Thursday, July 17, 2014

We had a surgical consult yesterday to discuss the proposed nissen fundoplication procedure to help Collin's reflux problem. A nissen fundoplication is a procedure where "the gastric fundus (upper part) of the stomach is wrapped around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter" (Wikipedia). The surgery would take 2-3 hours, and would initially be done laparoscopically. However if the surgeon were to go in and find a lot of scar tissue from radiation, a larger incision could be needed. Afterwards, Collin would need to stay in the hospital for at least 24 hours, but most children end up staying for 2-3 days.

The procedure is generally considered safe and effective, and there is a 95% chance that it would help fix Collin's reflux over time. However, there are risks with the procedure. After the procedure, it can take patients a while to be able to eat normally, because food can get stuck at the bottom of the esophagus where it has been tightened. There is also a risk of bloating, where air becomes trapped in the stomach. To help manage these risks, a gastrostomy tube (a tube that goes from the stomach through the abdomen) is automatically placed during the surgery, and would be left in for approximately six months. This would allow the stomach to be burped, and if the patient has difficulty eating, they can be fed through the g-tube. Other risks include tearing of the espophagus or stomach, and damage to surrounding organs during surgery. There is a small chance that the procedure would need to be redone in eight to ten years.

One question that we have asked is why Collin's reflux has returned/worsened over the last six months or so. Of course no one knows for sure, but he has been steadily gaining weight since his treatment ended. Since weight gain could be a possible factor, it's possible that changes in his diet could help. Cutting out foods that can aggravate reflux, and slowing his weight gain and giving his height time to catch up could help. Neither Bill or I feel comfortable jumping into this surgery, so over the next three to six months, we will make changes in Collin's diet and routine to try to manage the reflux better. Then down the road we can try stopping one reflux medication at a time to see if there has been an improvement, and possibly have another UGI study done to see if there has been any change. If Collin's symptoms worsen over time, or he aspirates while refluxing (breathes the acid into his lungs), we may reach a point where he would absolutley need the surgery. But since we're not at that point yet, we will try treating it more conservatively and less invasively. If we reach a point where he definitely needs the surgery, at least we'll know we tried everything else first.