Anti-reflux surgery - 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).
Gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe). F...
This surgery can also be done during a hiatal hernia repair.
Hiatal hernia
Hiatal hernia is a condition in which part of the stomach extends through an opening of the diaphragm into the chest. The diaphragm is the sheet of ...
This article discusses anti-reflux surgery in children.
Video Transcript
Gastroesophageal reflux in infants - Animation
Does your baby spit up all the time? Is he crying inconsolably and you can't figure out why? Your baby may have gastroesophageal reflux. When a baby eats, food passes from their throat to their stomach through the esophagus, also called the food pipe. Once food is in the stomach, a ring of muscle prevents food from moving backwards into the esophagus. If this muscle doesn't close well, food can leak back into the esophagus. This is called gastroesophageal reflux. If the reflux is causing problems, it's called GERD. How do you know for sure that your baby has GERD? Some reflux in infants after a meal is normal. Most will have reflux during their first three months of life because the ring of muscle, or sphincter, preventing food from moving back into their esophagus hasn't toughened up yet. The time to be concerned is if your baby is fussy a lot, has a chronic cough or chronic ear infections, does not eat well, or doesn't gain as much weight as he should. When GERD lasts beyond about 18 months, your child's doctor will probably want to run some tests, including pH probes, to find out how often and how long stomach acid is in your child's esophagus, gastric emptying studies, and x-rays. So, how is GERD in infants treated? Changing how you feed your baby can go a long way toward helping his reflux. Try burping your baby after he drinks one to two ounces of formula, or after feeding on each side if you are breastfeeding. You can add a tablespoon of rice to two ounces of formula, cow's milk (for baby's 12 months or older), or pumped breast milk. Changing the size of the nipple for your baby's bottle may help. Try holding your baby upright for 20 to 30 minutes after feeding too. Avoid overfeeding and avoid exposure to tobacco smoke. For some babies, avoiding cow's milk protein may also help. If reflux is still causing problems, your baby's doctor may try medications. Most babies outgrow this problem. But rarely GERD may last into childhood, potentially causing damage to their esophagus. Your child's doctor will keep an eye on the problem and let you know if surgery to fix it is a good idea.
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.
Pyloroplasty
Pyloroplasty is surgery to widen the opening in the lower part of the stomach (pylorus) so that stomach contents can empty into the small intestine (...
Read Article Now Book Mark ArticleThis 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.
Failing to thrive
Failure to thrive refers to children whose current weight or rate of weight gain is much lower than that of other children of similar age and sex....
Read Article Now Book Mark Article - 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
Bleeding
Bleeding is the loss of blood. Bleeding may be:Inside the body (internal)Outside the body (external)Bleeding may occur:Inside the body when blood le...
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Risks for anesthesia include:
- Reactions to medicines
- Breathing problems, including pneumonia
Breathing problems
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
ImageRead Article Now Book Mark Article - 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.
Diabetes
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
ImageRead Article Now Book Mark Article - 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.
Cold
The common cold most often causes a runny nose, nasal congestion, and sneezing. You may also have a sore throat, cough, headache, or other symptoms....
ImageRead Article Now Book Mark ArticleFlu
The flu (influenza) is a viral respiratory illness that causes fever, chills, runny nose, body aches, and cough. It spreads easily from person to pe...
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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.
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.
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.
