There are numerous reasons why an infant or child would need a G-tube and fundoplication operation at such a young age, but regardless of the reason, there are many advantages and disadvantages that parents should be aware of. Fundoplication is a surgery in which the upper part of the stomach is wrapped around the lower part of the esophagus; this is usually done to treat gastroesophageal reflux disease (GERD) if medications have proven ineffective for the child. A gastrostomy tube may be placed if the child has been using another feeding tube, such as a nasogastric (NG) or nasojejunal (NJ) tube. The gastrostomy tube may also be placed to provide a method of releasing air from the stomach to “burp” the child.
Reasons why some children need a G-tube and fundoplication
Surgery is definitely an option of last resort when it comes to children, but it is sometimes necessary to improve the health of patients. “Failure to Thrive” is a term often used when a child falls off the growth chart and is an indication that the child needs more nutrition and calories. There are several conditions that could lead to a child being stunted, but the most common would probably be a combination of GERD with poor oral intake of food.
It’s a vicious cycle as acid reflux irritates the esophagus, resulting in poor eating which can then be refluxed, usually several times a day. The child sometimes learns to associate the taste of the refluxed contents with food, and if the child refuses to eat, a feeding tube will be required to ensure she gets the nutrition she needs on a daily basis.
However, if the child’s reflux is not treated properly, there may be a chance that some or all of the tube feedings will be missed. That’s why a G-tube and fundoplication are sometimes needed: the G-tube to feed the child through the stomach, and the fundoplication to make sure the food stays in the digestive system.
Advantages of G-tube surgery and fundoplication in children
No one can deny that babies and toddlers are at an important developmental stage in their lives. Their growth is meticulously recorded, developmental milestones are marked according to the child’s months of age, and even the number of wet and dirty diapers are indicators of how healthy a baby is. That is why it is so imperative that a child grow up and gain weight. This surgery could help do that, simply because the G-tube would deliver food directly to the stomach and the fundoplication would prevent vomiting.
Another advantage of this, if the child has been using an NG or NJ tube, is that it would help with oral feeding. NG and NJ tube placement requires a very thin, flexible tube to be placed through the nose, down the esophagus, and into the stomach or intestine. Having a tube in your nose and also in the back of your throat doesn’t sound very comfortable, and having a tube that holds the “lid” of your stomach open doesn’t seem to help with reflux either. Elimination of this type of feeding tube would make the child much more comfortable with feeding and oral stimulation.
The Disadvantage of G-Tube Fundoplication Surgery in Children
Of course, there are some risks associated with the surgery and some possible side effects that can negatively affect the child. As with all surgeries, there is a risk of infection and it is a constant battle when it comes to a gastrostomy tube. To place the G-tube, the surgeon “tunnels” into the stomach from a hole under the left side of the ribs; A PEG tube is inserted into this tunnel with one end secured inside the stomach. The other end is available to deliver food and medicine and often needs to be secured inside the child’s clothing.
While the G-tube is in use, there is a hole in the body that may be susceptible to infection. Another thing this hole can be susceptible to is granulation tissue, or GT; it is skin that the body creates to fix the hole. GT is easily repaired using a prescription steroid cream or, if it becomes very large, it can be treated with silver nitrate in the surgeon’s office.
Fundoplication surgery prevents children from vomiting stomach contents; it often stops them from burping too! With no way for gas to go up through a burp, it has to go the other way, sometimes leading to gas pains in the child’s intestines. The stomach bandage may loosen over time, allowing the child to burp eventually.
Another possibility is that the stomach lining becomes completely loose, requiring another surgery to redo the fundoplication. Also, since this surgery requires using the upper part of the stomach to wrap around the esophagus, the stomach becomes smaller. As a result, a smaller volume of food is tolerated; Gagging may occur from the discomfort, and any gas within the stomach must be released through a common technique called ventilation.
While the gastrostomy tube and fundoplication can make it easier to give calories and nutrition to a child with a history of reflux and failure to thrive, it still has its drawbacks: smaller stomach volume, gas pains, retching, etc. However, if GERD has prevented the child from thriving and medications have failed to reduce acid reflux, G-tube and fundoplication surgery may be the only thing that can help.
