Download Life after oesophagectomy - Salford Royal NHS Foundation Trust

University Teaching Trust
Information for patients
Life after oesophagectomy
Turnberg Building
Upper GI General Surgery
0161 206 5062
Page 1 of 7
© G17051001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: SURG 16 (17). Review date: May 2019.
Life after oesophagectomy
University Teaching Trust
This booklet has three aims:
l To help you work towards a full recovery
after having major surgery
l To help you overcome any worries you may
have about returning home
l To help you and your family to be better
informed about the care available to you in
the community
Will I need to rest when I go home?
You have had a major operation that has
resulted in a long stay in hospital and you may
feel that life can never be the same again. It
can, with slight changes it can be a very good
life
Recovery from this type of surgery is not fast
and it may be several months before you return
to your normal activities of living.
Initially you may feel very tired, exhausted at
times, and will need plenty of rest and may
need a nap during the day when you first go
home. This will not affect your sleep at night
but will make your morning and afternoons a
little easier
The aim for you now must be to learn to live
with the changes in your system so that they
affect your quality of life a little as possible.
What do I do with the feeding tube
(jejunostomy)?
It is common to go home with the feeding tube
still in place.
It is likely that the dietician and medical staff
have suggested you continue on feed at
home for a short period. This will likely be an
overnight feed. You and your family will be
trained on how to use this tube and feed before
you leave hospital.
If you are not having feed at home you should
continue to flush the tube twice a day using
cooled boiled water.
You will be reviewed closely in the clinic
following your discharge. Once the team
decide you no longer need the feed and tube, it
will be removed in clinic.
Will I be able to swallow normally?
Yes, you should have no trouble in swallowing
normal food after the operation.
If you experience difficulty with swallowing
when you are at home you should contact the
Upper GI Specialist Nurse or your GP for advice.
What will I be able to eat after the
operation?
You should be able to eat a soft diet by the time
you leave hospital. You will remain on a soft
diet for 4-6 weeks following your discharge.
After this you should be able to eat a relatively
normal diet.
Page 2 of 7
© G17051001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: SURG 16 (17). Review date: May 2019.
Life after oesophagectomy
University Teaching Trust
Will I have problems eating after the
operation?
lTry to have high calorie foods
l You may find you need to eat smaller
amounts more frequently i.e little and often.
You should aim for small meals roughly palm
sized amounts
lTry to have nutritious drinks such as milk
shakes, milky coffee
l Chew food well and relax after meals
l Sit upright when eating
l Initially it is advisable to eat slowly and have
small portions until you know your own
capacity
l If you do eat too much at one sitting you
may feel uncomfortable, this will ease with
resting, usually within 30 minutes
l It is advisable not to have a drink with your
meal as the fluid may fill you up and make
you feel bloated. You should take fluids
approximately one hour before or one hour
after eating
l If you experience continued bloating and
nausea after eating it may be that your
stomach is not emptying as well as it did
before your operation. If this occurs you
should contact the specialist nurse or your
GP who can give you advice and prescribe
medication to help your symptoms
Will my sense of taste be affected?
Initially your sense of taste may be affected. Foods
may seem to lack flavour or taste differently
from before. This should settle down fairly
quickly and your taste should return to normal.
lStick to foods you like
lYour doctor may be able to prescribe you
supplement drinks under the supervision of
the dietician. There are a variety of these
supplements available and you should choose
the one which suits you best
lIf your lack of appetite persists and you are
losing weight contact the specialist nurse or
your GP
How can I gain weight?
lThe hospital dietician will give you advice
before you go home
lIt will be quite normal for you to lose a little
weight when you first go home
lTry to have regular snacks in-between meals
such as biscuits, cakes, chocolate, crisps, milky
drinks, yoghurts
lUse butter/margarine and avoid using low
calorie spreads
lTry to use at least one pint of full cream milk
daily
lAdd extra milk, butter, cream, cheese to
foods such as mashed potatoes, soups and
vegetables and extra cream, sugar, jam to
foods such as puddings, breakfast cereals.
lUse supplement drinks e.g. build up or
complan
What should I do if I have problems
with my appetite?
lEat small portions of food frequently, known
as little and often. You should aim for small
meals roughly palm sized amounts. You
should aim to eat every 2 hours
Page 3 of 7
© G17051001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: SURG 16 (17). Review date: May 2019.
