Nissen fundoplication is a surgical procedure performed to treat gastroesophageal reflux disease (GERD), acid reflux, and hiatus hernia, conditions where stomach acid flows back into the esophagus. This article provides a detailed guide to dietary modifications following Nissen fundoplication, aiming to minimize discomfort, promote healing, and ensure long-term relief.
Introduction
Following a Nissen fundoplication, dietary adjustments are crucial for a successful recovery. The surgery involves wrapping the upper part of the stomach around the lower esophagus to prevent acid reflux. Post-surgery, swelling around the esophagus can make swallowing difficult, necessitating a carefully managed diet progression. This guide, compiled with expert advice, offers a stage-by-stage approach to help patients navigate their dietary choices after surgery.
Immediate Post-Operative Diet: Clear Liquid Diet (Stage I)
When to Start: The morning after surgery. If issues arise with Stage II, revert to Stage I.
In the initial days after surgery, the primary concern is the difficulty in swallowing. To ease this, a clear liquid diet is recommended. This diet is easily digestible and minimizes strain on the esophagus.
Guidelines:
- Small meals, three to four times daily.
- Avoid extreme temperatures (too hot or too cold).
- Drink slowly, allowing cold foods to melt in the mouth before swallowing.
- Strictly avoid carbonated drinks for three to four weeks.
A clear liquid diet includes only liquids you can see through. These liquids are easy to swallow and digest. Examples include:
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- Water
- Clear broths
- Gelatin (Jell-O)
- Apple juice
- White grape juice
- Tea
Advancing to Soft Diet (Stage II)
When to Start: The morning two days after surgery.
After the clear liquid diet, the next step is a soft diet. This phase introduces foods that are gentle on the digestive system and easy to swallow.
Guidelines:
- Continue with small, frequent meals.
- Eat slowly and chew food thoroughly.
- Introduce new foods gradually, monitoring tolerance.
Level 1: Pureed Food (First 2 Weeks after Esophageal Surgery)
Foods in this group are pureed or blended. A safe rule is “anything you can pour” but you can try foods that are a smooth, mashed potato-like consistency. If necessary, the pureed foods can keep their shape with the addition of a thickening agent. Meat should be pureed to a smooth pasty consistency. Hot broth or hot gravy may be added to the pureed meat, approximately 1 oz. of liquid per 3 oz. serving of meat. Most people just skip meats during this time.
Caution: If any foods do not puree into a smooth consistency, it may make eating or swallowing more difficult. Avoid lumpy foods such as oatmeal and foods with seeds or tough skins (peas, corn, zucchini seeds) as they sometimes do not blend well.
Sample Menu: Level 1 - Pureed Foods
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Breakfast: Orange juice ½ cup, Cream of Wheat or cottage cheese ½ cup, Tea or coffeeLunch: Pineapple juice ½ cup, Pureed chicken noodle soup ¾ cup, Fruit and yogurt smoothie, MilkshakeDinner: Applesauce ½ cup, Mashed potatoes ½ cup, Pureed and cooled broccoli ½ cup, Pureed turkey barley soup ¾ cup, Mashed potatoes ½ cup, Pureed spinach ½ cup, Frozen yogurt ½ cup, Coffee or tea
Level 2: Soft Foods
After your first 2 weeks, you can advance to a soft diet. In general this diet is Level 1 plus “anything you can squish through your fingers” but you can also start trying slippery noodles, white fish, minced chicken and soft, cooked vegetables that are chewed well. Take it slowly. Eat small bites, chew well! Don’t be fooled- avoid rice. Stay on this diet until everything goes down easily.
Please advance to level 2 for at least 2 days prior to your office visit.
Sample Menus: Level 2 - Soft Foods
Breakfast: Favorite smoothie 1 cup, Oatmeal ½ cup, Scrambled eggs ½ cup, Tea or coffeeLunch: Pineapple juice ½ cup, Flat buttery noodles 1 cup, Mashed potatoes ½ cup, Minced broccoli ½ cupDinner: Applesauce ½ cup, Soup ¾ cup, Minced chicken 3 oz., Cooked spinach ½ cup, Frozen yogurt ½ cup
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Foods to Include:
- Yogurt
- Pudding
- Mashed potatoes
- Cooked cereals (like Cream of Wheat)
- Soft fruits (peaches, bananas)
- Well-cooked vegetables
Transitioning to a Regular Diet (Level 3)
After all of the foods in level 2 (soft foods) are passing through well advance up to the next level. This level includes French toast, pancakes, all pasta, ground red meat and steamed vegetables.
Once tolerance to soft foods is established, a gradual return to a normal diet can begin. This involves adding more solid foods, while still being mindful of potential swallowing difficulties or discomfort.
