Fundoplication is a surgical procedure in which the top of the stomach is wrapped around itself to prevent reflux. When the stomach is wrapped fully, it is referred to as a Nissen fundoplication (also called a Nissen, Nissen fundo, fundo, or just fundoplication). When the stomach is only partially wrapped, it is called a partial fundoplication.
This surgery is not required when getting a G-tube placed. It may be advised in instances when a child has severe reflux-related airway problems or when there is severe damage to the esophagus from reflux. Children who are aspirating secondarily (meaning they are aspirating their reflux) seem to be the best candidates for the Nissen. These children have likely had aspiration pneumonia, or are having breathing difficulties because of aspiration, or are turning blue.
Children who vomit a lot or who have delayed gastric emptying or gastroparesis are often not good candidates for a fundoplication. The fundoplication doesn’t address the cause of the vomiting, which is related to how slowly the stomach empties. In these children, fundoplication turns the stomach into a little pressure cooker. The contents of the stomach can no longer go up with a functioning fundoplication, and poor motility means they also cannot go down. Instead, you end up with a smaller stomach, and its contents don’t move in either direction. Kids in this situation tend to retch or have ongoing abdominal discomfort or pain. These children also tend to have more complications with vomiting past the fundoplication, the fundoplication slipping and needing to be redone, or the fundoplication herniating after it slips. A gastrojejunal tube (GJ-tube) may be an alternative to a fundoplication, or should be tried before moving forward with the procedure.
Children with neurological issues also tend to do much worse with Nissens, so these children should only receive a Nissen when the benefit clearly outweighs the risks. The GJ-tube would be a better alternative to consider.
Parents should discuss the procedure with their doctors and research the procedure before committing to a fundoplication. Note that the procedure cannot be reversed fully. Surgeons can only reconstruct the stomach as best as possible, but even this may result in additional nerve damage and complications. Few surgeons are willing to even attempt a fundoplication take down.