesophagus or stomach.
Your child’s doctor will discuss the risks with you and answer any questions you have.
