Gastroesophageal reflux (GER) is present, to some degree, in all children.  Spitting up (or vomiting) is the visible result of GER, however most GER involves regurgitation of stomach contents into the esophagus or mouth - which is then reswallowed.  GER is considered GER disease (GERD) when the child suffers adverse effects from the reflux.  These complications include: respiratory distress, aspiration pneumonia, discomfort, and poor growth.  When medicines, diet, and position changes do not correct GERD, then surgery may be necessary.  The most common surgery performed for GERD is fundoplication.  This well-conceived idea takes advantage of the stomach's normal tendency to contract when filled.  A portion of the upper stomach wall is wrapped around the lower part of the esophagus such that when the stomach is filled, the wrap will keep the junction of the esophagus and stomach closed.  This helps prevent reflux of stomach contents into the esophagus, while still allowing food to enter the stomach.

What is a Nissen fundoplication?

Nissen fundoplication is a surgery performed to help prevent GER.  The procedure is most commonly performed on infants and young children who are having significant problems related to GER and who have not responded to traditional therapy.

The upper part of the stomach is wrapped around the lower part of the esophagus.  This is sutured in place.  When food passes into the stomach, the stomach walls normally contract.  Instead of forcing stomach contents up into the esophagus (i.e., GER), the wrapped portion of the stomach tightens around the lower esophagus, closing the connection.

The procedure can be performed as an "open" surgery or by laparoscopy.

What are the reasons for fundoplication?

GER associated with...

• Apnea - not breathing for a significant amount of time, causing distress, blue or pale color, and death in extreme cases
• Bradycardia - a slow heart rate due to apnea
• An apparent life-threatening event (ALTE) - such as an episode of severe choking with apnea
• Aspiration with or without pneumonia - stomach contents entering the esophagus and then the airway and lungs
• Chronic lung disease
• Failure to thrive - poor weight gain
• Severe vomiting
• Damage to the esophagus due to stomach acid

Who performs the surgery?

A surgeon (typically a pediatric surgeon). 

What are the potential complications of fundoplication?

If the wrap is too tight...  This leads to difficulty swallowing, drooling, and frequent gagging.  There may be a complete inability to vomit.  The surgery may have to be repeated to repair the fundoplication.

If the wrap is too loose...  The symptoms of GERD may be unchanged by the surgery.  The surgery may have to be repeated to repair the fundoplication.

What are the success rates of fundoplication?

Over 70% of fundoplications are called "successful," according to several different studies.  Repeat operations are needed in between 7 and 26% of cases.  GER is often not COMPLETELY cured, however most infants stop having choking, aspiration pneumonia, and poor growth after fundoplication.