Following Surgery

Nutrition immediately following surgery
Will I need to follow a special diet?
Will I experience difficulty swallowing?
When will I be able to start eating and drinking?
How can I avoid or minimise acid or reflux?
What common problems may I experience? How can I avoid nutritional problems and minimise weight loss?
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Nutrition immediately following surgery

If you have an oesophagectomy you will have a jejunostomy (jej) ‘feeding tube’ placed in your abdomen at the time of surgery. A liquid feed is then given through your feeding tube which will provide you with all the nutrients you need. This will continue until you are able to tolerate a puréed diet. Your Specialist Dietitian will prescribe an appropriate feeding plan, monitor your progress and adjust your feed accordingly. You will usually go home with this tube still in place, but no longer used for feeding. The tube can be used to provide extra water at home for hydration. This will be discussed prior to your discharge, and you will be taught how to care for and manage your tube at home.

Please note: due to the nature of the surgery, the Surgeons do not place jej tubes in people who have a gastrectomy.

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Will I Need to Follow a Special Diet?

Immediately following your operation, your Surgeon will monitor you and advise ‘step-by-step’ what and when you can start eating. Gradually your food intake will be built up, often starting with fluids only, then progressing to soups and smooth pudding, followed by a puréed texture diet for home. Your dietitian will discuss this with you prior to discharge from the ward. At home you will be advised to follow a puréed texture diet for two weeks, followed by a soft and moist diet for four weeks. This will allow time for your digestive system to recover and heal from the surgery.

If you have had either an oesophagectomy or a gastrectomy you will find that you feel full very quickly. Arguably the single most important habit that you will need to develop is to eat LITTLE AND OFTEN, aiming for six very small portions of food per day. It is also important to eat slowly and chew food well.

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Will I experience difficulty Swallowing?

As the new ‘join’ between the remainder of your gullet and stomach or bowel heals, scar tissue can form and this can occasionally make swallowing food difficult for some people. This can be very worrying, but symptoms can usually be alleviated by stretching the join with a balloon during an endoscopy. If you experience problems swallowing, contact your Consultant, GP or Advanced Nurse Practitioner (ANP) to discuss this further.

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When will I be able to start Eating and drinking?

You will not be able to eat for about 4–5 days following your surgery but you can usually have small sips of water from day one or two. Hopefully your Surgeon will allow what we call ‘free fluids’ by day four. This would include squash, milk, tea and coffee. If you require any nutritional supplement drinks, your Specialist Dietitian will advise which ones are suitable. Please note: many drinks prescribed before surgery are no longer suitable after an oesophagectomy or a gastrectomy.

How can I avoid or Minimise Acid Or Reflux?

Sit upright when you eat and for a little while afterwards. Try not to eat or drink late into the evening, ideally we advise to stop at least two hours before going to bed. When in bed or resting, try to prop yourself up with a couple of pillows so that you are not lying flat.

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Download the OOSO Booklet

In conjunction with other OOSO members we have written a booklet that brings together the best of our knowledge. It starts with the basics, touches on what to do before surgery and describes how you might best recover from your operation. It combines many years of patient experience, has been checked and edited by experts from the medical team, and is titled

Life after an Oesophagectomy or Gastrectomy

They say that "imitation is the sincerest form of flattery" so we're flattered that our booklet is already appearing on other web sites - albeit without any acknowledgement to the Oxford Team. If you'd like to download an original copy, click here.

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What common problems may I experience?

You may encounter any of the following problems. Some patients experience them for a short time, others months, or a for a few, they may be permanent.

Weight loss

You may have lost weight before your surgery and it is common to continue losing weight for some time afterwards. Do not worry, in time this should level out, and hopefully you should be able to regain some of your weight in the longer-term. While you may not return to your ‘normal’ weight, the advice we give later on, will help you to minimize your weight loss and aid your recovery. Keep an eye on your weight, but weighing yourself once a week is usually enough. Rather than worrying about the exact figure the scales are telling you, focus on whether you are feeling stronger and your energy levels are improving.

Small appetite and feeling full quickly

You may find that you become full much more quickly than before. This is because your body’s capacity for food has been reduced following the surgery. You may also experience discomfort if you eat too much or too quickly. Therefore, changing your meal pattern to eat LITTLE AND OFTEN is the most important thing for you to focus on. Try to aim for six small meals per day – this can help to stimulate your appetite to return. It can also be helpful to use a smaller size plate, such as a tea or side plate, so you are not overwhelmed by portions which are too large for you to manage. Try not to compare the amount that you used to eat prior to your operation with the portion sizes now recommended.

Diarrhoea

Some people experience loose stools or diarrhoea, particularly in the first few months, but this usually settles with time. It often seems to happen for no reason and you may not be able to relate it to anything you have eaten. Be mindful that loose watery stools are one of the symptoms caused by eating too much or eating too quickly. If you experience issues with on-going diarrhoea speak with your Specialist Dietitian or ANP.

Acid and/or bile reflux

The sphincter at the bottom of the oesophagus linking into the stomach normally prevents acid reflux. However, problems occur if the sphincter does not work very well and allows the back-flow of acid from the stomach to the oesophagus.

This situation brings on an extremely unpleasant feeling into your mouth – it usually happens first thing in the morning. The problem appears to be caused by acid in an empty stomach. Should this happen, spit out as much fluid as you can or, if caught in time, drink some water to dilute the effect and encourage it to go downwards. It should become less frequent in time, but there may always be a possibility of it occurring.

If reflux becomes persistent you should contact your ANP or Surgeon. Occasionally, an endoscopy may be necessary.

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How can I avoid Nutritional Problems and minimise weight loss?
  • Eat slowly and have small mouthfuls of food.
  • Chew food thoroughly.
  • If you wear dentures make sure that they fit properly. Visit your dentist if they are uncomfortable.
  • Avoid drinks (including soup) before mealtimes as these will fill you up and leave little room for food. Aim to leave at least 45 minutes to an hour between eating and drinking as a standard.
  • EAT LITTLE AND OFTEN throughout the day. Aiming to have something every two hours is a good target.
  • Keeping a food diary – with timings, can help you to establish a pattern of eating that works for you following surgery.
  • Focus on high protein foods; milk, dairy products, eggs, meat and fish.
  • Add extra nourishment to drinks, snacks and meals. For example:
  • use full cream milk/cream/skimmed milk powder in drinks, food and cooking;
  • add extra butter or margarine to mashed potatoes;
  • grate cheese into soups or over mashed potato or scrambled egg;
  • add white or cheese sauce to soft fish;
  • do not use ‘light’, ‘diet’, ‘low-fat’ or reduced sugar products such as milk, spread, cheese, yoghurts and desserts;
  • if you find it difficult or tiring to cook, use convenience foods where necessary. Supermarkets have a range of frozen, chilled or packet ready meals available. Home delivered meals may also be an option.
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