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Post by jennifer2005 on Jul 8, 2007 22:58:01 GMT -5
Has anyone went thru the Nissen fundo surgery? did the reflux stop? Was it worth it? Peds surgeon wants to do a G tube as well...can anyone give me insight on this surgery? My DS son is 21 months old....
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Post by Chris too on Jul 9, 2007 21:34:58 GMT -5
Why a G tube? How would that help reflux? Do the GERD meds not work for your son; have you tried them all? Have you talked this over with your son's regular pediatrician?
Chris
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Post by momofrussell on Jul 10, 2007 10:02:18 GMT -5
I would assume the g tube is because they are aspirating. It could be for something different in JAS's case but there are some kids that have a g tube because they aspirate liquids too much. That would also be the reason for the fundo surgery. IF a child medically is aspirating, ect, then I'd do the surgery. BUT... I am wondering why they want to do both? Can't the g tube help alone or do they need to do both? Can you tell we have lots of questions for your doctor? LOL Oh.. and if your child has never aspriated or choked and they want to do all of this, I'd be questioning why  A. |
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Post by wrblack on Jul 10, 2007 13:08:51 GMT -5
Have no experience with either procedure, Nissen nor g-tube. We skipped that one. Charlie does have some reflux; we just take Zantac twice a day. You might want to read Dr. Leshin on GERD, www.ds-health.com/reflux.htmif you haven't already. As to why surgeon is recommending a g-tube as well, probably would be best to ask the surgeon and, if you have any doubts, ask a pediatric gastroenterologist, think we know a good one at CHOP. But one of possible reasons is that food, particularly liquids, could be "pooling" in the esophagus before reaching the stomach. Fundoplication would stop reflux from the stomach. But the way to prevent the pooling in the esophagus would be to bypass the esophagus by means of the g-tube. Oddly, there are kids who need g-tubes for other reasons, and then those kids are more prone to develop GERD because of the g-tubes. Couple of other questions you might want to pose for your son's doctors, what's long term prognosis? Do they think the need for the g-tube is something he may outgrow? Venture a guess on how many years? I believe there are at least two ways of performing the fundoplication procedure. I would ask the surgeon if that's correct? What's his or her preferred method? What method do they plan to use on your son? If I had any remaining questions, doubts, reservations about any of this, I wouldn't hesitate to ask more questions and get a 2nd or 3rd opinion if need be. But, yeah, think you could find quite a few kids with Ds who have had both a fundo and a g-tube. And believe those procedures have helped big majority of those kids. -- Bob (once again incredibly long-winded for someone who doesn't know anything about this stuff) |
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Post by laurasnowbird on Jul 11, 2007 10:50:00 GMT -5
Ethan had horrible reflux, which was complicated by an intestinal obstruction. A duodenal bypass was performed to correct the obstruction, but the stomach and esophagus were really dilated, and accompanied by the inevitable low tone, he continued to reflux. He takes Prevacid twice a day....and has since he was 8 months old. The surgeon believed we should do a fundo. The peds GI doc was undecided. We made the final decision and said "not yet".
Fundo is a pretty life-changing surgery, and from what I understand, rather hard to un-do. Children who have fundos are unable to vomit or belch. (In other words, you wouldn't want to drink a Coke really fast) The gas has to have an exit, so sometimes the g-tube is used partially to "vent" the gas. Ethan was very young when it was suggested, so we said no to the procedure. Our concerns were of course the inability to vomit (what if he swallowed something poisonous, and poison control told us to make him vomit?) the inability to belch, and the information shared by our feeding specialist, Lori Overland. Ethan had major food issues, and she said that in many cases, fundo would make the feeding issues worse. We were NOT up for a complication like that at the time. We also hoped that gravity would be our friend, and that when he began walking and spending more time upright it might get better.
After deciding to wait a while to decide about the surgery, and while continuing to research it, I found this:
Surgical procedure to treat GERD in children found to be ineffective
Main Category: Acid Reflux/GERD News
Article Date: 04 Nov 2004 - 0:00 PDT
|Article Also Appears In
GastroIntestinal / Gastroenterology
According to a study published in the American Gastroenterological Association (AGA) journal Clinical Gastroenterology and Hepatology, more than 60 percent of the children who received surgical fundoplication to control gastroesophageal reflux disease (GERD) had recurring symptoms of the disease months following surgery. The procedure is the third most common major surgical procedure performed in children. Overall, fundoplication as a treatment for GERD in children needs further evaluation.
