I resisted the surgery for a long time because I was convinced that it was possible to overcome reflux by thoroughly researching the available treatments and finding a suitable match for my daughter. I searched the Internet for information on treatments and sought the opinion of other specialists in case there was some secret cure out there. In the end, it turned out that the surgery was the secret cure that helped my daughter overcome her reflux.
An evaluation by a pediatric gastroenterologist is essential in determining the extent of the reflux and exploring all medical treatments before referring a child for surgery. I am always a bit concerned when I hear that an infant has been referred to a surgeon for GERD surgery without seeing a gastroenterologist first. A pediatric gastroenterologist may perform tests that provide vital information to the surgeon who must make the ultimate decision on whether a child is a good candidate for surgery.
It is important to find a pediatric surgeon with a great deal of experience with GERD surgery. A surgeon who is familiar with the procedure and performs the procedure on a regular basis will have the skill and practice to perfect the technique. Further, a surgeon who is familiar with pediatric gastroesophageal reflux disease will know the importance of scheduling tests before the surgery to assess the severity of the reflux and the seriousness of the complication that warrant surgery. In my experience, surgeons are quite careful about determining that the surgery will benefit the child before making a recommendation.
Sometimes the doctors and specialists don't agree on the need for surgery. This can be very confusing to a parent. Don't be discouraged by the mixed messages. Doctors base their decisions on their training and experience, and often there are many equally good ways to treat the same problem. As a parent, you will need to sort through all of the data and recommendations to decide on a treatment plan. It may help to get a second opinion from another specialist or surgeon before proceeding.
Parents often want to know where the best surgeon is so they can fly across the country or the world. The reality is, the Nissen Fundoplication surgery is a common pediatric surgery procedure in the United States, so it is unnecessary to travel very far to find a surgeon who can perform the procedure. It makes sense to consult the pediatric gastroenterologist and the pediatrician first since they are familiar with local surgeons and hospitals with pediatric care units.
In addition, some parents prefer to travel to a large city to obtain care at a large regional children's hospital. It is important to find a surgeon who you feel comfortable with. Some parents look for a surgeon with a good reputation while others need a doctor who will answer their multiple follow-up questions.
It is important to gather the medical records and test reports and make a list of questions before you meet with the surgeon.
Common questions include:
- What is your training and experience with GERD surgery? How often do you perform the procedure? What is the rate of success?
- What type of surgery procedure do you perform (Nissen, Thal, Toupet)?
- Would my child need an open or laparoscopic procedure?
- After hearing my child's history, why do you think he/she needs surgery?
- Is surgery urgent? Not urgent?
- Are other tests needed before doing the surgery?
- What is the expected outcome of the surgery?
- What are the expected/rare side effects of surgery? Risks?
- How long will my child need to stay in the hospital after the surgery?
- What can I expect in the hospital?
- What can I expect at home after surgery?
- How soon after surgery can my child eat, resume normal activities (school, sports)?
Ultimately, you will need to decide if surgery is the best option for your child after hearing the recommendations of the specialists and the surgeon. It may be helpful to use family, friends or a patient support network to share ideas and worries about the procedure. They know you and your child well and can help you sort out your questions and concerns about the surgery. In addition, it may be important to have a follow up meeting or phone call with the surgeon to clear up any questions or concerns.