Anti-reflux surgery - children - discharge

When Your Child Was in the Hospital

Your child had surgery to treat gastroesophageal reflux disease (GERD). GERD is a condition that causes food or liquid to come up from the stomach into the esophagus. This is the tube that carries food from the mouth to the stomach.

During the operation, the surgeon wrapped the upper part of your child’s stomach around the end of the esophagus.

The surgery was done in one of these ways:

• Through a large incision (cut) in your child’s upper belly (open surgery)
• With a laparoscope (a thin tube with a tiny camera on the end)
• By endoluminal repair (like a laparoscope, but the surgeon goes in though the mouth)

Your child may also have had a plyoroplasty procedure to widen the opening between the stomach and small intestine. The doctor may have also placed a g-tube (gastrostomy tube) in the child's belly.

What to Expect at Home

Most children can go back to school or daycare as soon as they feel well enough.

• Your child should avoid heavy lifting or strenuous activity, such as gym class and very active play, for 3 weeks.
• You may ask your child’s doctor for a letter about the surgery to give to the school nurse and teachers to explain restrictions your child has.

Your child may have a feeling of tightness when swallowing. This is from the swelling inside your child's esophagus. Your child may also have some bloating. These should go away in 6 to 8 weeks.

Recovery is faster from laparoscopic surgery than from open surgery.

You will need to schedule a follow-up appointment with your child’s primary care provider or gastroenterologist about a week after the surgery.

Care at Home

After your child goes home, you will slowly get him or her back to a regular diet.

• Your child should have started on a liquid diet in the hospital.
• Once the doctor feels your child is ready, you can add soft foods.
• Once your child is taking soft foods well, talk with your child’s doctor about returning to a regular diet.

If your child had a g-tube (gastrostomy tube) placed during surgery, it can be used for feeding and venting. Venting is when the g-tube is opened to release air from the stomach, similar to burping.

• The nurse in the hospital should have shown you how to vent, care for, and replace the g-tube, and how to order g-tube supplies. Follow instructions on gastrostomy tube care.
• If you need help with the g-tube at home, contact the home health care nurse who works for the g-tube supplier.

For pain, you can give your child over-the-counter pain medicines such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). If your child is still having pain, call your child’s doctor.

Wound Care

If sutures (stitches), staples, or glue were used to close your child’s skin:

• You may remove the dressings (bandages) and allow your child to take a shower the day after surgery.
• If your child cannot take a shower, give him or her a sponge bath.

If strips of tape were used to close your child’s skin:

• Cover the incisions with plastic wrap before showering for the first week. Tape the edges of the plastic carefully to keep water out.
• Do not try to wash the tape off. They will fall off after about a week.

Do not allow your child to soak in a bathtub or hot tub or go swimming until your child’s doctor tells you it is okay.

When to Call the Doctor

Call your child’s doctor or nurse if your child has:

• A temperature above 101°F (38.3°C)
• Incisions that are bleeding, red, warm to the touch, or have a thick, yellow, green, or milky drainage
• A swollen or painful belly
• Nausea or vomiting for more than 24 hours
• Problems swallowing that keep your child from eating
• Problems swallowing that do not go away after 2 or 3 weeks
• Pain that pain medicine is not helping
• Trouble breathing
• A cough that does not go away
• Any problems that make your child unable to eat

References

International Pediatric Endosurgery Group (IPEG). IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD). J Laparoendosc Adv Surg Tech A. 2009;19 Suppl 1:x-xiii.

Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391.

Khan S, Orenstein SR. Gastroesophageal reflux disease. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 315.

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