Nissen fundoplication is the final option, after medications haven’t worked, for controlling severe Gastroesophageal Reflux Disease(GERD). Reflux involves formula and stomach juices sloshing up into the esophagus. Reflux can make the baby spit up frequently, irritating the esophagus and if left untreated can result in esophageal cancer. Reflux can also cause apnea and cause formula and stomach juices to go into the baby’s lungs, which can cause lung damage.

Nissen fundoplication also referred to as the 'wrap' or ‘fundo’ is a surgical procedure to tighten the valve between the esophagus and the baby’s stomach. Similar to the way a scarf is wrapped around a person’s neck, part of the baby’s stomach called the "fundus" (hence the term fundoplication) is wrapped around the esophagus.

The procedure creates a one-way valve in the esophagus, which allows food to go into the stomach, but prevents stomach acid from coming back into the esophagus preventing GERD. It is not a cure for GERD and is only performed when severe symptoms and complications persist.

The procedure is performed ether 'open' or 'laparoscopically' with the patient under general anesthesia. To assist with postoperative recovery, frequently a gastrostomy tube will be placed at this time. If the G-tube is needed for feeding or gas bloat issues it may remain indefinitely, otherwise it is usually only needed for a few months.

Some reasons your child might need to have reflux surgery are esophageal stricture, Barrett’s esophagus (an absolute indication as this may end up in cancer), life-threatening apnea and recurrent aspiration pneumonia, large hiatal hernia, failure of maximal medical therapy to reduce severe symptoms, severe esophagitis (esophageal inflammation), recurrent pneumonia, chronic lung disease, bronchospasm, and failure to gain weight.

Fundoplication surgery has risks from anesthesia, infection, and bleeding just like every other surgery. However it can also cause the inability to burp or vomit, gas bloat syndrome, Retching or dry heaves, difficulty eating after surgery because of swelling at the fundo site or food aversion, dumping Syndrome, small bowel obstruction, disruption of the wrap, post-op dysphasia, and hiatus hernia.

My friend has a son with Down syndrome who had this surgery. He wasn’t gaining weight, was frequently ill, and had several hospitalizations. He did have a g-tube placed, which they used for over a year. That was several years ago and she has been very pleased with the results of the surgery.


Read more on About Down syndrome (DS)
About G-tube Feeding
Pediatric GERD
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