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Esophagectomy / Esophagogastrectomy Discharge Instructions

Surgery can take a lot of strength and energy out of you. At first, you will get tired easily but this will improve slowly and steadily over the next few weeks. For a smooth recovery and to help prevent further illness, follow these tips:

Diet

Nutritional support is very important during your recovery at home especially if you had lost weight before your surgery and also to help in wound healing. Nutritional support may include tube feedings and/or the use of oral supplements such as Ensure plus, Boost plus or Carnation instant breakfast. Tube feeding instructions and teaching will be given to you by the nursing staff prior to your discharge.
Small meals, usually four to six meals a day, are needed due to the area of food storage in the stomach being reduced. You should limit fluids to four to six ounces during meals.
At first you may feel full or short of breath while you are eating. Adjusting your meal size and eating slower will help you to overcome these feelings. Chew all food well.
Eat pureed or soft foods that are high in protein including chicken, fish, cheese, yogurt and eggs. Limit high fat foods like cakes, cookies, and fried foods.
You should avoid lying down, bending over, or straining for one and a half-hours after meals.
You should not eat two to three hours before bedtime.
You should weigh yourself twice a week. A weight loss of two or more pounds a week should be reported to your surgeon. Depending on your weight, your nutrition plan may need to be changed.

Activity

You may shop, do light gardening, cook, or go up and down stairs as long as you do not have problems doing so.
You may continue your usual sexual activities.
You probably will not have the energy to be very active, so pace yourself. Rest when you get tired. Stop and catch your breath if you get winded.

Exercise

Relaxation and deep breathing exercises must be done to help expand your lungs to help clear them of mucous. The staff will teach you how to do these exercises at home.
Use your incentive spirometer at home and take 10-15 breaths an hour with it, while awake. Keep using the incentive spirometer until your follow-up visit.
Balance exercise with periods of rest until you regain your strength. This can take from 7-14 days. In 4-6 weeks you should be back to full activity and feel more like yourself.
You should not do any heavy pulling and/or pushing.
Avoid push-ups, chin-ups, or lifting weights for at least 8-12 weeks. Your muscles need to heal and regain their strength.

Medicines

Take pain medicine as prescribed. You will have better pain control if you take the medicine at the first sign of pain, rather than waiting until the pain is more severe.
Prescriptions for pain medicine usually cannot be phoned to the pharmacy. They must be mailed to you or picked up from our office, so plan ahead when running low on medicines.
You may not drive while taking pain medication.

Sleeping

Try to get eight hours of sleep each night. For the first 2-6 weeks after going home, you may have trouble sleeping more than 3-4 hours at a time. This will get better as you heal and become more active.
You can sleep in any position that is comfortable. However, the head of the bed should be slightly elevated.

Showering

You can shower as usual.
The dressing over the incision and drain sites can be removed for showering. Remove bandage, shower, pat wounds dry and then place another dry piece of gauze over the sites if there is any drainage.
Leave steri-strip dressing on. You may take this dressing off after seven days; otherwise it will be removed at your follow-up visit. If staples were used, they will be removed at your follow-up visit.

Constipation

Constipation is sometimes a problem after surgery because anesthesia and pain medicine can affect your bowels.
Increasing your fluid, fiber intake and physical exercise may help in managing constipation.
Using a stool softener twice a day, such as Senokot S, will make it easier to have a bowel movement.
Also, you may need to take a mild laxative such as Milk of Magnesia or a fiber supplement such as Citrucel or Fibercon.