🧒🟡 Reflux After Fundoplication (or When Fundoplication Is Considered Again): A Parent-Friendly Guide

✅ Some children continue to have reflux symptoms after a fundoplication, or symptoms may return months or years later.
This does not always mean the surgery “failed.” There are many reasons symptoms can persist or recur—and many ways to help.
Care focuses on identifying why symptoms are happening and choosing the least invasive effective plan.

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Topic: Reflux related to fundoplication
Common terms: Post-fundoplication reflux, recurrent GERD after fundoplication, redo fundoplication (selected cases)

Plain-language summary (2–3 lines):
Fundoplication reduces reflux by strengthening the valve between the esophagus and stomach. Some children still have reflux-like symptoms due to gas, swallowing problems, delayed stomach emptying, or changes in the wrap over time. Evaluation helps determine the cause and best treatment.

Who it affects (typical ages):
Infants, children, and teens after prior fundoplication, especially those with neurologic or feeding conditions.

✅ What parents should do today:

• Track symptoms carefully (vomiting vs retching vs discomfort)
• Review feeding volumes, stooling, and constipation
• Keep follow-ups with GI and surgery teams
• Ask what problem the surgery was meant to solve—and if it still is

⚠️ Red flags that need urgent/ER care:

• Severe belly swelling with repeated retching and inability to vomit
• Trouble breathing or choking episodes
• Vomiting blood or black stools
• Severe dehydration

🟡 When to see the family doctor/clinic:

• Ongoing vomiting/retching
• Poor feeding or weight loss
• Pain with feeds
• Recurrent chest infections or choking

2) 🧠 What it is (plain language)

Fundoplication creates a tighter barrier to reduce reflux. After surgery, symptoms may be due to:

• true reflux returning
• retching (dry heaves without vomiting)
• gas bloat (air trapped, difficulty burping)
• swallowing problems (food sticking)
• slow stomach emptying
• wrap changes (loosening, slippage—uncommon but possible)

What part of the body is involved? (small diagram required)

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Common myths vs facts

• Myth: “Symptoms mean the surgery failed.”
  Fact: Many symptoms are not reflux and improve with targeted treatment.
• Myth: “Another surgery is always needed.”
  Fact: Most children improve without redo surgery.
• Myth: “After fundoplication, vomiting should never happen.”
  Fact: Some children can’t vomit easily and may retch instead.

3) 🧩 Why symptoms happen (causes & triggers)

Common causes

• Gas bloat: swallowed air, large feeds
• Retching: especially in neurologic conditions
• Constipation: increases belly pressure and symptoms
• Delayed gastric emptying
• Feeding technique issues

Less common but important

• Wrap loosening or slippage
• Hiatal hernia recurrence
• Esophageal narrowing (stricture)

Triggers

• Large or fast feeds
• Carbonated drinks
• Constipation
• Illness with coughing
• Poor positioning during feeds

4) 👀 What parents might notice (symptoms)

• Retching (heaving without vomit)
• Vomiting (small or large)
• Belly bloating or discomfort
• Refusal to eat
• Choking/coughing during feeds
• Poor weight gain

What’s normal vs what’s not

🟢 Common early after surgery:

• mild gas
• temporary feeding adjustment needs

⚠️ Concerning:

• repeated severe retching with belly swelling
• poor growth
• breathing symptoms
• blood in vomit/stool

Symptom tracker (very helpful)

• vomiting vs retching (which one?)
• feed volumes and speed
• burping ability
• stool pattern (constipation?)
• weight trend

5) 🏠 Home care and what helps (step-by-step)

✅ Most symptom improvement starts with feeding and bowel adjustments.

First 24–48 hours when symptoms flare

✅ Do this now:

• reduce feed volume; increase frequency (if advised)
• ensure upright positioning during and after feeds
• burp gently and often
• address constipation aggressively (per plan)
• review medications with your clinician

Ongoing supportive care

• avoid carbonated drinks
• slow feeding pace
• vent gastrostomy tube if instructed
• consistent bowel regimen

6) ⛔ What NOT to do (common mistakes)

• Don’t assume all symptoms are reflux.
• Don’t rush to redo surgery without evaluation.
• Don’t stop feeds abruptly unless advised.
• Don’t ignore constipation.

