Anti-reflux surgery - children - discharge

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Definition

Your child had surgery to treat gastroesophageal reflux disease (GERD). GERD is a condition that causes acid, food, or liquid to come up from the stomach into the esophagus. This is the tube that carries food from the mouth to the stomach.

Alternative Names

Fundoplication - children - discharge; Nissen fundoplication - children - discharge; Belsey (Mark IV) fundoplication - children - discharge; Toupet fundoplication - children - discharge; Thal fundoplication - children - discharge; Hiatal hernia repair - children - discharge; Endoluminal fundoplication - children - discharge

When Your Child Was in the Hospital

During the operation, the surgeon wrapped the upper part of your child's stomach around the end of the esophagus.

The surgery was done in one of these ways:

  • Through an incision (cut) in your child's upper belly (open surgery)
  • With a laparoscope (a thin tube with a tiny camera on the end) through tiny incisions
  • By endoluminal repair (like a laparoscope, but the surgeon goes in through the mouth)

Your child may also have had a pyloroplasty. This is a procedure that widened the opening between the stomach and small intestine. The doctor may have also placed a g-tube (gastrostomy tube) in the child's belly for feeding.

What to Expect at Home

Most children can go back to school or daycare as soon as they feel well enough.

  • Your child should avoid heavy lifting or strenuous activity, such as gym class and very active play, for 3 to 4 weeks.
  • You may ask your child's doctor for a letter to give to the school nurse and teachers to explain restrictions your child has.

Your child may have a feeling of tightness when swallowing. This is from the swelling inside your child's esophagus. Your child may also have some bloating. These should go away in 6 to 8 weeks.

Recovery is faster from laparoscopic surgery than from open surgery.

You will need to schedule a follow-up appointment with your child's primary care provider or gastroenterologist after the surgery.

Care at Home

You'll slowly help your child get back to a regular diet.

  • Your child should have started on a liquid diet in the hospital.
  • After the doctor feels your child is ready, you can add soft foods.
  • Once your child is taking soft foods well, talk with your child's doctor about returning to a regular diet.

If your child had a gastrostomy tube (G-tube) placed during surgery, it can be used for feeding and venting. Venting is when the G-tube is opened to release air from the stomach, similar to burping.

  • The nurse in the hospital should have shown you how to vent, care for, and replace the G-tube, and how to order G-tube supplies. Follow instructions on G-tube care.
  • If you need help with the G-tube at home, contact the home health care nurse who works for the G-tube supplier.

For pain, you can give your child over-the-counter pain medicines such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). If your child is still having pain, call your child's doctor.

Wound Care

If sutures (stitches), staples, or glue were used to close your child's skin:

  • You may remove the dressings (bandages) and allow your child to take a shower the day after surgery.
  • If taking a shower isn't possible, you can give your child a sponge bath.

If strips of tape were used to close your child's skin:

  • Cover the incisions with plastic wrap before showering for the first week. Tape the edges of the plastic carefully to keep water out.
  • DO NOT try to wash the tape off. They will fall off after about a week.

DO NOT allow your child to soak in a bathtub or hot tub or go swimming until your child's doctor tells you it is OK.

When to Call the Doctor

Call your child's health care provider if your child has:

  • A fever of 101°F (38.3°C) or higher
  • Incisions that are bleeding, red, warm to the touch, or have a thick, yellow, green, or milky drainage
  • A swollen or painful belly
  • Nausea or vomiting for more than 24 hours
  • Problems swallowing that keep your child from eating
  • Problems swallowing that do not go away after 2 or 3 weeks
  • Pain that pain medicine is not helping
  • Trouble breathing
  • A cough that does not go away
  • Any problems that make your child unable to eat
  • If the G-tube is accidentally removed or falls out

References

Iqbal CW, Holcomb GW. Gastroesophageal reflux. In: Holcomb GW, Murphy JP, Ostlie DJ, eds. Ashcraft's Pediatric Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 28.

Lightdale JR, Gremse DA; Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5):e1684-e1695. PMID: 23629618 www.ncbi.nlm.nih.gov/pubmed/23629618.

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