How to Care for Your Child at Home After a Fundoplication

It is very important that your child follows the post-operative guidelines listed below. Following these guidelines will help your child have the best outcome and the least discomfort after surgery. It is sometimes difficult to get a child to cooperate with these guidelines. However, not following these guidelines can mean that food can get trapped in the esophagus causing retching, gagging, vomiting and discomfort.

What Is Fundoplication?

• A fundoplication is a surgical procedure that prevents stomach contents from going back up the esophagus. The procedure narrows the part of the esophagus that connects to the stomach.
• In the first 2 to 3 weeks after the surgery there will swelling at the surgical site, which can initially narrow the esophagus.
• Your child may experience the feeling of food getting “stuck” in the esophagus. This will improve and go away with time.

Fluids

• We suggest milk, juices, punch or powdered drinks (including nutritional supplements/protein drinks).
• NO carbonated beverages.
• Avoid frozen drinks. They can cause esophageal spasm and discomfort.
• Offer very small amounts of fluids (1 to 2) ounces at first. Wait 15 to 30 minutes in between each feed, slowly increasing the amount of fluid, then slowly begin to offer fluids as much as tolerated.

Soft Solid Foods

• We suggest pudding, yogurt, applesauce and soups. Each should be smooth, without chunks. These foods should be pureed if there are larger pieces; including fruit, vegetables and noodles.
  • Mashed potatoes – thinned with milk or gravy.
  • Well-cooked rice with gravy or sauce
  • Softened, partially melted ice cream.
• When eating, take small bites of food, chew well and take sips of fluids frequently while eating.
• Sit upright while eating, and stay in a sitting position for 30 to 60 minutes after eating.
• Avoid eating 2 to 3 hours before going to sleep.
• Stop eating when you feel full.
• Avoid using straws, slurping food, chewing gum or sucking on ice. This can contribute to gas buildup and lead to pain.

Dressing

Your child will have a white gauze dressing(s) covered by a clear plastic (Tegaderm®).

• Remove this dressing 3 days after surgery.
• Beneath the gauze dressing(s) are small white bandages (Steri-strips®). These will usually fall off in 1 to 3 weeks.

Stitches

Stitches hold the incision together. Your child will have stitches that are under the skin and do not need to be removed. The body will absorb them.

Bathing

• Remove the dressing(s) 3 days after surgery.
• Sponge bathing is okay while the dressing(s) are in place.
• After the dressing(s) are removed, your child may bathe normally.
• As long as the incision(s) does not appear open and there is no drainage, you may swim or submerge the site below the water in a bath one week after surgery.

Activity

_____ Open Fundoplication:
No strenuous activity such as bike riding, gymnastics, contact sports, martial arts, school gym or weight lifting until you check with the surgeon at your follow-up appointment.

_____ Laparoscopic Fundoplication:
Your child may resume normal activities without restriction as tolerated.

Gastrostomy Tube

If your child has had a gastrostomy tube placed at the same time as the fundoplication, you will receive additional written instructions about how to take care of the gastrostomy tube. You will also have an individualized feeding plan for gastrostomy tube feeds.

Pain

• Your child may have a prescription for pain medication such as Tylenol® with Codeine or Percocet. If the incision(s) remains uncomfortable, use the prescription medication according to instructions.
• Your child may take Tylenol® (acetaminophen) or Motrin® (ibuprofen) for discomfort if the pain is mild.

Please call the surgery office if you child develops any of the following:

• Fever greater than or equal to 100.4 degrees F in children under 12 months of age.
• Fever greater than 101 degrees F in children 12 months of age and older.
• Redness, swelling, or drainage from the incision site.
• Pain despite the prescription medication.

If you have any questions, please call your child's pediatric surgeon or pediatric nurse practitioner.

Rev. 3/2013. This document is intended to provide health related information so that you may be better informed. It is not a substitute for a doctor's medical advice and should not be relied upon for treatment for specific medical conditions.