What Digestive Issue Causes Weight Gain Belching Gas Abdominal Pain Pros and Cons of G-Tube and Fundoplication Surgery in Children

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Pros and Cons of G-Tube and Fundoplication Surgery in Children

There are several reasons why a baby or child needs G-tube and fundoplication surgery at such a young age, but regardless of the reason, there are many pros and cons involved where the parents need to know about. Fundoplication is a surgery where 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) when medications have proven ineffective for the child. A G-tube, or gastrostomy tube, may be placed if the child has been using another feeding tube, such as a nasogastric (NG) or nasojejunal (NJ) tube. The G-tube may also be placed to provide a method to release air from the stomach to “burp” the baby.

Reasons why some children need a G-tube and fundoplication

Surgery is definitely a last option 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 can cause a child to not thrive, but the most common would probably be a combination of GERD with poor oral intake of food.

It’s a vicious cycle because the acid reflux irritates the esophagus, resulting in bad foods that 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, then a feeding tube would be necessary to ensure that the child gets the nutrition he or she needs daily.

However, if the child’s reflux is not adequately treated, there may be a chance that some or all of the tube feedings will be lost. Therefore, sometimes a G-tube and fundoplication are necessary: ​​the G-tube to feed the child through the stomach, and the fundoplication to ensure that the food stays in the digestive system.

Pros of G-Tube and Fundoplication Surgery in Children

No one can deny that babies and young children are at an important developmental stage in their lives. Their growth is accurately charted, developmental milestones are monitored according to how many months old the child is, 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 grows and gains weight. This surgery could help achieve that simply because the G-tube would deliver food directly to the stomach and the fundoplication would prevent it from regurgitating.

Another pro for this, if the child has used an NG or NJ tube, is that it would help with oral feeds. The placement of NG and NJ tubes require a very thin, flexible tube to be placed through the nose, down the esophagus, and into the stomach or intestine. Having a tube up your nose as well as the back of your throat doesn’t sound very comfortable, and having a tube holding the “lid” of your stomach open doesn’t sound like it would help with reflux either. Eliminating this type of feeding tube would make the child much more comfortable with oral feeding and stimulation.

The Downfall of G-Tube and Fundoplication Surgery for Children

Of course, there are some risks involved in surgery and some possible side effects that can negatively affect the child. As with all surgery, there is a risk of infection, and it’s an ongoing battle when a G-tube is involved. To place the G-tube, the surgeon makes a “tunnel” to the stomach from a hole under the left side of the ribs; a PEG tube is inserted into this tunnel with one end being secured inside the stomach. The other end is available to deliver food and medicine, and often needs to be secured in the child’s clothing.

As long as the G-tube is used, there is a hole in the body that can be susceptible to infection. Another thing that this hole can be prone to is granulation tissue, or GT; it is skin that makes the body to repair the hole. GT is easily fixed by using a prescribed steroid cream or, if it becomes very large, can be treated with silver nitrate in the surgeon’s office.

Fundoplication surgery prevents children from throwing up stomach contents – it often prevents them from burping too! With no way for gas to get through a burp, it has to go the other way, sometimes leading to gas pain in the child’s intestines. The stomach wrap can loosen over time, causing the child to eventually burp.

Another possibility is that the stomach wrap completely detaches, necessitating another operation to redo the fundoplication. Also, because this surgery requires the use of the top of the stomach to wrap around the esophagus, the stomach becomes smaller. As a result, a smaller volume of food is tolerated; retching of discomfort can ensue and all the gas inside the stomach must be released through a common technique called venting.

While the G-tube and fundoplication can make it easier to deliver calories and nutrition to a child with a history of reflux and not thrive, it still has its disadvantages: smaller stomach volume, gas pain, retching, etc. However, if GERD has made a child a failure to thrive and medications have failed to reduce the acid reflux, the G-tube and fundoplication surgery may be the only thing that can help.

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