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Pros and Cons of G-Tube and Fundoplication Surgery in Children
There are many reasons why an infant or child may need G-tube and fundoplication surgery at such a young age, but regardless of the reason, there are many pros and cons that parents should be aware of. 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 not worked 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 can also be placed to release air from the stomach to make the child “burp”.
Reasons why some children need a G-tube and fundoplication
Surgery is certainly a last resort when it comes to children, but sometimes it is necessary to improve the health of patients. The term “failure to thrive” is often used when a child falls off the growth chart and indicates that the child needs more nutrition and calories. There are many conditions that can cause a child to not thrive, but the most common is a combination of GERD and poor oral intake.
It’s a vicious cycle, as acid reflux irritates the esophagus, resulting in bad food that can then be regurgitated, usually several times a day. At times, the child learns to associate the taste of the regurgitated contents with eating, and if he refuses to eat at all, a feeding tube is needed to provide the child with the necessary daily nutrition.
However, if a child’s reflux is not treated properly, some or all of the tube feeding may be lost. This is why a G-tube and fundoplication are sometimes needed: the G-tube to feed the child through the stomach, and the fundoplication to keep the food in the digestive tract.
Advantages of G-Tube and Fundoplication surgery in children
No one can deny that babies and toddlers are at an important developmental stage in their lives. Their growth is meticulously mapped, developmental milestones are checked according to how many months the child is, and even the number of wet and dirty diapers indicates the baby’s health. Therefore, it is very important for the child to grow and gain weight. This surgery can help you achieve this simply because the G-tube delivers food straight into the stomach and the fundoplication prevents it from regurgitating.
Another advantage of this is that if the child used an NG or NJ tube, it would help with oral feeding. NG and NJ tube placement involves placing a very thin, flexible tube through the nose, down the esophagus and into the stomach or intestine. Having a tube in both your nose and throat doesn’t sound very comfortable, and having a tube holding the lid of your stomach open doesn’t help with reflux either. Eliminating this type of feeding tube would make the child much more comfortable during oral feeding and stimulation.
Disadvantages of Pediatric G-Tube and Fundoplication Surgery
Of course, surgery has risks and some possible aftereffects that can negatively affect the child. As with any surgery, there is a risk of infection, and it’s a constant battle when a G-tube is involved. To place the G-tube, the surgeon makes a “tunnel” into the stomach through a hole under the left side of the ribs; a PEG tube is inserted into this tunnel, one end of which is fixed in the stomach. The other end is available for carrying food and medicine and often needs to be attached to the child’s clothing.
While the G-tube is in use, there is a hole in the body that can be susceptible to infection. Another thing that this hole can be sensitive to is granulation tissue or GT; this is the skin that the body creates to cover the hole. GT can be easily fixed with 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 throwing up the contents of their stomachs – it often prevents burping too! Since there is no way for gas to come up during burping, it has to go the other way, which sometimes leads to gas pains in the child’s intestines. The stomach lining can loosen over time, so the child may end up burping.
Another possibility is that the gastric packing completely loosens and another surgery will be needed to redo the fundoplication. Also, because this surgery requires the top of the stomach to be used around the esophagus, the stomach will be smaller. As a result, they tolerate smaller amounts of food; the discomfort may cause itching, and gas in the stomach must be released using a common technique called venting.
Although the G-tube and fundoplication can facilitate the delivery of calories and nutrition to a child with a history of reflux and failure to thrive, there are still disadvantages: smaller stomach volume, gas pains, itching, etc. However, if the child has failed GERD and medications have not reduced the acid reflux, a G-tube and fundoplication surgery may be the only thing that can help.
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