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Gastroenterology (Expert Forum)
Post-operative retching from fundoplication.
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Post-operative retching from fundoplication.
by ccbournejr2004, Feb 03, 2005 12:00AM
My son (9wks) recently (@ 4wks old) underwent a nissen for severe reflux. He is on pump feedings (2 hrs on/ 2 hrs off) and has severe retching problems (16 incidents/day). Our surgeon suggested that it could be gas in the fundoplication and it does appear that if we give him Mylicon and he can work gas out of his feeding tube it does provide relief... although this is a rare event.
We've tried a multitude of different things:
contiuous feeding
contiuous venting
positioning during feeding
every formula known to mankind (although he's on MCT supplement, so if this gives him gas different formulas probably wouldn't help)
Q - Is there anything else that we could try? Should we have any test run? (Pre-op we had an upper GI)
Addt'l Info
-----------
Condition - Down Syndrome, Congenital Heart Defect (VSD), Nissen, G-tube.
Regular Meds - Digoxin, Lasix, Aldactone, Mylicon.
Regular Supplements - MCT, Sodium, 30 cal formaula.
Doctor's Answer
by Kevin Pho, MD, Feb 04, 2005 12:00AM
, Feb 04, 2005 12:00AM
Actually, I can't think of any further suggestions in this case, as I am not a pediatric gastroenterologist.
One possibility would include a 24-hr pH probe to monitor if reflux has returned despite the fundoplication. If so, then possible revision to the surgery, or concurrent medical therapy, can be considered.
Another consideration can be transpyloric feeding, where a feeding tube is placed fluoroscopically into the transpyloric position. Milk is then administed by slow infusion.
These options can be discussed with your specialist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
One possibility would include a 24-hr pH probe to monitor if reflux has returned despite the fundoplication. If so, then possible revision to the surgery, or concurrent medical therapy, can be considered.
Another consideration can be transpyloric feeding, where a feeding tube is placed fluoroscopically into the transpyloric position. Milk is then administed by slow infusion.
These options can be discussed with your specialist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
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We've also tried continuous vent with a 60cc syringe and the pump dripping into the syringe... sometimes this produces burping.
He doesn't cry during his retching, but he's really never cried... my wife and I are thankful that he's a very content baby.
as for feeds while sleeping, if he's really tired he feeds well. My wife and I are coming to realize that his stomach is very sensitive and he retches at almost any disomfort (gas, lots of movement, bowl movement) His GI surgeon has suggested keeping him on Tylenol, but at his dosage (0.4ml q 4) it seems not to be noticable if it's helping.
His surgeon says that his fundo is working if he is not producing stomach content and we've dyed his formula blue and nothing in his mouth is ever blue. We may try to see another specialist and get a g-tube UGI done, which was suggested by the his neonate dr. in the NICU but never happened.