Results of this retrospective cohort study, conducted on 198 children who underwent fundoplication at Texas Children's Hospital in Houston from 1996-1999, suggest that fundoplication for the treatment of GERD in children is not the most effective method of short- or long-term treatment for the disease. GERD in young children is often overlooked and is normally outgrown by the time a child reaches their first birthday. However, GERD that develops in older children can be very severe and persistent.
"Fundoplication is not a long-term solution for children with GERD, whether or not they have medical conditions that predispose them to the disease," said Hashem El-Serag, MD, MPH, senior study author. "This study emphasizes the importance of pre-operative counseling on alternative treatment options for GERD in children, as well as an assessment of the risks and benefits involved."
Fundoplication is a procedure which involves surgical strengthening of the sphincter between the esophagus and the stomach. This can reduce the amount of stomach acid that backs up into the esophagus, which can cause repeated vomiting, coughing and other respiratory problems in children.
Currently, there are a number of medical alternatives for GERD, including therapy with histamine-2 receptor antagonists (HRAs), proton pump inhibitors (PPIs) and prokinetics. There are several brands of each of these therapies available by prescription and over-the-counter; however, most of these therapies only provide short-term relief of symptoms. Although endoscopy is another method which provides a simpler way of treating GERD in adults, its long-lasting efficacy has not been determined. Researchers advise patients to discuss alternatives to fundoplication prior to surgery.
About the Study
Lead study author Mark A. Gilger, MD and other researchers at Baylor College of Medicine conducted a retrospective cohort study using the medical records of all children who underwent fundoplication during 1996 and 1999 at Texas Children's Hospital in Houston, TX. There were two groups of children in the study, those who had one or more associated medical conditions (e.g., cystic fibrosis, reactive airway disease) and those who had no pre-existing diseases that increased their risk of developing GERD. Moreover, children with associated medical disorders had an increased incidence of lung infections and dumping syndrome. Findings from this single-center study need to be confirmed in future prospective studies to determine generalizability.
About the AGA
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is the oldest medical-specialty society in the United States. The AGA's 14,000 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. On a monthly basis, the AGA publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The AGA's annual meeting is Digestive Disease Week, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
About Clinical Gastroenterology and Hepatology
The mission of Clinical Gastroenterology and Hepatology is to provide readers with a broad spectrum of themes in clinical gastroenterology and hepatology. This monthly peer-reviewed journal includes original articles as well as scholarly reviews, with the goal that all articles published will be immediately relevant to the practice of gastroenterology and hepatology.
Contact: Kimberly Wise
kwise@gastro.org
301-941-2620
American Gastroenterological Association
We have had Ethan's esophageal health monitored yearly, to make certain he is not suffering erosive effects from the reflux, and to ascertain that his Prevacid was working. Keep in mind also that he has never had aspiration pneumonia, which could be an important reason for doing a fundo.
Ethan still has significant reflux, and we have not completely ruled out a fundo at some point in his life, but we aren't inclined to believe it would be as effective as we were initially given to believe, KWIM? And we are considering it a last resort sort of option.
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Post by mommygwen on Jul 11, 2007 17:24:38 GMT -5
The fundiplication works by taking one of the stomach muscles off of the stomach and wrapping around the base of the esophagus. When the stomach muscles contract to cause vomiting or reflux the muscle at the esophagus tightens and blocks the exit from the stomach. It does not work to prevent GERD that occurs from lax muscles or gravity (lying down).
I did not want my younger son (who has cerebral palsy) to have the fundo because I knew of 2 children with CP who had retching syndrome after the surgery. (the heaves lasted for hours and sometime days at a time, in spite of opening the gtube to "vent" the stomach.) My son did need the gtube to get enough fluids and calories. He was 20 months old. He is now 13 and has had pneumonia 3 times this winter and spring. I am now considering the fundo if this continues.
The fundo can become undone. Especially if the child retches often.
The gtube can be removed and allowed to heal. There will be a scar. I just met someone whose child had 3 gtubes (one at a time) and is now done with them and eating well and normally.
