Hiatal hernia surgery is performed to correct a hernia in the diaphragm, and bariatric surgery is a medical procedure performed on individuals who are severely obese. After surgery, adhering to a proper diet is crucial for effective healing and preventing complications. Immediately after the surgery, swelling around the esophagus prevents you from swallowing regular food. For this reason, for the first two weeks after surgery you will be permitted liquids only. This article will explore the guidelines for a liquid diet after hiatal hernia surgery, including what to expect, how to transition, and long-term considerations.
Immediate Post-Operative Stage: Clear Liquid Diet
The initial phase after hiatal hernia repair involves a clear liquid diet. This diet includes only liquids you can see through because clear liquids are easiest for your body to digest. This stage typically begins the morning one day after surgery. Examples of clear liquids include:
- Water
- Broth
- Clear juices (apple, grape)
- Gelatin (Jell-O)
- Ice pops (without fruit pieces or dairy)
Small meals of clear liquids should be consumed three to four times daily. It is essential to sip water throughout the day, starting with small amounts and gradually increasing as tolerated. Allow cold foods to melt in the mouth before swallowing.
Advancing to a Full Liquid Diet
After a few days on the clear liquid diet, patients can advance to a full liquid diet. This diet includes all the liquids in a clear liquid diet, plus liquids that are thicker or not clear. This stage may begin the morning two days after surgery. Full liquids include:
- All clear liquids
- Milk
- Smoothies
- Soups (strained, without solid pieces)
- 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.
Read also: Is a liquid diet right for you?
Transitioning to a Soft Diet
As healing progresses and swelling goes down, you will advance to mechanically soft diet or blended food. After the full liquid diet, the next step is usually a soft diet, which includes foods that are easy to chew and swallow. This stage may begin a few days after surgery, depending on individual tolerance. Examples of soft foods include:
- Mashed potatoes
- Applesauce
- Yogurt
- Puddings
- Cooked cereals (oatmeal, cream of wheat)
Gradual Introduction of Solid Foods
Start to gradually add solid foods to your diet. Around 4 to 6 weeks post-surgery, solid foods can be gradually incorporated into the diet. It’s critical to choose low-fat, non-spicy, and non-acidic foods. Opt for lean proteins, whole grains, and cooked vegetables.
Foods to Avoid
Certain foods should be avoided to prevent complications and discomfort. These include:
- Carbonated beverages: NO carbonated drinks for three to four weeks.
- Acidic foods and drinks: It’s best to avoid acidic foods and drinks, such as those with citrus, tomato, broccoli, or chocolate.
- Spicy foods
- Fatty foods
- Caffeine
- Alcohol
Total Daily Intake
It is commonly recommended for bariatric surgery patients to aim for at least 64 ounces (about 1.9 liters) of fluids per day.
Importance of Hydration
Adequate hydration is essential during the recovery period. Bariatric surgery patients should be vigilant about signs of dehydration, including dark urine, dizziness, rapid heart rate, and dry mouth.
Read also: Explore the pros and cons of liquid diets
Potential Short-Term Effects
Due to swelling of the wrap used to prevent reflux in people who have had stomach fundoplication, the following short-term effects may occur:
- Difficulty swallowing some foods (dysphagia), due to swelling of the wrap
- Abdominal bloating and pain after eating foods that distend the stomach ("gas bloat syndrome")
These symptoms last from two to six weeks. The following dietary modifications help minimize these symptoms by alerting you to foods that tend to be difficult to swallow or distend the stomach.
Monitoring and Adjustments
Diet modification is important because swelling at the gastroesophageal junction is normal after surgery, and you may find that solid foods “get stuck.” This is expected during the first four weeks, which is why a gradual dietary progression is recommended as the swelling subsides.
Long-Term Dietary Considerations
Even after recovery, maintaining a diet low in fat and high in fiber is beneficial. This helps prevent complications such as acid reflux and indigestion.
Tips for a Smooth Dietary Transition
- Chew Food Thoroughly: Properly chewing your food can help ease the digestive process and prevent discomfort.
- Stay Hydrated: Drink plenty of water throughout the day, but avoid consuming large amounts with meals to prevent bloating.
- Keep an Eye on Food Triggers: Keep track of any foods that cause discomfort or reflux and avoid them. Common triggers include spicy foods, caffeine, and fatty foods.
- Follow Your Doctor’s Advice: Adhere strictly to your surgeon’s dietary recommendations and follow-up appointments. Your care team can provide personalized guidance based on your specific needs and progress.
- Gradual Introduction: Reintroduce foods slowly and observe how your body reacts. This gradual approach helps identify any potential issues early on.
- Get Plenty of Rest: Even if you’re feeling relatively good in the weeks following your procedure, be sure to take it easy and get adequate sleep.
Potential Long-Term Side Effects
Though many people experience significant relief following hiatal hernia surgery, some long-term effects may occur. For example:
Read also: Risks of Liquid Diets
- Dysphagia (Difficulty Swallowing): Some individuals may experience difficulty swallowing. This condition, known as dysphagia, may improve over time but can be persistent for some.
