Indicated for the treatment of severe GERD
The anterior and posterior wall of the stomach are sutured together around the lower esophagus to reinforce the closing function of the LES (lower esophageal sphincter).
May be performed open or laparoscopic.
Duration: 1-2 hours
Antibiotic: Usually Cefoxitin 40mg/kg or Cefazolin 30mg/kg- ask surgeon
EBL: Usually < 20ml
Equipment: standard monitors, urinary catheter, NG/OG tube to decompress the stomach, suction
Disease Specific Considerations: Patients may have active and uncontrolled GERD
Specific or Unique Room Set-Up Requirements
Drugs/Infusions: Consider non-depolarizing neuromuscular blockade if laparoscopic
Blood Availability: Not required
PICU Bed Availability: If patient is neonate with an open procedure, consider the possibility of post-operative ventilation
Induction: Consider RSI if uncontrolled GERD
Positioning: supine, bed not turned
Avoid nitrous oxide
Consider non-depolarizing neuromuscular blockade
Monitor ETCO2 and prevent hypercarbia from absorbed CO2 due to the insufflation.
Be reminded that stimulation of the Vagus nerve (CN X) can cause a vagal response resulting in bradycardia.
Confirm ETT placement with position changes.
NG/OG tube if requested by surgeon
Emergence: Awake extubation
May be asked to place a bougie down the esophagus.
DO NOT force the bougie. If there is any resistance, inform the surgeon and allow him/her to insert it. We don’t want to cause a perforation of the esophagus.
Emergence/Disposition: Awake Extubation v. Return to NICU/PICU Intubated
Post-Op Pain Management:
NSAIDS if ok with Surgeon
Acetaminophen (Oral or IV)
Consider regional/neuraxial anesthesia if open procedure
Esophagus sliding out of the wrap leading to decreased LES tone
Referred shoulder pain from insufflation
PONV in children >3yo
Jaffe, R. and Samuels, S. (2009). Anesthesiologist’s Manual of Surgical Procedures. 4th ed. Philadelphia: Lippincott Williams & Wilkins.