Immediately after the operation
As soon as you have recovered from the anaethestic you will be allowed sips of fluid. If they are tolerated you will be able to progress gradually onto sloppy foods. The ward staff will encourage you to move around. It is usual for the wounds to feel sore at first and some patients experience shoulder pain. This is caused by gas, used during the operation, remaining under the diaphragm. It should disperse within 72 hours.

Returning to normal eating
In the first few weeks following anti reflux surgery you may experience some difficulty swallowing. This is because the new valve that has been created at the lower end of the oesophagus will need time to "settle down". If food cannot pass into the stomach easily it will cause some discomfort. To avoid this and to allow time for healing, you are advised to avoid bread (including pizza), roast and boiled potatoes, chips and lumpy pieces of meat or fish for the first 4 weeks. Beef steak and beefburgers should be avoided for the first 4 weeks.

It is a good idea to start with "sloppy/pureed" foods and progress onto more solid foods as your tolerance increases (see suggestions overleaf). Food should be cut into small pieces and chewed well before swallowing. Poultry, fish and minced meat can normally be eaten, preferably with a sauce or plenty of gravy.

You can also assist the passage of food into the stomach by drinking small sips of water/squash with your meals. Drink slowly as it may be difficult to drink large quantities at once.

You may have difficulty expelling wind from your stomach and you may not be able to burp or vomit. An increased amount of air in your stomach can be uncomfortable and it is therefore advisable to avoid all wind producing foods such as baked beans, onions, cabbage, turnip and most particularly fizzy beverages (alcoholic or non-alcoholic) for 6 weeks.

Because part of vour stomach has been used to create the new valve, your stomach is effectively smaller than it was before the operation.You will probably find that you will feel full up after eating only small meals. It is therefore best to eat little and often and to avoid eating large meals until this feels comfortable. It is not uncommon for patients to lose weight in the first few weeks. Patients vary in the time taken to return to normal eating.

Stitches
You will have five small incisions, approx. one inch long. The stitches usually dissolve. However if the stitches are causing discomfort and have not dissolved after two weeks, contact your local health centre and arrange for the nurse to remove them. Some patients have metal skin staples which are removed by your GP or nurse.

Medication
Pain killers such as paracetamol are usually sufficient to relieve discomfort whilst at home.

Driving
You should be able to drive within two weeks. Check that you can perform an emergency stop safely and are comfortable wearing a seatbelt. If in doubt check with your insurance company.

Exercise and return to work
It is advisable to rest for 3-4 days and then resume normal activities gradually. Heavy lifting and sporting activities can be resumed after 4 weeks.
You may need 2-4 weeks off work, depending on the nature of your job. If your job is sedentary you may return to work as soon as you wish.
If your operation was converted to an open procedure, you will be given additional information regarding your convalescence.

Follow up
Your progress will be assessed at 6 months and 12 months following the operation. An oesophageal 24 hour pH and manometry lest will be performed after 6 months and an endoscopy at 12 months.

A balanced diet
A balanced diet is one that has variety and contains adequate amounts of protein, vitamins and energy-producmg foods essential for health. This can be achieved by choosing soft foods from the groups
listed below:

Cereals: lump-free porridge, pasta, breakfast cereals soaked in milk.
Meat, fish, eggs and beans: eg. tender meat, poached fish, scrambled eggs, omelettes, pureed pulses or lentils.
Milk, cheese and yoghurt: eg. soft cheeses, cheese sauces, grated cheese, custard, milk puddings, smooth yoghurts, fromage frais.
Fruit and vegetables:
Soft fruits eg. pears, bananas, tinned fruit and stewed fruit.
Soft tender vegetables eg. Cauliflower cheese, carrots, mashed swede, creamed potato.

If you are losing weight the following may help

	Eat little and often
	Fortify your milk by whisking 2oz (4tbs) of dried milk powder, into each pint and use this for sauces and soups
	Add minced meat. chicken or pureed pulses to soups
	Add evaporated or condensed milk to puddings Take propriatory drinks such as Build Up or Complan to suppliment or replace a meal.

Some menu ideas to try.
The following are some suitable meal ideas. You should start with a pureed diet but be able to progress onto a soft diet within a few days.

Ideas for Breakfast
Fruit juice plus either:
Smooth porridge made with milk and sugar
Ready Brek with milk and seedless jam
Weetabix with milk and sugar
Pureed stewed fruit and natural yoghurt

Ideas for Main Meals
Chicken casserole, mashed carrots, creamed potatoes
Poached fish with cheese sauce, creamed potatoes
Pasta with creamy mushroom sauce and green beans
Finely minced beef or lamb in gravy, mashed swede, creamed potatoes

Ideas for Light Meals
Cauliflower cheese, creamed potatoes
Macaroni cheese
Pureed thick vegetable soup and lentil soup
Mushroom omelette

Ideas for Desserts
Pureed stewed fruit with custard
Ground rice pudding with seedless jam
Fruit fool
Blancmange
ice cream and jelly
Egg custard

Between meal Snacks
Fruit puree milk shakes
Mousses
Fruit flavoured yoghurt or fromage frais
Savoury dips eg. hummus, taramasalata
Weetabix with milk and sugar

Nourishing Drinks
Ovaltine, Horlicks, Bournvita, Drinking Chocolate
Milk shake enriched with ice cream
Drinks such as Build Up or Complan

Remember
Chew your food well before swallowing
Moisten foods with sauces and gravies
Eat little and often
Drink fluids slowly
Gradually increase your tolerance to solid food

Outcome of surgery >>