Gastro-oesophageal reflux is extremely common in the first year of life and usually slowly gets better with time. There are however a number of children in whom significant gastro-oesophageal reflux persists. Medications can be very helpful in gastro-oesophageal reflux especially those medications that suppress acid and gastric fluid production such as Omeprazole. If gastro-oesophageal reflux is persistent and severe than a consideration might be made for a Nissen fundoplication. We usually only reserve an operation for gastro-oesophageal reflux for those children who have significant complications of gastro-oesophageal reflux.
These complications might be recurrent chest infections, persistent oesophagitis in spite of Omeprazole, or a failure to thrive because their vomiting is so significant that they are not able to keep enough calories down. Nissen fundoplication is generally done by a keyhole technique where the floppy upper part of the stomach is wrapped around the oesophagus to form a natural type valve. This does not impair the ability to swallow or take food orally but may impair the child’s ability to burp or vomit.
Over the first 1 – 2 days, starting with clear fluids the child is progressed back to a normal diet. The small laparoscopy holes are closed with dissolving stitches and then covered with a clear waterproof dressing so nothing further needs to be done for these. We recommend no baths or showers for 2 days and then normal baths or showers. The dressings will then fall off at some stage of their own accord. Tiredness can be significant after this operation so we recommend at least 1 week off school and then a graduated return, possibly starting with half days. Return to all normal activities about a week after surgery but probably wait for 3 weeks before returning to high energy activities and sports.
We would suggest avoiding fizzy drinks and thick foods which may get stuck (e.g. bread and chicken nuggets) for 6 weeks after surgery.