- Gas and Bloating: After surgery, you might experience increased gas and bloating. This is due to changes in the digestive process. It can generally be managed with dietary adjustments and medications if necessary.
- Reflux Symptoms: While the surgery is intended to reduce acid reflux, some people may still experience reflux symptoms. This can occur if the surgery does not fully correct the hernia or if the individual does not adhere to their doctor’s dietary recommendations.
- Infection or Wound Complications: As with any surgical procedure, there is a risk of infection at the surgical site. Following post-operative care instructions and maintaining good hygiene can help reduce these risks.
- Changes in Eating Habits: Long-term changes in eating habits may be necessary to manage symptoms. Some people may need to make permanent adjustments to their diet to avoid foods that trigger discomfort.
- Scarring and Adhesions: Internal scarring or adhesions can sometimes develop after surgery. Regular follow-up with your healthcare provider can help monitor and address these potential issues before they become troublesome.
Lifestyle Adjustments
Long-Term Lifestyle Changes Following Hiatal Hernia Repair: This procedure is designed to be an anti-reflux surgery, and most patients will be unable to belch to relieve gastric air after the operation.
Post-Operative Care
A member of your care team will give you instructions for getting ready for your surgery. When you wake up after your surgery, you’ll be in the PACU. A nurse will be keeping track of your temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a thin tube resting below your nose or a mask over your nose and mouth. You’ll get pain medication through your intravenous (IV) line. You may be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. You’ll have an IV line in one of your veins, usually in your hand or arm. You’ll get fluids and pain medication through your IV line. You may have a urinary (Foley) catheter through your urethra into your bladder. Your Foley catheter will drain urine from your bladder. This lets your care team keep track of how much you’re making. Your visitors can see you in the PACU, usually within 90 minutes after you get there. A member of the nursing staff will explain the guidelines to them. You’ll stay in the PACU for a few hours or overnight.
Hospital Stay and Recovery
The length of time you’re in the hospital after your surgery depends on your recovery. In your hospital room, you’ll meet one of the nurses who will care for you during your stay. You may have some pain after your surgery. Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain is not relieved, tell one of your healthcare providers. It’s important to control your pain so you can use your incentive spirometer and move around. If you had a minimally invasive (laparoscopic) surgery, you may have pain in your shoulder. This is called referred pain and is common. It’s caused by the gas that was put into your abdomen (belly) during your surgery. If you have pain in your shoulder, tell your nurse. They will bring you a hot pack to put on your shoulder to help with the pain. You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects.
Importance of Movement
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.
Lung Exercises
It’s important to exercise your lungs so they expand fully. Your nurse will give you an incentive spirometer. Use it 10 times every hour you’re awake. Keep using it for 1 to 2 weeks after you’re discharged from the hospital. Do coughing and deep breathing exercises.
Discharge Instructions
Before you leave, look at your incisions with one of your healthcare providers. Before you leave, your healthcare provider will write your discharge order and prescriptions. You’ll also get written discharge instructions. If your ride is not at the hospital when you’re ready to be discharged, you may be able to wait in the Patient Transition Lounge.
Pain Management at Home
People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision(s) for 6 months or longer. Do not drive or drink alcohol while you’re taking prescription pain medicine. Some prescription pain medicines can make you drowsy (very sleepy). You’ll have less pain and need less pain medicine as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil or Motrin) are examples of over-the-counter pain relievers.
Medication Guidelines
Follow your healthcare provider’s instructions for stopping your prescription pain medicine. Do not take too much of any medicine. Follow the instructions on the label or from your healthcare provider. Read the labels on all the medicines you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medicines. Taking too much can harm your liver.
Managing Constipation
It’s important to avoid constipation after your surgery. Constipation can lead to your hiatal hernia coming back. Talk with your nurse about how to prevent and manage constipation. Both over-the-counter and prescription medications are available to prevent and treat constipation. Ask your healthcare provider before taking any medications for constipation. This is very important if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider.
- Docusate sodium (Colace®): This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation.
- Polyethylene glycol (MiraLAX®): This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid.
- Senna (Senokot®): This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime.
Lifestyle Tips for Bowel Regularity
- Go to the bathroom at the same time every day. Your body will get used to going at that time.
- Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go.
- Exercise, if you can.
- Drink 8 to 10 (8-ounce) cups (2 liters) of liquids daily, if you can. Choose liquids such as water, juices (such as prune juice), soups, and ice cream shakes. Avoid liquids with caffeine (such as coffee and soda).
Increasing Fiber Intake
If you’re still constipated after you stop taking prescription pain medications, adding more fiber to your diet can help. Slowly increase the fiber in your diet to 25 to 35 grams per day.
Incision Care
You’ll have 6 small incisions in your abdomen after your surgery. It’s normal to have some bruising and tenderness around your incisions. This will go away with time. If the bruising or tenderness gets worse, call your healthcare provider. You’ll have sutures (stitches) inside your incisions to help them heal. They will dissolve on their own. If you do, they will loosen and fall or peel off on their own. Taking a warm shower is relaxing and can help with aches and pains. Use soap and gently wash your incisions when you shower. After your shower, pat your incisions dry with a clean towel.
