Understanding Antireflux Surgery and it’s Use on Children
Antireflux surgery is a type of surgery designed to treat and prevent symptoms of gastroesophageal reflux disease (GERD). GERD is a common chronic digestive disease where stomach contents flow back up the esophagus or the tube that connects the mouth and the stomach.
The reflux of stomach contents is caused by a weak or damaged esophageal sphincter. This is the muscle that normally keeps food and liquid from moving out of the stomach and back up the esophagus.
Reflux can cause discomfort and conditions such as heartburn or a burning sensation in the abdomen and chest and gas, often accompanied by problems swallowing food. Repeated reflux can permanently damage your esophagus.
Why Antireflux Surgery Is Done
While most cases of GERD can be controlled with medications and adjustments in diet and lifestyle, some serious cases require surgery to prevent future problems. A doctor will typically try to treat GERD with over-the-counter antacids (Tums), acid blockers (Pepcid AC), or acid inhibitors like Prilosec. If conditions don’t improve, surgery may be needed.
Antireflux surgery is typically performed on children whose GERD complications are drastically altering their health or when maintenance therapy has proven unsuccessful or overburdening.
Children may undergo antireflux surgery for numerous reasons, including:
- aspiration pneumonia, a condition where stomach contents are breathed into the lungs
- chronic cough caused by GERD
- bleeding in the esophagus
- narrowing of the esophagus, also called stricture
- part of your child’s stomach is becomes stuck in the lower chest (hiatal hernia)
How Antireflux Surgery is Performed
The most common type of antireflux surgery is Nissen fundoplication, which involves surgically wrapping the upper portion of the stomach around the lower portion of the esophagus and stitching it into place. During the surgery, which typically lasts three to four hours, your child will be under general anesthesia. They will be asleep and won’t feel pain. The surgeon may also install a gastrostomy tube during the procedure. This allows your child to release air from their stomach and can make eating easier if your child is having trouble swallowing.
There are three kinds of Nissen fundoplication antireflux surgery: open, endoluminal, and laparoscopic.
During open surgery, a surgeon will make a long incision in the child’s abdomen and operate inside the stomach cavity. This type of surgery is usually performed if your child is overweight, there is a risk of excess bleeding, or there is scar tissue from previous surgeries.
In laparoscopic fundoplication, a surgeon makes three to five incisions in the abdomen, and then inserts a tiny camera at the end of a thin flexible tube to guide the operation.
During endoluminal fundoplication, a surgeon enters the stomach through your child’s mouth and attaches clips to strengthen the connection between the stomach and esophagus.
After surgery, the incisions will be stitched, cleaned, and dressed. To avoid infection and irritation, do not disturb or remove medical dressings.
The Risks of Antireflux Surgery
Common risks and side effects of antireflux surgery include:
- difficulty burping or throwing up
- difficulty swallowing
In very rare cases, damage to the esophagus, liver, small intestine, or stomach is possible.
Antireflux surgery is safe and minimally invasive. Symptoms typically dissipate within a few months of the surgery, but some people will still need to take medications for heartburn.
How to Prepare for Antireflux Surgery
Before your child’s antireflux surgery, your doctor will perform a complete physical examination and administer several tests, such as blood tests or X-rays to view the esophagus. Your doctor or nurse will provide you with other important presurgical information.
Also, be sure to:
- alert the doctor to any medications or supplements your child is taking
- ask when you should stop giving your child any medication that could affect blood clotting, including aspirin, ibuprofen, and other drugs
- ask when your child should stop eating and drinking fluids before surgery
Following Up After Antireflux Surgery
Those who have antireflux surgery can spend anywhere from one to six days in the hospital, depending on whether the procedure was open or laparoscopic. Your child may experience pain or bloating from the surgery and will be given medication to reduce discomfort.
Following surgery, your surgeon will provide care information for the incisions and specific dietary restrictions. Before leaving the hospital, a registered dietician will inform you about an antireflux diet and list of acceptable foods. For several weeks after surgery, rigorous physical activity and heavy lifting should be avoided.
It is normal to have minor swelling around incisions. However, if your child experiences fever, bleeding, major swelling, or increased pain, contact your doctor right away.