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• severe belly swelling with distress
• trouble breathing
• collapse or severe dehydration

🟠 Same-day urgent visit

• repeated retching with inability to vomit
• worsening pain with feeds
• blood in vomit/stool
• fever with severe symptoms

🟡 Book a routine appointment

• ongoing retching/vomiting
• feeding refusal
• weight concerns

🟢 Watch at home

• mild symptoms improving with adjustments and plan in place

8) 🩺 How doctors evaluate it (what to expect)

What the clinician will ask

• original reason for fundoplication
• current symptoms (reflux vs retching)
• feeding method and volumes
• stooling pattern
• respiratory symptoms

Possible tests (and why)

• pH-impedance or pH probe (reflux burden)
• upper GI contrast study (wrap position/anatomy)
• endoscopy (esophagitis/stricture)
• gastric emptying study (selected cases)
• swallow study if aspiration suspected

What tests are often not needed

• repeating all tests without a focused question

9) 🧰 Treatment options

✅ Treatment depends on why symptoms are happening.

First-line treatment

• feeding plan optimization
• bowel regimen
• posture and pacing strategies
• medications (selected cases)

If not improving

• targeted therapy (for motility, gas, or retching)
• multidisciplinary review (GI + surgery + nutrition)
• adjust tube-feeding strategy if applicable

Redo surgery (selected cases only)

• considered if clear anatomic failure or dangerous reflux
• requires careful risk–benefit discussion

10) ⏳ Expected course & prognosis

• Many children improve with non-surgical adjustments.
• Symptoms may fluctuate with growth or illness.
• Long-term outcomes depend on the child’s underlying condition.

11) ⚠️ Complications (brief but clear)

• gas bloat
• retching
• feeding aversion
• wrap failure (uncommon)

12) 🛡️ Prevention and reducing future problems

• manage constipation proactively
• avoid overfeeding
• maintain follow-ups
• address swallowing problems separately from reflux

13) 🌟 Special situations

Neurologic conditions

Higher risk of retching; bowel and feeding strategies are key.

Tube-fed children

Venting and feed adjustments may help greatly.

Neurodevelopmental differences

Predictable routines reduce distress-related symptoms.

Travel considerations

Carry feeding plan and emergency instructions.

School/daycare notes

Allow feeding accommodations and positioning.

14) 📅 Follow-up plan

• GI follow-up for symptom tracking
• surgery follow-up if anatomy concerns
• nutrition review for growth
• urgent plan for severe retching + swelling

15) ❓ Parent FAQs

“Does this mean the surgery failed?”

Not necessarily—many symptoms are treatable without surgery.

“Can my child still take reflux medicine?”

Sometimes, yes—depends on symptoms and testing.

“Will another surgery fix it?”

Only in selected cases with clear anatomic problems.

“Can my child eat normally?”

Many can, with pacing and volume adjustments.

“When can we stop treatment?”

When symptoms are controlled and growth is stable—guided by your team.

16) 🧾 Printable tools (high-value add-ons)

🧾 Printable: Post-Fundoplication Symptom Plan

• Identify symptom type (vomit vs retch)
• Check stool pattern
• Review feed volume/speed
• Call clinic if symptoms persist

Urgent/ER if:

• severe belly swelling + retching
• breathing trouble
• blood in vomit/stool

🧾 Printable: Feeding & Symptom Tracker

Date: ______

• Feeds (volume/speed): ______
• Vomiting: yes/no
• Retching: yes/no
• Belly bloating: none/mild/severe
• Stools: ______
• Notes: _______________________

17) 📚 Credible sources + last updated date

Trusted references:

• Pediatric GI and surgery patient education materials
• Children’s hospital reflux surgery follow-up guides

Last reviewed/updated on: 2025-12-30
Management varies based on child’s condition and surgical history.

🧡 Safety disclaimer

This guide supports—not replaces—medical care. If you are worried about your child, trust your instincts and seek urgent medical assessment.

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings.

To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca
In the email subject, please write: New Assessment Appointment with Dr. Hussein

Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP