22 May 2012

Re-fundo Or No?

I brought Vera back to the surgery team that did her first fundoplication today.

I wanted to know once and for all, if getting a re-fundo would be the best thing to do for her silent reflux.

All in all, there seems to be more cons than pros.

1. There is no guarantee how long the re-fundo will last. (Her first lasted less than a year.)
2. The possibility of keyhole surgery vs open stomach surgery is 50/50.
3. Open stomach surgery recovery is more painful and longer.
4. There is no guarantee that the band will be just right. Too loose and the surgery will have to be repeated to correct it. Too tight and she would not be able to swallow her saliva, leading to pooling at the throat. Surgery would also have to be repeated to correct it.
5. It does not mean that she will not gag on her saliva (which she does frequently now) after a successful re-fundo.

The medical basis for justifying a re-fundo is 1 episode of severe Aspiration Pneumonia involving intubation. Vera has this when she was 2 years old.

She had another episode but did not require intubation, so we'd consider it less severe.

Given the list of negatives, it seems like surgery would be out of the question for now.

The other management options are
1) Continuous feeding. This we are not keen on, given how active Vera's hands are. We'd have to pin her down if it were the case.
2) A Motility medication called Domperidone. Is anyone's kid on this? We are hoping this will help empty her tummy faster as we feed.