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Pros and Cons of G-Tube and Fundoplication Surgery in Children
There are numerous 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 involved that the parents should know about. Fundoplication is a surgery where the top part of the stomach is wrapped around the lowest part of the esophagus; this is usually done to treat gastroesophageal reflux disease (GERD) if medications have proven to be 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 of releasing air from the stomach, in order to “burp” the child.
Reasons Why Some Children Need a G-Tube and Fundoplication
Surgery is definitely a last-resort option when it comes to children, but it sometimes is necessary to improve patients’ health. “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 could lead a child to become failure to thrive, but the most common would probably be a combination of GERD with poor oral intake of foods.
It is a vicious cycle as the acid reflux irritates the esophagus, resulting in poor feedings which can then be refluxed out, usually several times a day. The child sometimes learns to associate the taste of the refluxed contents with eating, and if the child refuses to eat at all then a feeding tube would be required to ensure the child gets the nutrition he or she needs daily.
However, if the child’s reflux is not being adequately treated, there may be a chance of some or all the tube feedings to be lost. That is why a G-tube and fundoplication is sometimes necessary: the G-tube for feeding the child through the stomach, and the fundoplication to make sure 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 in an important developmental stage in their lives. Their growth is meticulously charted, developmental milestones are checked off 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 would be able to help achieve that, simply because the G-tube would deliver food straight to the stomach and the fundoplication would prevent it from being thrown up.
Another pro to this, if the child has been using 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 in your nose and also the back of your throat doesn’t sound very comfortable, and having a tube keeping 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 a lot more comfortable with oral feeding and stimulation.
The Downside of Children’s G-Tube and Fundoplication Surgery
Of course, there are some risks involved with surgery and some possible after-effects that may negatively affect the child. As with all surgery, there is a risk for infection, and it is 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 inside the child’s clothing.
For 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 susceptible to is granulation tissue, or GT; it’s skin that the body creates to fix the hole. GT is easily fixed by using a prescribed steroid cream or, if it becomes very large, can be treated with silver nitrate at 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 come up through a burp, it has to go the other way, sometimes leading to gas pains in the child’s intestines. The stomach wrap can loosen over time, allowing the child to burp eventually.
Another possibility is that the stomach wrap will loosen completely, requiring another surgery to redo the fundoplication. Also, since this surgery requires using the top of the stomach to wrap around the esophagus, the stomach gets smaller. As a result, a smaller volume of food is tolerated; retching from discomfort can ensue and any gas inside the stomach needs to be released through a common technique called venting.
While the G-tube and fundoplication may make it easier to deliver calories and nutrition to a child with a history of reflux and failure to thrive, it still has its disadvantages: smaller stomach volume, gas pains, 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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