Nutrition and Dietetics
It usually takes a few months for your body to adapt to the changes after surgery. During this time, it is very important that you receive adequate nutrition to aid your recovery and promote wound healing. The following information aims to explain the nutritional plan following this surgery and explain how the operation is likely to affect your dietary intake.
During your surgery you may have had most of your oesophagus and a small part of your stomach removed. The rest of your stomach has been brought up into your chest and attached to the remaining part of your oesophagus to form a tube. This will affect the way that you eat, as the stomach can no longer stretch to accommodate large portions of food.
Nutrition after your surgery
- The surgeon will place a feeding tube into your small bowel, known as a ‘jejunostomy tube’ (JEJ) during the operation. This is used for feeding from the first day following the operation and allows us to give you nutrition early in the post-operative phase, which has been shown to improve outcomes and recovery. Your feeds will slowly be increased to meet your nutritional requirements over the course of 4 to 5 days.
- You will be nil by mouth (NBM) for approximately 3 to 4 days following your operation to allow the surgical join to heal. At this point, you may or may not have a water-soluble swallow test to establish whether you can start drinking fluids by mouth. If the test is ok, you will usually start sips of fluid and gradually build up your fluid intake over the next few days until you are drinking freely at around a week after the operation.
- Once fluids are established and tolerated, you will be started on a ‘liquid diet’ consisting of small amounts of soup, ice cream, yogurt, jelly and mousse.
- You will then progress on to a “light diet” consisting of the above, plus foods like omelettes, mashed potatoes, fish pie, cornflakes, and porridge. At this point, the volume of your jejunostomy feeds will usually be reduced, to allow for the introduction of food.
- The initial light diet should be increased to soft options after the first few days of oral intake. This is commenced at this stage so that at the point of discharge you should be able to manage small amounts of soft diet, for the next 4 to 6 weeks.
Post operation side effects
- It is very common to have a poor appetite after the operation due to the reduction in stomach capacity.
- Portions need to be small and regular, aiming to eat around 5 to 6 times a day. As you intake is limited, foods need to be high in calories and protein to help with the body’s repair and recovery.
- It is important to listen to your body and recognise feeling full when eating meals. The amount you can eat comfortably, will increase with time.
- Avoid drinking with your meal, have drinks 30 mins after main meals and in between meals or snacks.
- Weight loss is very common following oesophagectomy and our aim is to avoid this to help with your recovery.
- Swallowing problems can occur immediately or months after the operation. Scar tissue can form where the oesophagus was re-joined and narrow the oesophagus. If this persists, please contact the Upper Gastrointestinal (UGI) specialist nurses or dietitians for further advice.
- Acid regurgitation may be a problem. After this operation you will be required to take a proton pump inhibitor (PPI) daily, which is a medication to reduce stomach acid. Try to avoid eating and drinking for 2 to 3hrs prior to bedtime. Sleeping propped up with extra pillows can help minimise reflux symptoms.
- Your altered digestive system means food can sometimes pass through to the small intestine too quickly and this can cause something known as ‘Dumping Syndrome’. Symptoms can include sweating, feeling faint or dizzy, nausea, abdominal cramps, shortness of breath, and abdominal pain followed by diarrhoea. Symptoms can be managed by the following:
- Chewing well and eating slowly
- Eating 5 to 6 small meals daily
- Being aware that food high in fat and sugar, can increase the symptoms of dumping. If dumping symptoms occur limit portion sizes of these and contact your Dietitian for further advice.
- Avoid fluid intake with meals.
- These symptoms will usually resolve over time.
- A change in bowel habits is common after the operation. Loose stools are often a problem because of your new anatomy, dumping syndrome and reduced ability to absorb your nutrients. Less commonly, you may experience constipation because of a reduced dietary intake, limited fibre intake, and/or side effects of medication.
