Fundoplication Post Op Care

A fundoplication is a procedure that your surgeon does to help prevent heartburn, reflux or gastro-oesophageal reflux disease (GORD). You may already be on tablets for this and tried changing your diet, however, it has not helped.

A fundoplication (full or partial) is where your surgeon takes the top of your stomach and wraps it around the base of your oesophagus (full). The surgeon may only complete a partial fundoplication – this means that the stomach is not wrapped the whole way around.

To reduce surgery risks, your surgeon may require you to be on a low-carbohydrate and low-fat, high protein diet for two weeks prior to your procedure. After the surgery, there is a staggered reintroduction to foods, which is essential to ensure that foods slide easily into the stomach to help with healing. If you jump ahead and choose foods not suitable for your stage post-op, you may risk the surgical repair.

Here are some tips that will help you eat after your procedure:

• Start eating meals in an upright position. If you slouch, this will create pressure and affect food entering the stomach. Stay upright for thirty minutes after your meal. Do not lie down after eating.
• Eat slowly. Practice eating mindfully. Take small bites. Chew food for 20 times, wait 20 seconds between mouthfuls. This will help the food pass easily into the stomach.
• Drink slowly. Take your time with drinking and try not to gulp.
• Avoid carbonated beverages, chewing gum, smoking (if applicable), alcohol and drinking through a straw. These actions and carbonated beverages for four weeks post-op.
• Relax. Make sure you eat in a relaxed state. Enjoy your meals. This will also help prevent any pressure on the stomach.
• Follow the diet as per your dietician. See your dietician three weeks post-op for progression.

POST-SURGERY DIET

Following your surgery, you may not feel like you want to eat. It is important that you eat slowly and progress back to solid foods. You are learning how to eat again.

FLUID DIET - IMMEDIATELY FOLLOWING SURGERY

As your stomach needs to recover, you should not eat or drink anything until your surgeon gives you the go ahead in hospital. For the first few days, you will not be able to drink very much. It is important that you start slowly introducing liquids, then foods.

IN HOSPITAL

After your surgery, you will be placed on a clear or free fluid diet. Initially, you will not be able to drink very much. Try as much of the clear/free fluids that the hospital gives you. You won’t be able to finish all the drinks provided. Choose the milky-based products first. Make sure you eat and drink slowly. Stop when you feel full.

PUREE DIET - WEEK 1 & WEEK 2 AFTER SURGERY

Once you get home, you will need to start on the Optifast regimen again. Most patients stick to high protein soups for the first week. Please consult with your Dietician for more options.

Ensure you boil and puree your vegetables well. Pureed foods need to be soft and of similar consistency to baby food. This is important to help the recovery of your stomach. This must be followed for two weeks. After three weeks, please make an appointment to see your Dietician for progression with your diet.

TEXTURE

Pureed foods have a smooth, moist, yet thick consistency. They should not be visibly lumpy but may have a grainy texture. Most foods will need to be blended with the exception of already smooth foods. During this stage, it is important to avoid dry lumpy or highly fibrous foods. Gradually progress with the thickness over the 2 weeks.

PROTEIN

Similarly, to the fluid stage, you continue to need protein for wound healing and muscle. Try adding some protein containing foods to your puree diet at all meal and snack times.

Good sources of protein include pureed casseroles or stews containing meat, chicken, fish or legumes, pureed baked beans, lightly scrambled eggs, low fat yoghurt, low fat cottage or ricotta cheese. If you are unable to meet your protein requirements from food alone, you will need to either add protein to your fluids or fortify your meals with protein powders.

FLUIDS

Continue aiming for 1.5-2 litres of fluids per day. Avoid drinking fluids with meals and limit drinking 30 minutes before and 30 minutes after each meal.

FIBRE

The quantity of food you will now be eating will be significantly less than before surgery therefore it is normal to experience bowel motions less frequently. However, if this is causing you any discomfort, please seek advice from your Dietician or GP. It can be difficult to obtain adequate fibre on the puree diet and this can lead to constipation. Try adding vegetables and legumes to soups and casseroles, having pureed fruit as snacks, make sure you have enough fluid, and if necessary, trial a fibre supplement such as Benefibre. 

POST-OP DIET: LIQUIDS - Week 1 & Week 2

Remember:

• Drink liquids slowly. Tea/coffee counts towards your fluid intake. Drink water in between meals so you don’t get full.
• Nourish your body with protein rich foods. Protein will help healing from the surgery.
• Eat until satisfied. Eat slowly. Use a small spoon to eat. Take your time.
• Chew your foods well. Make sure your food is well pureed and has no lumps. This will ensure that the food will not disrupt the repair.
• Trial having 1 cup vegetable juice to increase nutrient intake.

POST-OP DIET: SOFT FOODS - Week 3 & Week 4

If you have no issue with nausea, vomiting, pain or your bowels, you can move on to the soft food stage of your post-op diet. If you do have issues with nausea, vomiting, pain or your bowels, contact our rooms or dietician for advice.

The soft diet is the final transition phase prior to going back to any texture. The foods allowed on the soft phase are very similar to those on the puree phase, however they no longer need to be blended. Foods on the soft diet should be able to be easily cut with the side of the fork. This means some foods will need to be cooked a bit longer than usual (ie: steamed vegetables). Please avoid any crunchy foods such as nuts, crackers, and raw salad vegetables whilst on the soft phase.

Remember to eat slowly, chew your food well and keep fluids away from mealtimes.

Soft-Food Meal Suggestions:

Meat & High Protein Foods

Note: All meat needs a sauce.

Red Meat:       Beef, pork, veal, chicken, lamb (1/2 cup portion size)

                        Taco mince – add salsa

                        Spaghetti bolognaise mince – no pasta

                        Savoury mince – tomato/bbq sauce

                        Shepherd’s Pie mince

                        Beef rissoles/mini meatballs and sauce

Chicken:          Softly cooked – thigh, not breast (100g portion size)

                        Poached, boiled or steamed

Fish:                 Tinned tuna/salmon (mixed with low-fat mayonnaise)

                        White fish/salmon steaks – flake with a fork and serve with a sauce

Tofu:                Marinated and steamed (100g portion size)

Baked Beans:  Mashed with a fork and eat with sauce (1/2 cup portion size)

Eggs:                (1-2 eggs portion size)

                        Poached or soft boiled

                        Curried eggs

                        Scrambled egg/omelette made with low-fat milk/cheese

Dairy

1 cup skim milk

1 tub (170g) Greek yoghurt

½ cup low-fat cottage/ricotta cheese

1 slice low-fat cheese

1-2 tbs low-fat cheese (grated)

2 cheese sticks

Vegetables

Vegetables do not need to be pureed at this stage. Make sure you cook the vegetables until they are soft and have no resistance. No starchy vegetables (eg. Potatoes, sweet potatoes, pumpkin, corn and raw vegetables).

Fats/Oils

1 tsp olive oil or other vegetable oil

2 tbs mashed avocado

Please Note: No fruit, starchy vegetables or grains (breads, cereal, rice or pasta) at this stage. 

FOODS TO BE AVOIDED PRE & POST FUNDOPLICATION SURGERY

Foods on the ‘avoid list’ are not forever, however it is highly recommended that you avoid all carbonated beverages, limit your intake of carbohydrate-based foods and those foods can increase gas in your stomach, which may be uncomfortable.