Fundoplications in children

I was wondering what your personal observation has been with nissen fundoplications in children, and the long-term success rate. It seems that some doctors say it's wonderful, very few risks, long-term success in controlling reflux. Others say that it is only successful part of the time and the complications are often worse than the initial reflux.

Is there an age when it is more successful than at other ages? I have heard that it's not as successful in infants because of rapid growth.

I am NOT looking for medical advice-- that's what the doctor is for-- but I am just looking for your own persona observations and experiences as nurses. My child has reflux and a gtube and no history of aspiration so we have held off on the fundo for now and the doctors support this for the most part. She is doing just fine with slow bolus feeds. There may be a time when I would be advised to consent to this and I just want to know from "insiders" what the results of this surgery usually are.

Thanks! :)

I'll put in my two cents. I don't work in peds GI anymore, but I used to. In our markey I have seen at least one complete cycle go around. From everyone with GERD gets fundo to no one gets one. Mostly if they are having FTT or aspiration they are indicated. Since your child already has a GT the biggest problem, not being able to burp is alleviated. That being said, if you are not having problems, then why take a risk. It is still surgery and has risks. Generally they do not last forever and most break down over time. The one thing that I have learned about this, is that you want a surgeon that has done a ton of these (more than 500 preferrably). This is a very difficult operation to get right (not tremendously tough to do). If you get it wrong the children are miserable.

Best of luck

David Carpenter, PA-C

David thanks so much for responding. It's been interesting with the trends. On my parent support group, patients in the midwest still seem to get an automatic fundo with any gtube placement (reflux or not). Patients at CHOP and other leading hospitals, as well as east coast seem to not get one anymore unless there is a strong reason to (such as aspiration problems).

By the way, since posting that I found out that my daughter has E.E. So getting a fundo would not have been the right treatment for her. I'm so glad I waited and said no, let's see what might be causing her vomiting and reflux problems. She is now on an elemental formula and a very restricted diet of safe foods when she feels like eating. Hopefully her problems will get better soon.

Her old doctor was pushing the fundo and said he was just waiting for me to give the word. Her new doctor said she wanted to do a scope first and see what might be going on. I think I like the new doctor better.

I have a hard time believing that anyone would consider a fundo without a scope. Around here the minimum would be 24 hour pH and an EGD. In adults you want manometry also. Good luck with the EE. The good luck is that most kids with food allergy as infants outgrow it so you won't be on liquid gold forever.

David Carpenter, PA-C

David, I guess you never met her old GI. Her last scope was at 8 mos old with the PEG placement. She continued to vomit and show distress, only tolerate 4 oz a time, etc etc. He said she has GERD, there's nothing more we can do for her. If you get tired of her vomiting I'll do a fundo. Finally at nearly 3 years old I take her to a new GI and a short time later she has a dx of EE. (She also has GERD-- burps all the time and the GI even saw her reflux during the scope-- but she also has known food allergies).

Just found out that after our samples of elemental formula run out, insurance only will pay 50% of it. Which means we pay $400/month as our share. Gulp. There is no way we can afford that. So I guess they like paying for those enteral supplies for the rest of her life instead, 'cause until she feels better she's not going to eat. Makes no sense to me. Sigh.

Sorry to get so off topic.

Talk to your GI they may have samples they can give you. Also look into patient assistance programs. Finally look into getting it paid for through either prescription benefit or medical benefit (whichever will pay the best). There are ways around this but its tough. You may need to have them sign up for home health nursing and dietary to get this covered under medical.

David Carpenter, PA-C