What is nissen fundoplication surgery?

This surgery is done to treat gastroesophageal reflux disease (GERD). The doctor strengthens the valve between the stomach and the esophagus. The esophagus is the tube that connects the mouth to the stomach.

The doctor wraps the upper part of the stomach (fundus) around the lower part of the esophagus. This prevents stomach acid from moving back into the esophagus. After surgery, your child should have fewer symptoms of GERD, such as heartburn.

This is usually a laparoscopic surgery. This means that the doctor makes small cuts in your child's belly to do the surgery. These cuts are called incisions. The doctor puts a lighted tube, or scope, and other surgical tools through the incisions. The doctor is able to see your child's organs with the scope.

The doctor may do an open surgery instead. This means that the doctor makes a larger incision in the middle of your child's belly.

Your child will probably stay in the hospital for 3 to 5 days after surgery. After laparoscopy, most children can go back to doing their usual activities in 2 to 3 weeks. If your child has open surgery, it may take 4 to 6 weeks to recover.

The type of surgery your child has depends on your child's health needs. The incisions from both types of surgeries leave scars that fade over time.

Activity

• Have your child rest when he or she feels tired.
• Allow your child's belly to heal. Don't let your child move quickly or lift anything heavy for about 2 weeks, or 4 to 6 weeks if your child had an open surgery.
• Don't allow your child to do sit-ups or any exercise or activity that uses the belly muscles.
• Don't let your child take part in any activity where your child could be hit in the belly. Your child can do routine activities when it feels okay to do so.
• Have your child hold a pillow over the incisions when coughing or taking deep breaths. This will support the belly and may help to decrease pain.

Diet

• For the first week, give your child a liquid or soft diet. This includes broths, soups, milk shakes, puddings, and mashed potatoes. When your child can eat these, give your child other foods that are easy to swallow, such as ground meat, shredded chicken, fish, pasta, and soft vegetables.
• Have your child eat 5 or 6 small meals each day instead of 2 or 3 large meals.
• Have your child chew each bite of food very well. Encourage your child to eat slowly. It may take 20 to 30 minutes to eat a meal.
• Avoid crusty breads, bagels, pizza, tough meats like hot dogs, raw vegetables, nuts and seeds (including crackers and breads that have nuts and seeds), and other foods that are hard to digest.
• If your child feels full quickly, try to give fluids between meals instead of with meals.
• Avoid fizzy drinks, such as soda pop.
• Avoid drinking with straws. This may help your child swallow less air when drinking.
• Gradually return to your child's normal foods. This usually takes 4 to 6 weeks.
• If your child's bowel movements are not regular right after surgery, you can help him or her to avoid constipation and straining. Have your child drink plenty of water. The doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

• Your doctor will tell you if and when your child can restart his or her medicines. The doctor will also give you instructions about your child taking any new medicines.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave your child a prescription medicine for pain, give it as prescribed.
  • If your child is not taking a prescription pain medicine, ask the doctor if your child can take an over-the-counter medicine.
• If the doctor prescribed antibiotics for your child, give them as directed. Do not stop using them just because your child feels better. Your child needs to take the full course of antibiotics.

Incision care

• If your child has strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or alcohol. They can slow healing.
• Keep the area clean and dry.

Hygiene

• Your child may shower. Pat the incision dry. Your child should not swim or take a bath for the first 2 weeks, or until the doctor tells you it is okay.

• In most people who have laparoscopic surgery for GERD, the surgery improves symptoms and heals the damage done to the esophagus.
• Over time, some people have symptoms come back, have esophagitis come back, need to take medicine for symptoms, or need another operation.
• Surgery can cause new and bothersome symptoms. Over time, some people have trouble swallowing, more flatulence (gas), and/or trouble belching.

Surgery can be stressful for both your child and you. This information will help you understand what you can expect. And it will help you safely prepare for your child's surgery.

Preparing for surgery

• Talk to your child about the surgery. Say that it will help your child have fewer symptoms of GERD. Hospitals know how to take care of children. The staff will do all they can to make it easier for your child.
• Ask if a special tour of the surgery area and hospital is available. This may make your child feel less nervous about what happens.
• Plan for your child's recovery time. Your child may need more of your time right after the surgery, both for care and for comfort.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell the doctor ALL the medicines, vitamins, supplements, and herbal remedies your child takes. Some may increase the risk of problems during the surgery. Your doctor will tell you if your child should stop taking any of them before the surgery and how soon to do it.

The day before surgery

• A nurse may call you (or you may need to call the hospital). This is to confirm the time and date of your child's surgery and answer any questions.
• Remember to follow your doctor's instructions about your child taking or stopping medicines before surgery. This includes over-the-counter medicines.