- Soft foods should be “fork mashable” for 4 to 6 weeks post op. This means they should be soft, tender, moist and can be mashed with a fork. Use well-fitting lids or foil to cover foods such as cottage pie, hot pots or lasagne whilst baking them, to prevent the top becoming hard and crispy.
Soft diet – recommended foods
| Meat and fish and alternatives | Meat and fish and alternatives Minced or tender meat for example, beef, lamb, chicken. Baked or poached fish, eggs, baked beans, soya or meat free mince, meat substitutes for example, Quorn products or smooth peanut butter. |
| Fruit and vegetables | Soft fruit (should be mash-able with a fork) for example, tinned fruit, ripe bananas, berries, avocado, and well-cooked vegetables. |
| Dairy foods | Milk (this includes milk alternatives such as soya, oat and rice milk), milky puddings, yoghurts, custards, mousses, ice cream and cheese. |
| Cereals and potatoes | Porridge, wheat biscuits, crisped rice cereal or cornflakes soaked in milk. Soft-cooked pasta, soft rice, soft crackers, soft biscuits, bread sticks. |
Foods to be avoided (for 4 weeks following your operation)
- All bread and pastry
- Tough gristly meat for example, sausages, bacon, steak
- Uncooked raw and stringy vegetables for example, green beans, celery, salad
- Tough skins and coatings for example, jacket potato skin, chips
- Nuts
- Carbonated drinks
Enriching your food and drinks
As you are only able to eat small amounts of food at one time, it is useful to try and optimise the calorie and nutrient content of every meal and snack by following the below:
Choosing high calorie or full fat options of food and drinks where possible and avoiding “diet” or low-calorie products.
Adding butter, cream and cheese to savoury foods e.g. soup, mashed or jacket potatoes, scrambled eggs, white sauces or vegetables.
Adding syrups, jams, honey, sugar and full fat milk to puddings, or cereals.
Replacing standard milk with fortified milk in hot drinks, cereals, soups, and puddings. To make fortified milk, add 4 tablespoons of skimmed milk powder to 1-pint of full fat milk.
Try using dry skimmed milk powder into milky puddings, creamy soups, porridge or cereals, and hot milky drinks.
Choose nutritious drinks in between meals for example fortified milk or milky hot drinks (hot chocolate, malted milk drinks, milky tea and coffee).
We would encourage you to focus on establishing food intake post operatively, and therefore avoid the use of nutritional supplement drinks whilst on JEJ feeds.
On discharge
- Your jejunostomy tube will remain in place on discharge from hospital and top-up feeds will continue in order to meet your nutritional needs. You will usually be receiving around 50 to 75% of your nutritional requirements through the tube at this point. Training will be provided to show you and your family how to administer the feeds at home.
- The tube will remain in situ and feeds will continue until your weight is stable and oral intake is adequate. How long this takes varies and will depend on whether you are having further treatment after the operation.
Follow-up
- You will be seen in clinic by the UGI dietitian and the UGI specialist nurse at around 2 to 3 weeks post discharge and ongoing appointments will be arranged thereafter.
- Please complete the 3 day food diary attached, including a rough idea of portions sizes, for the 3 days prior to your appointment, and bring to your UGI therapy appointment.
N.B. Sometimes there can be variations in post-surgery recovery which can affect your nutrition. Your UGI specialist nurse and dietitian will work together with you closely if these issues arise.
Please note: This leaflet should only be used in conjunction with advice from a dietitian.
Contact us
If you require further information please contact:
- UGI Dietitians
Dietetics & Nutrition Department
James Cook University Hospital
Telephone: 01642 854777 - UGI Specialist Nurses
Endoscopy Department
James Cook University Hospital
Telephone: 01642 282874
Email: [email protected]
Food and Fluid Diary
Day 1
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| Comments |
Day 2
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| Comments |
Day 3
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| Afternoon snack: | Drinks: |
| Dinner: | Drinks: |
| Supper: | Drinks: |
| Comments |
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