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Post by liasmom on Jul 11, 2007 22:26:52 GMT -5
Ok- I am thinking Lia needs this surgery- They have tried many combination of drugs on her- currently on Prevacid, Carafate and Erythromycin (instead of Raglan). She is soooo symptomatic. Has the Sandifer syndrome where she arches her back and looks up- probably more than once a minute. She actually runs into stuff. Also tips her head to the side or bends over and puts it on the ground almost. It is ruining her life. Can not concentrate because of this. I can't imagine the surgery would be worse than this. Nancy
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Post by pmjc on Jul 12, 2007 5:18:43 GMT -5
Nicky is nearly 20, he had a Nissans fundoplication when he was 6 and without it he would not have survived. He had very severe reflux which badly scarred his oesophagus which eventually closed up completely due to scar tissue so it was fortunate that he had a gastrostomy at the same time as the fundo, he has now been totally tube fed for 13 years. His oesophagus was re-routed out through the side of his neck and his secretions now come out through the stoma so he no longer gets aspiration pneumonias every couple of weeks.
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Post by pmjc on Jul 12, 2007 5:25:14 GMT -5
P.S. Nicky can not vomit but if I see him heaving I open the g tube and release his stomach contents through it so vomiting has not been a problem.
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Post by mommygwen on Jul 12, 2007 20:05:34 GMT -5
Paula - so glad to read your explanation
Jonathan has had so much trouble managing his saliva. He arches his back and then gags. Repeated pneumonias means even more secretions. Now I know how it can be handled if suctioning becomes an unending need.
Gwen
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Post by steffipoo on Jul 17, 2007 21:00:48 GMT -5
they almost did a fundoplication on my girl when she was 18 months due to reflux and aspiration. Since her regular gi doctor was out of town I asked to wait for him to read her ph probe that the rest of the doctors read and said she HAD TO have the surgery quickly. WELL glad I waited cause her GI doctor said her reflux was actually getting better and she aspirated not once. He HIGHLY recommended she NOT do it then he gave the entire GASTRO team a HUGE lecture cause he made em all sit and read the results with him then ripped the head doctor and his students (he was the other head doc) another you know what cause they just so happened to be studying funo surgery then and voila wpoulda ripped my girl open to learn a lesson. Boy never seen a doc so mad in my life as her GI doctor. Please make sure you get all the information on this surgery as possible. Laura really gave you some A#1 info.
Nancy I hear ya sounds like something needs to be done with Lia she sounds miserable. Give her a ((HUGS))) steff
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Post by steffipoo on Jul 17, 2007 21:05:44 GMT -5
We repeated Livs PH probe when she was up and walking for about 6-8 months. Her GI doctor was right. He had said even if he were to do the fundo he would wait until she was up and walking for 6 months or so before repeating the ph probe. cause he said sitting up , walking, standing is a HUGE way to relieve kids of reflux,gerd, . Livs aspiration was caused by a vascular ring which was repaired (aound her esophogus-trachea)but still compressed and not completely normal like it is now. So that just got better with time. But walking for a while ...her ph probe was perfect and just like any other kids without reflux.Just thought i'd throw that in there...
BYW do you thicken his drinks? try kerns nectars they work for both constipation and reflux cause they are thicker than most drinks. ((HUGS))) steff
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Post by Chris too on Jul 17, 2007 21:20:18 GMT -5
Gwen,
Does Jonathan get feeding therapy to help improve his swallowing? Stevie aspirated everything thinner than pudding in the beginning, but a great therapist has been working with her weekly and she's great now with as thin as nectar (milk is fine in a valved sippy). Her reflux continues, but Prevacid handles that. I don't know why a fundo would help Jonathan with handling saliva; sounds like he needs Sabra (our OT who's teaching Stevie), or someone like her.
JAS, what's up? Please post up soon to let us know what's going on, whether or not your son will be having this procedure or something else, and how he is doing.
Chris, too
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Post by NoahsMommy on Jul 25, 2007 9:36:12 GMT -5
My son has a g-tube and has the nissen done. Both really were not an option for us. He was born with esophageal atresia (7 cm of his esophagus was missing), so had to have the g-tube placed for nutrition. They are very easy to maintain as long as you have a Mickey button. They're pretty flat on the tummy with no extensions hanging out. We've never had a problem with one.
He also had the Nissen done when he was about 18 months old. Once his esophagus was fixed, he was refluxing all the way into back of his mouth. We had it done and he recovered very quickly. He was unable to throw up for about 1-1.5 years. It has loosened up over time and he can throw up now, however reflux does not seem to be an issue with him, so I think he just needs the force to actually push things through when he throws up. I have heard some kids need to have the surgery repeated as they can come completely undone. I also have read there are partial and full Nissens, may want to discuss with your doctor which he will do. I believe Noah's was a complete.
If you have any questions please feel free to email me.
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