Just yesterday I started writing on the subject of Nissen Fundoplications and the prevalence in many communities of surgical options being pushed on kids with different gastric difficulties. Then, in response to the topic coming up on the BD forum, the typically excellent and educative Kristina Blizzard had this to say - well put and coming from experience. Food for thought indeed.
"For what it is worth, here is my two cents worth on Fundoplication (Nissen)
surgery in general:
Before starting the blended diet, and eliminating formula, we were told many times my daughter needed a G tube. One of the reasons I was so against the idea was because I was told that most doctors would want to do a Nissen (Fundoplication) as well, due to her projectile vomiting, which she did 3 - 6 times every day. I was told doctors in my area were routinely doing a Nissen when placing a G tube. I believe the complication rate was high enough that they no longer do them routinely.
I asked the nurse at the Cincinnati Aerodigestive Feeding Clinic, what the complication rate was for a Nissen. She said it is about 30%, which seems really high to me. Part of the problem with that surgery is that it is subjective. What I mean by that is the doctor has to decided how tight to make the Nissen. If it
is made too tight, solid food will not be able to enter the stomach easily, and you get gagging, wretching, etc. If it is made too loose, the patient will continue to reflux/vomit/possibly aspirate. There is also the possibility of causing nerve damage that can contribute to the wretching issue.
For those of you who don't know, when they do a Nissen, they basically pull the top part of the stomach up around the bottom of the esophagus, and sew it in place, with the intent of creating a one way valve. Hopefully food can go in, but not back up in the form of reflux or vomiting. This surgery does reduce the
volume capacity of the stomach, which can become an issue, especially for those who already had low volume tolerance to begin with.
In a person with aspiration issues, doing a Nissen can be life saving. There are people who have had the surgery, and have done very well afterwards. Those people are very happy they did it, but don't tend to be nearly as vocal about the surgery as the people who have complications from it.
Sadly, for some people, the Nissen causes more trouble than it solves. Those who are sorry they did it, feel (perhaps quite rightly) compelled to warn everyone of the negative possibilities. I think that is why most of what I hear about Nissen surgery is negative, and often pretty scary.
I think used very judiciously, Nissen surgery can be a good thing, like I said before, life saving in some people. Where I get concerned though, is that often there is not enough investigation of the cause of the reflux/vomiting/oral aversion prior to surgery. I am afraid surgery is sometimes being used to treat
symptoms, instead of identifying the cause of the symptoms. Vomiting/reflux/oral aversion can have many causes, but just be very sure to eliminate food allergy/intolerance as the cause BEFORE you have surgery.
And no, just trying someone on Elecare or a similar formula is not considered a sufficient investigation in my book. Not everyone tolerates Elecare despite what the doctors say, it CAN cause issues. I know several kids who couldn't tolerate it at all. I think it should be a criminal offense to alter someones anatomy
like that without first doing an elimination diet to rule out food allergy/intolerance issues.
If you are thinking, what about allergy testing? It is often not reliable either. (A topic for another post perhaps.) In my opinion, an elimination diet is really the only way to know for sure what someone can tolerate.
The medical community doesn't as yet have a very good understanding of the many interactions between food, and the digestive system. They know even less about the role of the immune system in reactions to food.
If it wasn't for me finding the blended diet, and starting my daughter on a hypoallergenic blend, she would have had surgery. It was scheduled for two days later, but she did so well on the hypoallergenic blend I made her, I was able to cancel the surgery.
I had been told repeatedly, her vomiting was a result of her brain injury, and something we would just have to live with. Once I figured out everything she doesn't tolerate, her vomiting went away. Her oral aversion is gone now, but she still has texture issues, probably because her esophagus doesn't contract well. With blended diet, my daughter, is now able to happily, comfortably and independently meet her calorie & nutritional needs, something I consider miraculous when thinking about where we were back in Sept 2009.
So my word to the wise, unless it is life threatening, don't do surgery for reflux/vomiting/oral aversion without first trying an elimination diet to rule out allergy/intolerance as the cause. Maybe you will get lucky and not need the surgery at all."
Retired ICU RN, BSN
Mother to Morgan, 3 years old, former 26 week micro preemie with a bilateral
grade 4 brain bleed, cognitive delay, communication disorder, mild cortical
visual impairment and feeding disorder. She takes her blends orally, in her