Most children with gastroesophageal reflux disease improve with simple changes in their feeding and in the way they sit. They may also take an antacid medication. Before thinking about surgery, your child's health-care team may suggest taking these steps:
- Keep your baby in a straighter, more upright position at all times. Gravity can help keep the food in the stomach.
- Make your baby's milk or formula thicker; for example, by adding rice cereal.
- Feed your baby smaller amounts more often, and burp your baby often during feeding.
- Give your baby medicines that help food move from the stomach to the intestines faster, or that cut down on stomach acid.
Surgery for Gastroesophageal Reflux
If these steps don't improve your baby's symptoms, doctors may suggest surgery to create a valve at the bottom of the esophagus. This surgery is called fundoplication (pronounced fun-doe-plik-A-shun). There are several methods for fundoplication. Your child's doctor will discuss these with you.
In general, during fundoplication the surgeon pulls the top of the stomach up and wraps it around the lower esophagus. Then the surgeon sews the newly formed valve in place and closes the incision. The surgery takes about one to two hours, and your child will be in the recovery room for another hour.
Most often, surgeons choose to perform a laparoscopic, or minimally invasive, surgery. During minimally invasive surgery, the surgeon makes several small incisions. Then the surgeon inserts a thin, lighted tube with a camera and their surgical instruments through the incisions.
The advantage of laparoscopic surgery is that surgeons don't have to cut through the stomach muscles. Children may recover faster.
Sometimes, though, surgeons need to make one longer cut (incision) instead of the smaller incisions. This is called open surgery. Your child's surgeon will discuss this with you if it appears to be the best choice for your child.
Sometimes this operation is combined with placement of a gastrostomy tube, a feeding tube in the stomach that is placed through the abdominal wall. If your child needs this operation, their surgeon will discuss it with you.
For some children, another surgical option is to put in a feeding tube called a gastrojejunostomy tube. This tube bypasses the stomach and takes food directly into your child's small intestine.
After Surgery for Gastroesophageal Reflux
After surgery, we will give your child pain medicine to make them comfortable. They will get fluids and medicine through an IV (intravenous) line, a tube that goes into a vein. Your child may also need a tube that goes from the nose to the stomach. This is called a nasogastric tube, or NG tube. It helps keep the stomach empty during recovery.
You can expect your child to stay in the hospital for about two to five days. At home, you'll need to keep the incisions clean and dry until they heal. The surgery team will teach you how to care for the incision, explain what kinds of food or medicine to give your child, and tell you if you need to limit your child's activity for a while.
About two to three weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.