Medical treatment successfully controls the symptoms and complications of Gastroesophageal Reflux Disease (GERD) in the vast majority of infants and children. All of the medication, special diets and positioning can be labor intensive and yield limited results at first. Over time, the treatments will reduce the irritation to the esophagus and allow an infant or child to eat, sleep and grow normally. If an infant or child has significant complications from GERD despite optimal medical treatment, surgery may be suggested as an option. Examples may include: severe esophagitis (irritation to the lining of the esophagus and stomach), ulcers, breathing issues or failure to thrive (severely underweight). In addition surgery may be warranted if a child continues to have severe symptoms despite treatment and faces a lifetime of medical management such as the need for daily high doses of medication. A high percentage of infants and children with handicaps (cerebral palsy, Down Syndrome and Autism) are at risk for severe GERD and may require surgery.
There are several surgical options but the Nissen Fundoplication is the most common surgical procedure for the treatment of Gastroesophageal Reflux Disease in all age groups. Most surgeons perform the surgery using a less evasive laparoscopic method. During laparoscopic surgery, several small incisions are made into the abdomen (stomach) and small instruments are used to perform the surgery. A very small baby may need to have one large incision called an Open Nissen Fundoplication. In either case, the top of the stomach is wrapped around the base of the esophagus and stitched into place. Some surgeons have been trained in the Thal Fundoplication or the Toupet Fundoplication (partial wrap). The Toupet has a reduced rate of complications from gas bloat and swallowing issues but may not be as effective for severe reflux.
My daughter Rebecca has a Laparoscopic Nissen Fundoplication procedure when she was 6 years old due to aspiration and asthma from severe GERD. I tried every possible medication and combination of medications, elevated her bed for sleeping and fed her small, frequent meals. Despite the best medical treatment, she could not eat enough food to gain weight and had daily pain, frequent respiratory illnesses and pneumonia from aspiration. It was clear that she needed the surgery.
Adults with GERD have the option of having the Nissen Fundoplication or one of the newer, non surgical treatments such as the Stretta Endoscopic Procedure, Bard Endocinch and Enteryx. Just this week, the FDA approved use of the Plicator II and the Transoral Incisionless Fundoplication. Even with several options available to adults, the Nissen Fundoplication is still the gold standard for treatment.
Parents are often discouraged to find that the newer, less evasive procedures are not available for infants and children. As of this writing, the other non surgical methods are still being refined for adult use so parents should not delay surgery in hopes of finding an alternative treatment in the near future.
Regardless of the type of surgery (Nissen, Thal, Toupet), it is vitally important to find a surgeon who has a great deal of experience and training in performing the procedure. I will never forget the surgeon I met at a medical conference that used his tie to demonstrate the different methods he uses to perform GERD surgery! In addition to being entertaining and informative, this surgeon was passionate about his job and knew how to get the best result for his young patients.