Activity and Exercise
Do not lift anything heavier than 10 pounds (4.5 kilograms). It’s important to slowly go back to doing your usual activities after surgery. Spread them out over the course of the day and avoid activities that cause discomfort. Doing gentle aerobic exercise will also help you gain strength and feel better. Aerobic exercise is any exercise that makes your heart beat faster, such as walking or climbing stairs. Gradually increase the distance you walk.
Returning to Work
If your job involves a lot of movement or lifting more than 10 pounds (4.5 kilograms), you should return on restricted, light duty. Many people need to be on light duty for about 8 weeks.
Follow-Up Appointments
Your first appointment after surgery will be 2 to 3 weeks after you’re discharged from the hospital.
MSK MyChart
MSK MyChart (mskmychart.mskcc.org) is MSK’s patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.
Dietary Progression
After your surgery, you’ll slowly start drinking and eating again.
- Clear liquid diet: This diet includes only liquids you can see through. Clear liquids are easiest for your body to digest.
- Full liquid diet: This diet includes all the liquids in a clear liquid diet, plus liquids that are thicker or not clear.
- Nissen soft diet: This diet includes all the liquids in a full liquid diet, plus foods that are physically soft. This means less chewing is needed to get the food into a texture that’s smooth and easy to swallow.
Most people follow a clear liquid diet for about 2 days, then a full liquid diet for about 3 days, then a Nissen soft diet for about 2 weeks. Everyone’s tolerance for food is different. Your doctor will tell you when to move to the next diet.
Eating Habits
After your surgery, the area where your esophagus joins your stomach will be swollen. This can make it harder for food to move through your digestive tract. Always sit up while you eat and for 30 minutes after eating. It’s normal to feel full more quickly than usual after your surgery. This is because your stomach is slightly smaller. Eating or drinking too much at once can cause discomfort. This should slowly get better over about 6 to 8 weeks. Eat small, frequent 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).
Managing Nausea
Vomiting (throwing up) can weaken or undo your repair. Your doctor will give you a prescription for an anti-nausea medication when you’re discharged from the hospital. If you feel nauseous, take the anti-nausea medication.
Addressing Swallowing Difficulties
It’s common to have trouble swallowing after your surgery. This can be caused by the swelling from your surgery. 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.
Reducing Gas and Discomfort
After your surgery, you may swallow more air than you did before your surgery. This can cause gas, discomfort, or both. Keep taking an over-the-counter medication to prevent constipation, such as a stool softener or laxative.
Dumping Syndrome
Dumping syndrome is when foods move from your stomach into your small intestine too quickly. If your pyloric sphincter was changed or removed during your surgery, sugary foods and other refined carbohydrates (such as white bread) may cause dumping syndrome. It’s best to avoid sugary foods. Choose sugar-free options. Include complex carbohydrates (such as whole wheat bread and pasta) in your diet. Add sources of soluble fiber to your diet. Avoid drinking too much with your meals.
Specific Dietary Guidelines
- Clear Liquid Diet: A clear liquid diet includes only liquids you can see through. These liquids are easy to swallow and digest. Drink different types of clear liquids. Hard candies, such as Life Savers®. Suck on them.
- Full Liquid Diet: A full liquid diet includes all the things allowed in a clear liquid diet, plus dairy products and opaque liquids (liquids you cannot see through). It’s best to avoid acidic foods and drinks, such as those with citrus, tomato, broccoli, or chocolate. Dairy products may cause diarrhea. You may need to avoid them at first. Gradually add them back into your diet in small (½ cup) portions.
General Recommendations
Avoid having any foods and drinks that cause discomfort, even if they’re listed in the “to Include” column. Add meats to your diet last. Make sure to trim off any fat you can see. Cook them so they’re easy to break apart with a fork. Eat these in moderation. Do not eat them by themselves. If you have any questions, contact a member of your care team.
Diet Modification Prior to Surgery
Two days before your hiatal hernia repair, you should start a clear liquid diet. Do not eat or drink anything beginning eight hours prior to your scheduled operation. The reason for the clear liquid diet is to help "shrink" the liver prior to surgery, which improves exposure of your hiatal hernia during the operation.
Diet Modification Following Hiatal Hernia Repair
After surgery, you will be admitted for 23-hour observation and pain control. You will be discharged home within 23 hours on a full liquid diet. You will stay on a full liquid diet for two weeks, after which Dr. Madni will advance you to a soft diet for an additional two weeks. You should return to a regular diet four weeks after surgery.
Signs of Food Impaction
Advancing your diet too fast may lead to complications. The most common complication is food impaction at the lower esophageal sphincter. Retching and dry heaving due to food impaction immediately after surgery may disrupt the wrap. Eat slowly, avoid carbonated beverages, and drink plenty of water to avoid dehydration.