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Life after an oesophagectomy or gastrectomy

                  Enhanced Recovery After Surgery (ERAS)

                  Enhanced Recovery is a new way of improving the experience and well-being of
                  people who need major surgery. It helps you recover sooner so that life can return
                  to normal as quickly as possible.

                  The programme focuses on making sure that patients are actively involved in their
                  recovery. Daily goals and targets for mobilising (walking) and nutrition (eating and
                  drinking) help to keep you focused and motivated in your recovery.

                  The Oxford University Hospitals NHS Foundation Trust has Enhanced Recovery
                  Programmes for oesophagectomy and gastrectomy.

                  You will be encouraged to start moving around on the first day after your operation
                  and then regularly from then until your discharge. This is an essential part of your
                  recovery. If you have to stay in bed it is important to do regular leg movements to
                  prevent blood clots forming in your legs. The Physiotherapist and ward nurses will
                  help you until you are able to walk independently. To enable you to monitor your
                  progress you will be provided with a diary to keep track of your progress and the
                  ward has a walking track with distances clearly marked every 10 metres. You will
                  be discharged with a supply of blood-thinning injections (to last 28 days after your
                  operation) to reduce the risk of blood clots. In addition, you will be encouraged to
                  complete a prescribed exercise programme to help with strengthening and
                  recovery after surgery. You will also have access to a gym space where you can
                  complete supervised exercise with specialist equipment.

                  Eating and drinking
                  At first you will be allowed sips of water, and the usual progression is to clear fluid;
                  free fluids (drinks including tea/coffee with milk); soups and smooth puddings and
                  then onto a puréed diet for home. Mouthwashes can help freshen the mouth.
                  During an oesophagectomy, a feeding tube will be placed into the small bowel
                  (jejenum)through a small cut made in the wall of the abdomen (tummy) and this
                  will be held in place with three stitches. This is used for feeding, extra water and
                  medications until you are able to eat and drink enough. You will be discharged
                  with the feeding tube in place and all of the equipment needed to use it at home
                  for top-up feeding.

                  You will be shown by the ward nurses how to the flush the Jej tube daily and a
                  Nutrition Nurse will visit you on the ward to show you how to feed at home and
                  use the equipment for home feeding. You can also receive further assistance
                  once you are at home if you need more help or a refresher session. It is important
                  to inform your Nurse Specialist or Specialist Dietitian if one or more of the stitches
                  come out. If this happens, put a dressing over the tube until you get it stitched
                  back in place. The tube is usually kept in place until you are able to meet your
                  nutritional needs again by mouth and your weight has stabilised. You will be
                  encouraged to use your jej tube for additional fluids until you are able to drink

                  You may feel afraid to swallow for a short while and you may be able to feel the
                  upper join when you swallow. Eating and drinking and using the oesophageal

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