Life after oesophagectomy
University Teaching Trust
Will I be able to drink alcohol?
You can drink alcohol as long as it does not
interfere with any of your medications.
When will I be able to start exercising?
You should be able to start light exercise as
soon as you get home. Short walks or a little
light housework should be possible within a
few weeks. Progress maybe frustratingly slow
and you should not push yourself to do too
much in the early stages. As time progresses
and you feel you have more energy increase the
exercise as you feel able.
Light exercise will stimulate your appetite and
your breathing.
It is also beneficial to carry on with the
breathing exercises you were taught by the
physio in hospital. This may help prevent chest
problems once you are discharged.
Will I have pain when I go home?
Most patients will have little or no pain a few
weeks after the operation. If you do have any
pain it will be assessed before you leave hospital
and appropriate painkillers will be prescribed to
take home with you.
You may experience some discomfort in your
right chest where the scar from your operation is
when you carry out certain exercise manoeuvres.
You may also have limited mobility of your
right arm initially after the operation but with
regular exercise this should return.
Will my voice change after the operation?
Some other possible problems
Coughing
After surgery you may have a dry cough,
perhaps when talking. It will hopefully settle in
time. You can speak to your Specialist Nurse for
further advice on how to manage this cough.
Food sticking
In the early months after surgery scar tissue at
the new join of the oesophagus may cause you
to feel like food is becoming stuck. This can be
worrying for you but can be alleviated fairly
easily. You will likely need to have your new join
stretched, this will be performed via a camera
test (endoscopy), and it can be performed as an
outpatient. It is known as a dilatation.
Sickness
Sometimes food can remain in the stomach
too long causing you to feel sick and bloated.
This problem can often be relieved by
taking a medicine such as metoclopramide
or domperidone. You will need to take this
medicine 3 times per day, taking half an hour
prior to each main meal. This medicine will
hopefully improve the function of your stomach
allowing it to empty a little easier.
Reflux
It occurs most commonly at night or early
morning. If you suffer from reflux when sleeping
or resting it may help to lie on your left side and
avoid the right. You may also find it helps to
sleep propped up, you can do this by using extra
pillows. You may experience some problems
when bending or stooping forward. This can be
avoided by kneeling or squatting. Medication
can also be prescribed to control your symptoms.
There is a possibility that you may have some
hoarseness of your voice after the operation.
This may occur due to injury of the vocal cords.
Page 4 of 7
© G17051001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: SURG 16 (17). Review date: May 2019.
Life after oesophagectomy
University Teaching Trust
Dumping Syndrome
Will I need further treatment?
Dumping occurs when the sugar content of the
food you have eaten passes rapidly through the
system. It can cause you to experience dizziness,
feeling faint, feeling hot, sickness, abdominal
pain and/or diarrhoea. The Nurse specialist and
dietician can talk to you in more detail about
this if needed.
Once you have had the operation you may need
a course of chemotherapy.
Driving
You can drive when you feel you can safely do
an emergency stop without hurting yourself
or damaging your wounds. It is wise to inform
your motor insurance company that you have
undergone major surgery before you start
driving again.
Returning to work
The timing of your return to work depends on
many factors such as type of work you do and
your current health and fitness. Regardless it may
be many months before you do get back to work.
What should I do about my wound?
If you have any dressings that need to be
changed or stitches that need to be removed, a
member of the healthcare team will arrange for
a district nurse to call at your home.
You will also be prescribed a 28 day course of
blood thinning injections; these are given to
prevent you from getting a blood clot. These
are given from day 1 of your surgery; you will
complete the remainder of the 28 day course
at home. You will be shown how to administer
these yourself whilst in hospital.
Will I be followed up at the hospital
after the operation?
