Post Fundoplication Operation

After Fundoplication Surgery

Life After a Fundoplication

There are a few things that you should know long term after your fundoplication surgery.

Vomiting

You will probably not be able to vomit after fundoplication surgery. When you were discharged from the hospital, you were given a prescription for Compazine (Prochlorperazine). This is for nausea and vomiting. Keep it with you just in case. If you are traveling and get sick, please call the office and we will call in mediation to a pharmacy near you. If you do end up with the dry heaves, you may have some swelling at the surgery site and find it difficult to swallow for a few days. You may need to go to a more liquid consistency until the swallowing improves. If this lasts more than a few days, or you are not able to keep yourself hydrated, call the office.

Swallowing

In the first few weeks after fundoplication surgery, it takes longer for food and liquids to go down your esophagus and reach your stomach. This is because the esophagus is a little stunned from surgery, so it is not pushing as well and because there will be swelling where the esophagus meets the stomach- where the surgery took place. This is why you were on liquids for a while after surgery. If you eat too big of a bite, too fast, or do not chew well, most likely food will sit in your esophagus and cause pain until it passes or you regurgitate it back up.

There are a few things you can do to minimize swallowing issues:

• Take your time eating. It really should take you 30-45 minutes to eat a small meal.
• Eat small frequent meals. For a while after surgery, you will notice you get full fairly quickly. This is normal and unfortunately will go away about 6 months out from surgery.
• Take small bites and chew food well. This goes for liquids as well. You need to take frequent sips and will most likely not tolerate gulping liquids.
• Room temperature liquids tend to do better than cold ones.
• If something does get stuck, sip on some warm tap water until it passes.
• Steak, chicken and bread seem to be the most problematic. When you chew these, they do not become more liquid, they just become a ball. Avoid these until you are comfortable with how your swallow feels and you think you can handle it.

After you have healed from surgery and on a regular diet, you should not have much problem swallowing. If you take a big bite, do not chew very well, eat too fast then you may have the sensation of food sticking (painful). If this happens, sip on some warm tap water and the food will either pass or come back up.

If you start to have food stick all of a sudden without any obvious reason, or if food sticking becomes a problem, please email or call the office.

Return of Symptoms

About 1 in 10 patients will experience some return of symptoms in the first 10 years after fundoplication surgery. If symptoms return, we would really like to be involved and try to sort out what the best treatment is (often the symptoms are not due to GERD!)

If you are prescribed PPIs, or if symptoms recur, please email or call the office.

Gas and Bloating After Surgery

Problems with intestinal gas often go hand in hand with reflux. The reason for this is quite simple. Over 99% of intestinal gas comes from swallowed air. For people with reflux, the only remaining defense for their esophagus is to swallow more often to try to clear the stomach juices from the esophagus. Over time, a person develops an unconscious habit of swallowing more often, therefore swallowing large amounts of air. If their lower esophageal sphincter (LES) is defective, this gas is easily belched back up without even being noticed. Once you have surgery to correct this valve, the frequency and amount of air you can belch decreases. This will continue until your body learns that you do not need to swallow as much, because you do not have reflux anymore. This relearning can take 2-8 months after surgery. Around 6 months out from surgery, the LES will start to have some relaxations; you may even be able to belch. This will help with some of the excess air.

Some eating habits can contribute to excess gas production as well: eating too quickly, drinking through a straw, chewing gum or sucking on candy, overeating, consumption of high fat and sugar containing foods, tobacco, and anxiety.

There are some general things that you can do until your gas problems resolve:

• Slow down when you eat, chew food well, do not talk while chewing, avoid gulping foods
• Avoid overeating: eat smaller frequent meals; reduce high fat and high sugar foods (high fatty food sit in the stomach longer and cause more bacterial action; sugar ferments causing gas)
• Avoid things that increase swallowing air: smoking, chewing gum, carbonated beverages, chewing ice, sucking on hard candy
• Avoid foods that may be gas producing: beans, peas, cabbage, broccoli, onions, cauliflower, brussel sprouts, corn, cucumbers, dried fruits, nuts. Also try limiting milk products. Limit alcohol and coffee.
• Increasing roughage can help. Low fiber foods go more slowly through the intestine, giving more time for bacteria to make more gas. Eat whole grains and cereals, fresh fruits and vegetables. Drink at least 8 glasses of water a day.
• Some over the counter medications containing simethicone (gas x) can help. You can also try Beano.