Guidelines:
- Introduce new foods one at a time.
- Continue to chew food thoroughly and eat slowly.
- Avoid overeating, as the stomach may feel full more quickly.
Foods to Include:
- Lean meats (chicken, fish)
- Cooked vegetables
- Fruits
- Pasta
- Bread
Foods to Avoid or Limit
Certain foods can exacerbate discomfort or hinder the healing process after fundoplication. It's important to be aware of these and limit their intake.
- Carbonated Beverages: These can cause bloating and gas, leading to discomfort.
- Acidic Foods: Citrus fruits, tomatoes, and chocolate can irritate the esophagus.
- Spicy Foods: These can also irritate the esophagus and cause heartburn.
- Fatty and Fried Foods: These can slow digestion and increase the risk of reflux.
- Alcohol: Can relax the lower esophageal sphincter, increasing the risk of acid reflux.
- Caffeine: Coffee and tea can affect not just the stomach and food pipe but also the function of the intestines.
General Dietary Recommendations
Beyond specific food choices, adopting healthy eating habits is crucial for long-term success after fundoplication.
- Eat Small, Frequent Meals: This prevents overfilling the stomach and reduces pressure on the wrap.
- Chew Food Thoroughly: This aids digestion and prevents food from getting stuck in the esophagus.
- Eat Slowly in a Relaxed State of Mind: This principle applies to water and other liquids, and it is important to drink slowly. Eating fast leads to poor chewing and poor coordination of the multiple muscles used in swallowing, which also leads to frequent overeating.
- Stay Upright After Eating: Sit upright while eating and stay upright for 30 minutes after each meal. Gravity can help food move through your digestive tract. Do not lie down after eating.
- Drink Plenty of Water: Staying hydrated helps with digestion and prevents constipation.
- Avoid Eating Before Bed: Allow several hours for digestion before lying down to sleep.
- Limit Fluids with Meals: Do not have more than ½ cup (4 ounces) of liquids with meals and snacks. Avoid drinking too much within 1 hour of meals (before and after). Drinking large amounts of fluids with meals can stretch your stomach.
Addressing Specific Post-Operative Issues
Several common issues may arise after fundoplication surgery, and dietary adjustments can help manage them.
- Difficulty Swallowing (Dysphagia): This is common due to swelling. If you’re having trouble swallowing, tell your surgeon. They may recommend going back to following a liquid diet while the swelling lessens. You can also try drinking warm liquids. Warm liquids can be easier to swallow.
- Gas and Bloating ("Gas Bloat Syndrome"): Avoid foods that cause stomach gas and distention.
- Dumping Syndrome: This describes the rapid emptying of foods from the stomach to the small intestine. Sweets move more rapidly and dump quickly into the intestines. Drinking large amounts of fluids with meals can stretch your stomach. Avoid drinking through a straw and chewing gum or tobacco. These actions cause you to swallow air, which produces excess gas in your stomach.
- Constipation: This is very common following a surgery. Taking pain medications such as vicodin or Percocet also cause bowel to move more slowly. It is also suggested to take a stool softener such as colance with taking pain medications.
Lifestyle Adjustments
In addition to dietary changes, certain lifestyle adjustments can further aid recovery and long-term relief.
- Regular Exercise: Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Getting up and walking every 2 hours is a good goal. Try to walk for as long as you comfortably can.
- Weight Management: Maintaining a healthy weight reduces pressure on the stomach.
- Avoid Smoking: Smoking can worsen acid reflux and delay healing.
- Proper Posture: Sitting and standing upright can aid digestion.
- Stress Management: Stress can exacerbate digestive issues.
Long-Term Dietary Considerations
After the initial recovery period (6-8 weeks), most patients can gradually return to a more normal diet. However, it's essential to continue practicing healthy eating habits and be mindful of any recurring symptoms.
- Listen to Your Body: Pay attention to how different foods affect you and adjust your diet accordingly.
- Maintain a Balanced Diet: Focus on whole, unprocessed foods and limit unhealthy fats, sugars, and processed foods.
- Stay Hydrated: Drink plenty of water throughout the day.
- Regular Follow-Up: Attend regular check-ups with your surgeon or gastroenterologist to monitor your progress and address any concerns.
The Importance of Protein Shakes
Protein shakes are an important source of proteins for healing after surgery. Avoid protein shakes with high sugar content as these may cause dumping.
Resuming Normal Eating Habits
After the improvement in swallowing difficulty in the initial days, non-vegetarian food, such as meat, chicken, and fish, can also be consumed very well. Although, one should keep in mind that it is cooked in a healthy manner, and the non-vegetarian food is not fried, too oily or spicy. This advice applies even to the initial days of surgery. The main concern for the initial days is the consistency of food.