Anti-reflux surgery - children
Fundoplication - children; Nissen fundoplication - children; Belsey (Mark IV) fundoplication - children; Toupet fundoplication - children; Thal fundoplication - children; Hiatal hernia repair - children; Endoluminal fundoplication - children
Anti-reflux surgery is surgery to tighten the muscles at the bottom of the esophagus (the tube that carries food from the mouth to the stomach). Problems with these muscles can lead to gastroesophageal reflux disease (GERD).
This surgery can also be done during a hiatal hernia repair.
This article discusses anti-reflux surgery in children.
A band of muscle fibers, the lower esophageal sphincter, closes off the esophagus from the stomach. If the sphincter does not close properly, food and liquid can move backward into the esophagus and cause heartburn and other symptoms known as gastroesophageal disease (GERD). To alleviate symptoms dietary changes and medications are prescribed. For a patient who has persistent symptoms despite medical treatment, an anti-reflux operation may be an option.
Description
The most common type of anti-reflux surgery is called fundoplication. This surgery most often takes 2 to 3 hours.
Your child will be given general anesthesia before the surgery. That means the child will be asleep and unable to feel pain during the procedure.
The surgeon will use stitches to wrap the upper part of your child's stomach around the end of the esophagus. This helps prevent stomach acid and food from flowing back up.
A gastrostomy tube (g-tube) may be put in place if your child has had swallowing or feeding problems. This tube helps with feeding and releases air from your child's stomach.
Another surgery, called pyloroplasty may also be done. This surgery widens the opening between the stomach and small intestine so the stomach can empty faster.
This surgery may be done several ways, including:
- Open repair -- The surgeon will make a large cut in the child's belly area (abdomen).
- Laparoscopic repair -- The surgeon will make 3 to 5 small cuts in the belly. A thin, hollow tube with a tiny camera on the end (a laparoscope) is placed through one of these cuts. Other tools are passed through the other surgical cuts.
The surgeon may need to switch to an open procedure if there is bleeding, a lot of scar tissue from earlier surgeries, or if the child is very overweight.
Endoluminal fundoplication is similar to a laparoscopic repair, but the surgeon reaches the stomach by going through the mouth. Small clips are used to tighten the connection between the stomach and esophagus.
Why the Procedure Is Performed
Anti-reflux surgery is usually done to treat GERD in children only after medicines have not worked or complications develop. Your child's health care provider may suggest anti-reflux surgery when:
- Your child has symptoms of heartburn that get better with medicines, but you do not want your child to continue taking these medicines.
- Symptoms of heartburn are burning in their stomach, throat, or chest, burping or gas bubbles, or problems swallowing food or fluids.
- Part of your child's stomach is getting stuck in the chest or is twisting around itself.
- Your child has a narrowing of the esophagus (called stricture) or bleeding in the esophagus.
- Your child is not growing well or is failing to thrive.
- Your child has a lung infection caused by breathing contents of the stomach into the lungs (called aspiration pneumonia).
- GERD causes a chronic cough or hoarseness in your child.
Risks
Risks for any surgery include:
- Bleeding
- Infection
Risks for anesthesia include:
- Reactions to medicines
- Breathing problems, including pneumonia
- Heart problems
Anti-reflux surgery risks include:
- Damage to the stomach, esophagus, liver, or small intestine. This is very rare.
- Gas and bloating that makes it hard to burp or throw up. Most of the time, these symptoms slowly get better.
- Gagging.
- Painful, difficult swallowing, called dysphagia. For most children, this goes away in the first 3 months after surgery.
- Rarely, breathing or lung problems, such as a collapsed lung.
Before the Procedure
Always make sure your child's health care provider know what medicines your child is taking including medicines, drugs, herbs, and vitamins you bought without a prescription.
Planning for your child's surgery:
- If your child has diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats your child for these conditions.
- If needed, prepare your home to make it easier for your child to recover after surgery.
During the week before surgery:
- Your child may be asked to temporarily stop taking medicines that keep the blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
- Ask your surgeon which medicines the child should still take on the day of surgery.
- Let your surgeon know about any illness your child may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes breakout, or other illness. If you do get sick, your surgery may need to be postponed.
On the day of the surgery:
- Follow instructions about when to stop eating and drinking..
- Give your child the medicines your surgeon told you to take with a small sip of water.
- Arrive at the hospital on time.
After the Procedure
How long your child stays in the hospital depends on how the surgery was done.
- Children who have laparoscopic anti-reflux surgery usually stay in the hospital for 2 to 3 days.
- Children who have open surgery may spend 2 to 6 days in the hospital.
Your child can start eating again about 1 to 2 days after surgery. Liquids are usually given first.
Some children have a g-tube placed during surgery. This tube can be used for liquid feedings, or to release gas from the stomach.
If your child did not have a g-tube placed, a tube may be inserted through the nose to the stomach to help release gas. This tube is removed once your child starts eating again.
Your child will be able to go home once they are eating food, have had a bowel movement and are feeling better.
Outlook (Prognosis)
Heartburn and related symptoms should improve after anti-reflux surgery. However, your child may still need to take medicines for heartburn after surgery.
Some children may need another operation in the future to treat new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the esophagus too tightly or it loosens.
The surgery may not be successful if the repair was too loose.
References
Chun RH, Noel RJ, Arvedson JC. Pediatric swallowing, laryngopharyngeal and gastroesophageal reflux disease, eosinophilic esophagitis, and aspiration. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 212.
Holcomb GW. Gastroesophageal reflux. In: Holcomb GW, Murphy JP, St. Peter SD, eds. Holcomb and Ashcraft's Pediatric Surgery. 7th ed. Philadelphia, PA: Elsevier; 2020:chap 28.
Khan S, Matta SKR. Gastroesophageal reflux disease. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 369.
Version Info
Last reviewed on: 1/17/2025
Reviewed by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
