Anti-reflux surgery is surgery to repair 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 repair a hiatal hernia.

A procedure called fundoplication is the most common type of anti-reflux surgery. Your child will be under general anesthesia during surgery. This will make your child unconscious and unable to feel pain. This surgery usually takes 2 to 3 hours.

• During this surgery, 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 g-tube (gastrostomy tube) may be placed to help with feeding and to release air from your child’s stomach. The surgeon may use a g-tube if your child has had swallowing or feeding problems.
• The surgeon may do another procedure called a pyloroplasty. This procedure widens the opening between the stomach and small intestine so that the stomach can empty faster.

Ways the doctor may do this surgery are:

• Open repair. The surgeon will make a large incision (cut) in your child’s belly area (abdomen).
• Laparoscopic repair. The surgeon will make 3 to 5 small incisions in the belly. The surgeon will insert a laparoscope (a thin, hollow tube with a tiny camera on the end) through one of these incisions and other tools through the other incisions. 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.

GERD is a condition that causes food or stomach acid to come back up from the stomach into the esophagus. This is called reflux. It can cause heartburn and other uncomfortable symptoms. Reflux occurs if the muscles where the esophagus meets the stomach do not close tightly enough.

A hiatal hernia occurs when the natural opening in the diaphragm is too large. The diaphragm is the muscle layer between the chest and belly. Your child’s stomach may bulge through this large hole into their chest. This bulging is called a hiatal hernia. It may make GERD symptoms worse.

Surgery is usually done to treat GERD in children only after medicines have not worked or problems develop. Your child’s doctor may suggest 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 their chest or is twisting around itself.
• Your child has strictures (a narrowing of the esophagus), bleeding in the esophagus, is not growing well, or has failure to thrive.
• Your child has aspiration pneumonia (a lung infection caused by breathing contents of the stomach into the lungs), a chronic cough, or hoarseness.

Risks for any anesthesia are:

• Reactions to medicines
• Breathing problems, including pneumonia
• Heart problems

Risks for any surgery are:

• Bleeding
• Infection

Risks for this surgery are:

• Gas bloat, which makes it hard to burp or throw up. It also causes bloating after meals. These symptoms slowly get better for most people.
• Pain and difficulty swallowing, called dysphagia. For most children, this goes away in the first 3 months after surgery.
• Gagging, gas, and bloating
• Damage to the stomach, esophagus, liver, or small intestine. This is very rare.
• Breathing or lung problems, such as a collapsed lung. This is also rare.
• The repair may be too loose. This makes the surgery ineffective.

Always tell your child’s doctor or nurse if your child is taking any drugs, supplements, or herbs you bought without a prescription.

A week before surgery, you may be asked to stop giving your child medicine and supplements that affect blood clotting. Some of these are aspirin, ibuprofen (Advil, Motrin), vitamin E, and warfarin (Coumadin).

On the day of your child’s surgery:

• Do not allow your child to eat or drink anything after midnight the night before surgery.
• Have your child take the drugs your child’s doctor told you to give with a small sip of water.
• You child may take a bath or shower the night before or the morning of surgery.
• Your child’s doctor or nurse will tell you when to arrive at the hospital.

Children who have laparoscopic surgery usually spend 2 to 3 days in the hospital. Children who have open surgery may spend 2 to 6 days in the hospital.

Usually 1 to 2 days after surgery, your child can start eating again. Usually your child will be given just liquids at first.

If your child had a 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.

If your child did not have a g-tube placed, they may have a tube that goes from the nose to their stomach to help release gas. This tube will be 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 (poop), and are feeling better.

Anti-reflux surgery repair is a safe operation. Heartburn and other symptoms should improve after surgery. But, your child may still need to take drugs for heartburn after surgery.

Some children will 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.

Brant K. Oelschlager BK, Eubanks TR, Pellegrini CA. Hiatal Hernia and Gastroesophageal Reflux Disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 42.

Orenstein S, Peters J, Khan S, Youssef N, Hussain SZ. Gastroesophageal reflux disease (GERD). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 320.

Lobe TE. The current role of laparoscopic surgery for gastroesophageal reflux disease in infants and children. Surg Endosc. 2007 Feb;21(2):167-74.

Saedon M, Gourgiotis S, Germanos S. Is there a changing trend in surgical management of gastroesophageal reflux disease in children? World J Gastroenterol. 2007 Sep 7;13(33):4417-22.