Risks or complications after fundoplication surgery include:

• Trouble swallowing because the stomach is wrapped too high on the esophagus or is wrapped too tightly.
• The esophagus sliding out of the wrapped portion of the stomach so that the valve (lower esophageal sphincter) is no longer supported.
• Heartburn that comes back.
• Bloating and discomfort from gas buildup because the person can't burp.
• Excess gas.
• Risks of anesthesia.
• Risks of major surgery (infection or bleeding).

For some people, the side effects of surgery—bloating caused by gas buildup, swallowing problems, pain at the surgical site—are as bothersome as GERD symptoms. The surgery can't be reversed. And in some cases it may not be possible to relieve the symptoms of these complications, even with a second surgery.

Fundoplication surgery is done to treat gastroesophageal reflux disease (GERD). In this surgery, the doctor strengthens the valve between the stomach and the esophagus. The esophagus is the tube that connects the mouth to the stomach.

A strong valve prevents stomach acid from moving back into the esophagus. The doctor will wrap the upper part of the stomach (fundus) around the lower part of the esophagus. After surgery, you should have fewer symptoms of GERD, such as heartburn.

You may be sore and have some pain in your belly for several weeks. If you had laparoscopic surgery, you also may have pain near your shoulder for a day or two.

It may be hard for you to swallow for up to 6 weeks.

You may also have cramping in your belly, feel bloated, or pass more gas than before. The cramping and bloating usually go away in 2 to 3 months. But you may keep passing more gas for a long time. When you burp, you may not get as much relief as you did before the surgery. Or you may not be able to burp after surgery.

The surgery makes your stomach a little smaller, so you may get full more quickly when you eat. In 2 to 3 months, the stomach adjusts. You will be able to eat your usual amounts of food.

How quickly you recover depends on what type of surgery you had. After laparoscopic surgery, most people can go back to work or their normal routine in about 2 to 3 weeks. It depends on their work. After open surgery, you may need 4 to 6 weeks to get back to your normal routine.

The incisions from both types of surgeries leave scars that fade over time.

The doctor wrapped the upper part of your child's stomach (fundus) around the lower part of the esophagus. This prevents stomach acid from moving back into the esophagus.

Your child may be sore and have some belly pain for several weeks after surgery. If your child had laparoscopic surgery, there may also be some shoulder or back pain. This pain is caused by the gas used to inflate the belly to help see the organs better. The pain usually lasts about 1 or 2 days.

For up to 6 weeks after the surgery, it may be hard for your child to swallow and burp. Your child may also have belly cramps, feel bloated, or pass more gas than before. The cramping and bloating usually go away in 2 to 3 months. But your child may pass more gas for a long time.

Because the surgery makes the stomach a little smaller, your child may get full sooner when eating. In 2 to 3 months, the stomach adjusts and your child will be able to eat the usual amounts of food.

How quickly your child recovers depends on whether your child had a laparoscopic or open surgery. After laparoscopy, most children can go back to their normal routine in about 2 to 3 weeks. After open surgery, children may need 4 to 6 weeks to get back to their normal routine.

• Follow the instructions exactly about when your child should stop eating and drinking. If you don't, your child's surgery may be canceled. If your doctor told you to have your child take any medicines on the day of surgery, have your child take them with only a sip of water.
• Follow the doctor's instructions about when your child should bathe or shower before the procedure. Do not apply lotion or deodorant.
• Your child may brush their teeth. But tell your child not to swallow any toothpaste or water.
• Do not let your child wear contact lenses. Bring your child's glasses or contact lens case.
• Be sure your child has something that's a reminder of home. A special stuffed animal, toy, or blanket may be comforting. For an older child, it might be a book or music.

At the hospital or surgery center

• A parent or legal guardian must accompany your child.
• Your child will be kept comfortable and safe by the anesthesia provider. Your child will be asleep during the surgery.
• The surgery will take about 1 to 2 hours.
• After surgery, your child will be taken to the recovery room. As your child wakes up, the recovery staff will monitor your child's condition. The doctor will talk to you about the surgery.

Fundoplication surgery is most often used to treat GERD symptoms that are likely to be caused in part by a hiatal hernia and that have not been well controlled by medicines. The surgery may also be used for some people who don't have a hiatal hernia. Surgery also may be an option when:

• Treatment with medicines does not completely relieve your symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.
• You do not want or, because of side effects, you can't take medicines long-term to control your GERD symptoms, and you accept the risks of surgery.
• You have symptoms that don't improve enough when treated with medicines. Examples of these symptoms are asthma, hoarseness, and cough along with reflux.

In this surgery, the doctor wraps the upper part of the stomach (fundus) around the lower part of the esophagus.

It's most often done as laparoscopic surgery. The doctor puts a lighted tube, or scope, and other surgical tools through small incisions (cuts) in your belly. The doctor is able to see your organs with the scope. Most people stay in the hospital 2 to 3 days.

Your doctor may do an open surgery. The doctor makes a larger cut in the middle of your belly. You will probably stay in the hospital for 4 or 5 days after open surgery.