In children where gastro-esophageal reflux is unacceptably high leading to worrying weight loss or failure to thrive, or esophagitis, and medication is ineffective, surgery may be the next step.

Fundoplication is the surgical procedure of choice and the intention to operate is mainly to tighetn and improve the competence of the lower esophageal sphincter and prevent gastric reflux into the esophagus.

Long term follow up of surgery shows improvement of between 60-90%.

Nissen Fundoplication involves a 360 degree wrap around the distal end of the esophagus with fundal part of the stomach. This is the commonest fundoplication done and a five year follow up show good clinical improvement in 88% of children.

Surgical intervention is the last resort and a decision to operate should be made very carefully. Abdominal surgery carries a risk of adhesions. They are fine fibrous tissues that develop after surgery. They can cause obstruction of the small bowel. Laparoscopic fundoplication has significantly reduced the post operative complications and adhesions.

 Dr. Phil Hariram.