Yes, you will be seen in the outpatient department
approximately 2 weeks after discharge and then
at regular intervals form then on.
Will I have any support when I go home?
Support will be available to you on discharge
if needed. You will be assessed by individual
members of the team before you leave hospital
to see if you need help and support when you
go home.
The team includes:
l Medical staff
You can have a bath or shower. Avoid putting
any creams or powders directly on the wound
until it has healed well.
l Specialist Nurses
If the wound becomes sore, red or begins to
leak, let you’re GP or district nurse know.
l Physiotherapist
You can expect some soreness around the wound
for several weeks after the operation. Keep taking
painkillers regularly to ease this discomfort.
l Ward nursing staff
l Dietitians
If needed then a social worker and occupational
therapist can be involved.
Any care you need will be provided an arranged
before you leave hospital.
You may experience some redness around the
feeding tube (jejunostomy) site due to the
stitches, we encourage you to bathe this daily to
ensure it stays as healthy and clean as possible.
Page 5 of 7
© G17051001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: SURG 16 (17). Review date: May 2019.
Life after oesophagectomy
University Teaching Trust
Psychological effects after surgery
Now that you are recovering you may find that
you have an emotional reaction to the events
you have been through recently. The specialist
nursing team and your GP can help. Your may
find it helpful to speak to other patients who
have been through something similar, details of
the patients support group are below.
Is there a support group for patients
who have had oesophagectomy?
Yes, it is known as the Oesophageal Patients
Association. They may be contacted at:
Oesophageal Patients Association
16 Whitfield Cresent
Solihull, West Midlands
B91 3NU
0121 704 9860
Salford Upper GI cancer service has an
established support group. The group is an
open forum giving patients space and time to
explore and share individual issues with other
sin a similar situation. The group also offers
support to relatives and carers.
Contact the Upper GI Nurse Specialists for dates
of next meeting.
For further advice or information please contact:
Upper GI Specialist Nurse
0161 206 5062
07623 604196 pager
07623 606807 pager
07623 622347 pager
[email protected]
Upper GI Surgical Secretaries
0161 206 5472
0161 206 5448
0161 206 5128
Salford Royal Switchboard
0161 789 7373
ask for bleeps 5077 or 2366
The meetings are divided into two parts, the
first hour consists of structured information,
education and support programmes and the
second hour an open forum offering the
opportunity for members to explore and share
individual experiences.
The group is facilitated by the Clinical Nurse
Specialist who are qualified counsellors and
have completed Advanced Communication Skills
Training.
Meetings are held in the:
Mayo Building,
Salford Royal NHS Foundation Trust,
Stott Lane,
Salford, M6 8HD
Page 6 of 7
© G17051001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: SURG 16 (17). Review date: May 2019.
Life after oesophagectomy
University Teaching Trust
For further information on this leaflet, it’s references and sources used,
please contact 0161 206 5062.
If you need this interpreting please telephone
Copies of this information are
available in other languages
and formats upon request.
In accordance with the
Equality Act we will make
‘reasonable adjustments’
to enable individuals with
disabilities, to access this
treatment / service.
Email: [email protected]
Under the Human Tissue Act 2004, consent will not be required
from living patients from whom tissue has been taken for
diagnosis or testing to use any left over tissue for the following
purposes: clinical audit, education or training relating to human
health, performance assessment, public health monitoring and
quality assurance.
If you object to your tissue being used for any of the above
purposes, please inform a member of staff immediately.
Salford Royal
operates a
smoke-free policy.
For advice on stopping
smoking contact
the Hospital Specialist
Stop Smoking Service
on 0161 206 1779
Salford Royal NHS Foundation Trust
Stott Lane, Salford,
Manchester,
M6 8HD
If you would
like to become a
Foundation Trust
Member please visit:
If you have any suggestions
as to how this document
could be improved in the
future then please visit:
Telephone 0161 789 7373
www.srft.nhs.uk/
for-members
http://www.srft.nhs.uk/
for-patients
www.srft.nhs.uk
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© G17051001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: SURG 16 (17). Review date: May 2019.