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Pros and Cons of G-Tube and Fundoplication Surgery in Children
There are many reasons why a baby or child would 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. Fundoplasty is a surgical procedure 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) if medications have proven ineffective for the child. A G-tube, or gastrostomy tube, may be placed if the child was using another feeding tube, such as a nasogastric (NG) or nasogastric (NJ) tube. The G-tube may also be placed to provide a method of releasing air from the stomach in order to “burp” the child.
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. “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 a number of conditions that could lead to a child failing to thrive, but the most common would probably be the combination of GERD with poor oral intake.
It’s a vicious cycle as acid reflux irritates the esophagus, resulting in poor feeding which can then be regurgitated, usually several times a day. The child sometimes learns to associate the taste of the regurgitated contents with food, and if the child refuses to eat at all, then a feeding tube will be needed to ensure that the child is getting the nutrition they need every day.
However, if the child’s reflux is not adequately treated, there may be a chance that some or all of the tube feeds will be missed. This is why a G-tube and fundoplication are sometimes necessary: the G-tube to feed the child through the stomach and the fundoplication to make sure the food stays 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 recorded, developmental milestones are checked according to how old the child is, and even the number of wet and dirty nappies are indicators of how healthy a baby is. This is why it is so imperative for a child to grow and gain weight. This surgery could help achieve this simply because the G-tube would deliver the food directly into the stomach and the fundoplasm would prevent ejection.
Another benefit to this if the child is using an NG or NJ tube is that it would help with oral feeds. Placement of NG and NJ tubes requires a very thin, flexible tube that must be placed through the nose, down the esophagus, and into the stomach or intestine. Having a tube up your nose and also the back of your throat doesn’t sound very comfortable, and having a tube holding your stomach “lid” 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 downside of G-tube and fundoplication surgery for children
Of course, there are some risks involved in surgery and some potential 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 a G-tube is involved. To insert 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 with one end secured into the stomach. The other end is available for the delivery of food and medicine and often needs to be secured inside the child’s clothing.
As long as the G-tube is in use, there is a hole in the body that can be susceptible to infection. Another thing this hole can be sensitive to is granulation tissue, or GT. it is the skin that the body creates to make the hole. GT is easily corrected with the use of a prescription steroid cream, or if it becomes too large, it can be treated with silver nitrate in the surgeon’s office.
Fundoplasty surgery prevents children from throwing up in their stomachs – it often prevents them from belching too! With no way to get gas out through a burp, it has to go the other way, sometimes leading to gas pains in the child’s bowels. The stomach lining can loosen over time, allowing the child to burp eventually.
Another possibility is that the stomach lining will loosen completely, requiring another surgery to repeat the fundoplication. Also, since this surgery requires the top of the stomach to be used to wrap around the esophagus, the stomach becomes smaller. As a result, a smaller volume of food is tolerated. relief of discomfort may occur and any gas in the stomach must be released through a common technique called venting.
While the G-tube and fundoplication may make it easier to provide 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, distention, etc. However, if GERD has caused a child to fail to thrive and medications have failed to reduce acid reflux, G-tube and fundoplasty surgery may be the only thing that can help.
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