Fundoplication procedure factsheet


The Nissen’s fundoplication is a procedure used to manage severe reflux and vomiting in children.

Reflux is when acid from the stomach comes back up into the oesophagus, the tube connecting the mouth and stomach. This can be very uncomfortable for children and may feel like burning in the mouth and throat. 

When reflux happens regularly, it is called gastro-oesophageal reflux disease (GORD). GORD can cause the oesophagus to become 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 having a fundoplication.  

 Before the procedure

The hospital will contact you before your child’s procedure. They will give you information including:

  • when to stop eating and drinking
  • what time to arrive
  • what to bring with you.

Your child’s doctor will explain what will happen during the procedure. All procedures have risks, including:

  • bleeding
  • infection
  • leakage from the oesophagus or stomach.
  • Ask your child’s doctor if you have any questions or concerns about the fundoplication procedure.

 During the procedure

Your child will be under a general anaesthetic for the fundoplication, which means they will be asleep and will not feel any pain.

The fundoplication procedure is usually done laparoscopically or by keyhole surgery.

Laparoscopy, or keyhole surgery, is when the doctor makes a very small cut in your child’s abdomen and uses long instruments to reach the organs inside. This type of surgery is used to help your child have a quicker recovery.

Generally, the steps of the fundoplication are:

  1. the surgeon makes small cuts in your child’s abdomen or belly
  2. the surgeon inserts the surgical tools and a small camera to see inside
  3. the tools are used to wrap the upper part of the stomach, called the fundus, around the oesophagus
  4. the surgical tools are removed, and the small cuts are closed with stitches.

Wrapping the upper part of the stomach around the oesophagus can help to tighten the valve that connects them. This makes it less likely that stomach acid will travel back up.

Some children will also have a gastrostomy or g-tube created during the procedure. A g-tube is a tube that is inserted through the abdomen or belly into the stomach. This tube helps keep the stomach empty while healing after the procedure.

Some children are not able to have keyhole surgery. Your child’s doctor will discuss this with you.

 After the procedure

Your child will stay in the hospital for around 5 days after the procedure. This is to make sure your child is recovering well and getting enough nutrition and fluids.

Your child’s treating team will give you information about pain relief, eating and managing the gastrostomy before you go home from the hospital.


Vomiting, gas and constipation

After the procedure, your child may have trouble vomiting and burping from gas building up in the stomach. This should get better over time. In some children, it can be permanent.

Bloating is when gas builds up in the stomach. It can happen after fundoplication because your child’s stomach is now smaller.

You can manage vomiting and gas by giving your child smaller amounts of food more frequently.

Avoid over-feeding your child, and make sure they are getting enough fibre and fluid in their diet to prevent constipation.

Constipation is when poo becomes hard and difficult to pass. Constipation is very uncomfortable and can make vomiting and bloating worse.

Looking after the gastrostomy tube

If your child has a gastrostomy, 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.

Read the Gastrostomy (G-tube) procedure factsheet for more information.

Diet changes

After fundoplication, your child can swallow and eat like they did before.

They might feel a bit 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 are when there is a problem sending messages from the brain to different body parts.

Some neurological conditions can affect the oesophagus and swallowing, including:

Children with neurological conditions can have a higher risk of vomiting after the procedure.

This means there is a higher risk that the wound from the procedure will break down, and the reflux will return.

Speak to your child’s doctor about managing the fundoplication procedure with a neurological condition.

Last updated Tuesday 30th January 2024


This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024