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Fundoplication Risks

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Question

Can you please outline the possible risks (and benefits) of Fundoplication surgery? I am in contact with a mom who is embarking on the surgery for her eight-year-old daughter.

Answer of our experts

A fundoplication is a major operation which entails all the complications of being in the hospital and having surgery. There is a significant chance (as high as 20%) that the child may have dysmotility after surgery such as gagging, bloating, retching, or diarrhea. Sometimes the "Nissen" is too tight and must be dilated. It can also be too loose and not help the problem. If there was another problem contributing to the GER (gastroesophageal reflux) such as poor gastric emptying, the stomach still can't empty and can't vomit either. Most of the dysmotility resolves over several months, but may not. Otherwise, the procedure may work perfectly well for many years

CP/TK 7-13-10

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Recommendation(s)

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Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
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Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
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If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
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Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.

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